Over the past decade, awareness on mental health issues have been increasing thanks to concerted efforts and campaigns run by governmental and non-governmental bodies. And because of this, more and more people are knocking on the doors of medical practitioners seeking help.
But with more awareness comes more misinformation in the general public. When information can now be easily sourced online, diagnosed patients would be more willing to trust the internet over certified psychiatrists or clinical psychologists.
The prescriptions given by psychiatrists to medicate some spectrum of mental health issues are called psychotropic or psychiatric drugs. There are five different types used to manage symptoms and these are [1]:
- Stimulants (e.g. Ritalin and Adderall) are prescribed for disorders that involve unorganised behaviour (e.g. ADHD) improving concentration and providing calming effects.
- Anti-anxiety is used to treat physical symptoms of anxiety such as an increased heartbeat. Often, they are prescribed along with tranquillizers or sleeping pills to treat both anxiety and insomnia.
- Antidepressants, as the name suggests, are used to tackle depressive symptoms, with different types prescribed according to the severity of the symptoms.
- Antipsychotics are prescribed to those who are experiencing psychosis. Delusions and hallucinations are common symptoms of psychosis.
- Mood stabilisers are used to manage a range of erratic emotions experienced by those who are diagnosed with bipolar disorder and extreme mood swings.
Currently, psychotropic drugs are kept under lock and key. But even with strict directions from psychiatrists, many patients have been using their prescriptions as they see fit behind the backs of their psychiatrists. Some have even refused to take prescribed medications for fear of addiction and side effects without consultation.
Awareness That Leads To Misinformation
At the dispensing counter in clinics and hospitals, patients are briefed on details of the medication including the medication dosage, the interval of administration in hours, the length of consumption, whether it can be taken with meals as well as the potential side effects.
But their decision-making is often influenced by external factors.
In recent years, information on mental health spread like wildfire on online platforms such as Tik Tok and Instagram. In the USA alone, more than 18 billion views were recorded under the mental health hashtag on Tik Tok in 2021 [2]. The videos include personal experiences of those who suffer from mental health issues, how to detect signs and symptoms and coping methods.
The abundance of information has helped in normalising conversation surrounding mental health issues amongst the younger generation. But the catch is that some of the media are created by laypeople who may not be certified medical practitioners.
People always think awareness is good. Awareness without the right information actually creates misinformation. – Ellisha Othman, managing director at Thrive Well
Popping Pills According To The Internet
Sometimes being aware may generate an active conversation with medical practitioners that could help in making informed decisions.
Doctors explain but I also study myself…every single medicine I take I study myself because of side effects. I also have colitis and hypertension and am given Amlodipine 10 mg. But when I read an article from the year 2016, it states it can trigger colitis. So, I told the doctor I don’t want Amlodipine. – Participant response on Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration[3]
Some went to Google for a second opinion on their prescription.
So, the first time I got this medicine from the pharmacist, I was surprised why I got this medicine. So, I said, now it is the internet world…so I Googled. From there I know and I don’t want to depend on this medicine. – Participant response on Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration [3]
The act of managing and tweaking their prescription would only increase if pharmacies are allowed to provide psychotropic medications as proposed by the Poison Act Amendments, where a prescription slip is no longer necessary to purchase controlled medications.
We observe superficial awareness in the community without fact-checking, or referring to the right sources. This just adds on to the misinformation on mental health illness and psychotropic medication.– Ellisha Othman, managing director at Thrive Well
Putting A Band-Aid Over A Deep Cut
To the younger generation, medications appear to be a quick fix for mental health problems. Coupled with available information, there is a likelihood of adjusting prescriptions unbridled.
Medication is a quick fix because all these adjunctive therapy takes a longer time. In particular, for those with more severe mental illness. The symptoms can be very overwhelming. Sometimes adjunctive therapy, talk therapy – you have to wait for the sessions, they just want something immediate, something that can help. – Ellisha Othman, managing director at Thrive Well
Some take more than the recommended dosage especially in situations when external stressors seem overwhelming, thus prompting them to find ways to calm themselves immediately.
I want to calm down and I don’t want to get admitted to the hospital… drips this one, that one, people come and visit me. I don’t want that to happen. So, I take more than what the doctor said. – Participant response on Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration[3]
Proceed With Caution
But there are long-term consequences to consuming medications without recommendations.
Psychotropic medications are often prescribed to tackle physical manifestations of mental health illness and require follow-ups. Doctors may recommend patients wean off their prescription, change the medication or adjust the dosage on follow-ups.
The idea of this medication to stabilise the symptoms. The psychiatrist can advise to wean off if the physical symptoms no longer persist. – Ellisha Othman, managing director at Thrive Well
But many patients will continue consuming the medication despite no longer being prescribed.
