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  • Kim WD, Psych NP

Is it Me? Or is it my Chemistry?

When can a person’s mental health be improved by the use of medications, and when can it be improved by therapy?

Was I born this way?

Let’s start out by asking ourselves a couple of questions. Think back to what you were like and how you felt when you were a kid.

  • What was your mood usually like? Were you happy? Sad? Angry? Anxious? Outgoing? Scared? A bookworm? Angry? Always in trouble? Teacher’s pet? Everybody’s friend?

  • Do you remember a time when you were very young and you were happy? When you didn’t have many cares, and thought life was great?

  • Do you remember always feeling afraid, scared, or anxious when you were very young?

  • Did you have friends? Did you get along with people? Did you make friends easily? Were you bullied? Were you a bully?

  • Were you a loner? Did you have trouble making friends?

Remember how you felt as a young child. Is it similar to the way you feel now? If that’s the case then there’s a good chance you were born this way (happy, content, anxious, crabby, optimistic, pessimistic, irritable, angry, whatever). “Born this way” means that this set of emotions and reactions very likely represents your hard wiring – your personality. This set of personal characteristics (your personality) was mostly settled before you were born. No medication or drug is going to change your base personality over the long term. We can’t medicate away personality, and we really don’t want to. But that’s okay – everybody is entitled to a personality, and it's okay that everybody’s is different.

You can learn to live with and even love your personality. And if you don’t, you can learn to appreciate or express your personality differently. Maybe as a kid you learned to do something negative as a response to a stressor (hit, cry, hide, avoid, lie, whatever). If you did, it was likely that little kid’s functional or survival response. If you don't like the negative response patterns you use (which have become behavioural habits), then you can probably unlearn those response patterns. You can learn to not react the same negative way over and over, and instead substitute a positive behaviour or response. You can learn to understand that your responses are a choice, and that you can choose to respond differently. You can learn how to be a person who has an easier time functioning in society.

Medications can't change your personality. But changing the way you express your personality is a perfect job for therapy.

Am I experiencing a situational reaction or response?

What if the moods or emotions that are making you uncomfortable happen only at certain times, or only when you encounter specific stressors?

  • Are you mad because you think people are being mean to you?

  • Are you angry because you think life is unfair and you didn't get yours?

  • Are you unable to appreciate another person's good fortune?

  • Are you sad due to a loss, either current or in the distant past?

  • Are you nervous or anxious about a future event? Are you getting nervous or anxious because you know you always get nervous or anxious about a particular event?

Your feelings probably reflect how you’ve learned to respond to the situations you are faced with. No medication or drug is going to change that. You can, however, learn to respond differently to what the world is throwing at you. You can learn to not react in a way that you (or others) don’t like. You can be shown how any response is a choice, and that you have the power to choose to react differently. You can become a person who has an easier time functioning in society. This is another great job for therapy.

But – your brain may be temporarily too overwhelmed to absorb what therapy can teach you. If that’s the case, then a short course of the right medication may take the edge off, and help you engage in the therapeutic process. Think of medication used this way as a bike's training wheels. Once therapy has taught you how to ride that bike, the training wheels can come off – they’ll only get in your way and you'll be faster without them.

But how can I tell if it is my brain chemistry?

We've looked at ways your personality and your learned behaviours can affect your moods, your emotions, your reactions, and your function in life. But what if the challenges you are facing can't be traced back to personality or reactivity? Then we might be looking at an issue with brain chemistry.

  • Did your emotional life change course at some point?

  • Are you trying to enjoy life, but there's this cloud of sad you just can't shake?

  • Have you been feeling unusually happy, unusually irritable, or unusually energetic for more than a week?

You might have a chemical imbalance in your brain. This may be a job for medications, and trialing a medication designed to rebalance the chemical activity of your brain may be worth a shot. If it is a chemical imbalance, you and your psychiatric provider may have to trial more than one medication in order to find the best fit and the best effect.

But I did that already! Nothing worked! I'm still not happy!

If you have trialed several medications, in several classes, over an adequate amount of time, at therapeutic doses, and nothing has worked, be assured that no one is holding out on you. If medications didn’t work, then it’s less likely that the issue is a chemical imbalance, and more likely that you will need to re-explore wiring and response with a therapist.

This is not a failure of medications.

This is not a failure of yours.

This is not a failure of your prescriber.

This is a correct use of medications to help diagnose the source of the mental health challenge you are experiencing. Medications that haven’t helped can still get you back on track – by eliminating chemistry as the cause of your dysfunction and distress. If brain chemistry isn’t the issue, then be happy – therapy is probably the answer and therapy works for the great majority of people who give it a try.


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