Unfortunately, such patients who stop seeing doctors and get their prescriptions repeated at pharmacies may continue to do so until they have developed metabolic syndrome, including obesity and diabetes. – Dr Tan Chee Khuan, former Malaysian Medical Association (MMA) Penang branch chairman[4]
Some have even taken expired medications despite their doctors refusing to continue prescribing psychotropic drugs to them.
I want to be happy and calm down. But when I don’t have one, I eat the expired one. I know eating the expired one has many effects, but that doctor doesn’t want to give me where I can find it. – Participant response on Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration[3]
Certain substances such as sleeping pills have a higher prevalence of dependency. Some clients or patients rely more on substances to fall asleep rather than practising proper sleep hygiene prolonging their therapy duration.
For sleeping pills, I think it’s more of the dependence, they become more dependent on where it can affect their functioning and also affect their talk therapy. Because when we do psychotherapy, actually sleep is part of it, so it kind of prolongs their treatment period. – Ellisha Othman, managing director at Thrive Well
Alarmingly, there have even been reports that some psychotropic medications can be obtained from pharmacies and online black markets without prescription slips by medical practitioners. This was a normal occurrence for Karen* who purchased anxiety medication for her husband at the local pharmacy in Setapak.
As soon as I walk in (the pharmacy) people know me… the pharmacist will even ask me if it’s Xanax (a brand of medicine used to treat anxiety and panic disorders) I’ve come for. – Karen[5]
Some have developed addictions to medications commonly prescribed for conditions like anxiety and insomnia due to having lax access to medication in local pharmacies.
We have come across patients who are addicted to 30 to 50 tablets of diazepam, Dormicum and Stilnox (sleeping pills) daily. They have successfully been helped to reduce their usage to just one tablet or stop entirely with the help of other psychiatric medication. – Dr Tan Chee Khuan, former Malaysian Medical Association (MMA) Penang branch chairman[4]
Why Are People Becoming Their Own Doctors?
But on the other end of the spectrum are patients who are reluctant to consume the medication. The common fear that is expressed by many is the fear of dependency that would lead to long-term addiction.
Patients sometimes have this stack of medication and they just self-prescribe based on what they have. As opposed to following the dosage, they tweak it. – Ellisha Othman, Ellisha Othman, managing director at Thrive Well
Some have even refused to continue their medication due to the side effects. As Ellisha Othman, a clinical psychologist and managing director at Thrive Well has observed, millennials, in particular, have an aversion to meeting a psychiatrist in order to tackle more severe mental illnesses.
What we see it’s more of a stigmatisation of psychotropic drugs, so they are actually very averse to seeing a psychiatrist, they are much more averse to seeing a psychiatrist. -Ellisha Othman,Ellisha Othman, managing director at Thrive Well
Most often, millennials are referred to a psychiatrist when they are at their breaking point by their general practitioners to seek treatment. The aversion to psychiatrists is a result of a long-standing stigma in society on mental health illnesses.
Malaysians associate stigma to shame in receiving diagnosis of illness, the taking of medication or even attending psychiatric counselling. – Dr Shaeraine Raaj, Registrar Psychiatrist at the Royal College of Surgeons Ireland (RCSI)[6]
There is also a hesitancy to step back and communicate with psychiatrists to find a better solution.
But one thing that I noticed is that they don’t want to discuss with the psychiatrist, when they can. They should go back to the psychiatrist, discuss the side effects because there are alternatives and the psychiatrist will then advise them what works right, but not suddenly cold turkey. Because it will definitely have an effect. – Ellisha Othman, managing director at Thrive Well
At times, patients quit taking their medication after observing their symptoms have subsided. However, this shouldn’t be the case as psychotropic medicine works differently than most over-the-counter medications.
This is not like your Panadol or cough syrup. It works very differently, and you have to go back to your psychiatrist, talk about it. – Ellisha Othman, managing director at Thrive Well
The effects of quitting the medication mid-way are detrimental to the patient.
It’s dangerous when you stop any form of psychotropic drugs. It has very detrimental effects on your physical and psychological health. – Ellisha Othman, managing director at Thrive Well
Breaking The Myths Behind Psychotropic Drugs
The act of playing with prescriptions either by refusing to take the medications, underdosing or overdosing is stemmed from the persisting myths in the community on psychotropic drugs.
Ellisha shared that most of the time, clinical psychologists would have to address the importance of the medication in combination with psychotherapies to manage mental health problems.
So it’s a lot of counselling for them – on understanding what psychotropic drugs are. -Ellisha Othman, a clinical psychologist at Thrive Well
Some of the myths that are prevalent in the community include:
#1: Consuming psychotropic drugs are for the weak.
There is an existing stigma in the community, especially amongst millennials, that consuming psychiatric medication is considered weak. However, for more severe mental illnesses that could affect your daily functioning, it’s a necessary evil. In these instances, talk therapy or psychotherapy would lack its effectiveness if the physical symptoms are not managed.
#2: Mental health medication side effects are often unbearable.
All medications have potential side effects. For example, tricyclic antidepressants could cause dry mouth and weight gain. However, some side effects will subside in time. If the side effects persist, talk to your mental health provider. It is important to keep an open communication line with your psychiatrist.
#3: “I’ll be dependent or addicted to the medications!”
There is a reasonable fear of dependency or addiction towards psychotropic medications. Some medications, such as Xanax or sleeping pills, do come with a risk of psychological dependence. Hence, most psychiatrists would only recommend it for a short while and in a controlled dosage.
#4: “I’ll be a different person after taking medications.”
The common misconception of psychiatric medication is the belief it will change one’s personality. Psychiatric medication’s function is to maintain an optimal level of neurochemicals, or in other words, to correct a chemical imbalance in your brain to improve your quality of life. It is similar to how ibuprofen would work to tend to your headache. It will manage your symptoms. But the catch is to complete the course of the medication.
Working In Tandem
Mental health treatment is complex, and medication is just one part of the equation. Some mental health illnesses do not necessitate consultation with a psychiatrist, and talk therapy is often adequate. Those with more severe symptoms would require medication to stabilise their neurochemicals, but psychotherapy will also be in place to tackle the root cause.
Medication is the biological part of mental health. But if the psychological, the social and the spiritual part is not addressed, that’s where I see the dependence of medication remains. Medication is meant to be stabilising, in the acute stage. – Ellisha Othman, managing director at Thrive Well
That’s why mental health treatment is multidisciplinary. It is a well-oiled machine between a client, a clinical psychologist, a counsellor and a psychiatrist working together.
For a long-term solution, you’re supposed to improve your psychological, social and spiritual aspect of your mental health. But very often, these three parts are not addressed, whether you’re young or old.I see this across the board, a generalisation, then, they keep going back to overdependence on medication, and for some of them, especially, severe mental illness, it’s a lifelong thing. – Ellisha Othman, a clinical psychologist at Thrive Well
At the same time, ensure your knowledge of mental health comes from the right channels and any decisions you would like to take is through consultation with mental health practitioners.
What’s useful is that if you reach out at the preventative stage, we can help you to learn some skills, resources on how to manage that. Hopefully, if you’re able to cope, then it won’t trigger more severe issues in the future. – Ellisha Othman, managing director at Thrive Well
There is no harm in soliciting the help of a clinical psychologist or counsellor early on before the issue spirals into something bigger in the future.
Below are accessible and affordable psychological assistance you can seek to ensure you are receiving a proper diagnosis of your mental health issues:
#1: Thrive Well
A social enterprise providing a comprehensive range of mental health programs and services including individual psychotherapy and counselling. They also offer family, and couples therapies and career guidance at varying rates. There is also an option for online therapy sessions.
Price: RM70 per session for individual therapy (only for B40 individuals with limited slots)
Opening hours: Tuesday to Saturday, 9:00 am – 6:00 pm
Schedule your appointment here.
#2: Mental Illness Awareness and Support Association (MIASA)
The association was founded in 2017 and offers mental health assessment, consultation and counselling services. There is also an online counselling session option. The NGO also provides free counselling sessions to B40 groups.
Price:
– RM200 per 1-hour face-to-face session (non-member)
– RM180 per 1-hour face-to-face session (MIASA’s member)
Opening hours:
Monday to Friday, 10:00 am – 5:00 pm.
Please contact +60 13-534 9366/+60 18-361 7345/ +6013-3330767 for scheduling an appointment or inquiries, or email miasa.malaysia@gmail.com.
#3: HumanKind Community Counselling
HumanKind’s mission is to provide affordable mental health services through online and in-person counselling. All counselling is conducted and supervised by licensed healthcare medical practitioners.
Price:
– RM50 per session for intern counsellors
– RM 150 per session with professional counselors, art therapist and clinical psychologist
Package rates are also available:
– 5 sessions with intern counsellors for RM200
– 5 sessions with professional counsellors for RM675
Couples Counseling – 90 minutes
– RM 220 per session with. professional counsellors
Opening hours:
Monday to Sunday, 9:00 am – 9:00 pm.
The last appointment is at 8:00 pm.
Schedule an appointment here.
Explore our sources:
- WebMD.(2021). What Are Psychotropic Medications? Link
- J.Wood. (2021). Managing Mental Health Misinformation on Social Media. Penn Medicine News. Link
- K.Rajiah., M.K.Maharajan. H.Ramaya., & W.N.A.Wan Ab Rahman. (2021). Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration. Link
- CodeBlue. (2019). Malaysians Getting Antidepressants From Pharmacies Without Prescriptions, Doctor Claims. Link
- A.Ruban. & M.Robertson. (2018). No prescription, no problem: Buying medicines is as easy as buying candy really. The Malay Mail. Link
- Bernama. (2017). Cast aside the stigma relating to mental illness. Daily Express. Link
