What are the important questions to ask about Psychiatric Drugs?
Rethinking Psychiatric drugs
For the last half century, psychiatric medication has been one of the dominant tools for treating mental health conditions. Antidepressants and antipsychotics are often presented as if they can correct a “chemical imbalance” in the brain, much in the same way insulin is prescribed to stabilize blood sugar in diabetes. But unlike insulin, psychiatric medications don’t target a known deficiency or imbalance in a precise, individualized way. They act more like a broad chemical “reset,” influencing complex neural networks in ways that are still not fully understood.
This raises a pressing question: if our brains, a little like our microbiome in our gut, are profoundly individual, how can a one-size-fits-all pharmaceutical approach truly serve people living with mental distress?
The Theory Behind SSRIs and Antipsychotics
SSRIs (Selective Serotonin Reuptake Inhibitors) were developed on the theory that depression is linked to low serotonin. By preventing the reabsorption of serotonin in the brain, SSRIs increase its availability in the synaptic gap, theoretically improving mood. Yet research increasingly suggests that the “serotonin deficiency” hypothesis is oversimplified, and many people on SSRIs experience only modest improvements - if any - alongside substantial side effects.
Antipsychotics work primarily by blocking dopamine receptors, aiming to reduce hallucinations, delusions, and agitation. While they can dampen acute psychotic symptoms, they don’t address the underlying causes of mental distress. In fact, suppressing dopamine for long periods can lead the body to adapt in destabilizing ways, leaving patients vulnerable to severe episodes when medication is reduced or stopped.
I should state that this is not everyone’s experience. For some, medication can on the appropriate dose, be an undeniable anchor that provides a sense of safety or at least a much needed window of breathing space, in a sea of overwhelming sensations and debilitating anxiety.
A Personal Perspective
This is not just theory for me - it is lived experience. 35 years ago, my sister was diagnosed with schizophrenia. Over the decades, I have seen her placed on an array of powerful medications: Risperidone, Olanzapine, Depixol, Clopixol, Clozapine, Quetiapine to name a few. None of these have resolved her core struggles. Instead, I have witnessed a heartbreaking cycle: “stability” (with emotional and mental detachment) while on the drugs, followed by “spikes” or psychotic breaks when she tried to come off them, leading doctors to reinstate or increase the dose. My father, diagnosed with bipolar disorder, has also been through years of medication. In both cases, medication is treated as the main -if not sole- solution, with little regard for its broader impact on a person's life and health.
Ask the psychiatrist: Does this drug induce psychotic “spikes”, panic attacks or other uncomfortable sensations when reducing the dose or coming off it completely?
How will this be managed, and what support will I receive, if I want to reduce my medication?
Also ask the psychiatrist what they have witnessed from their own personal experience.
Side Effects and Hidden Costs
Long-term use of psychiatric medications often carries significant burdens:
Parkinsonian symptoms (tremors, stiffness, sluggish movement) due to dopamine suppression.
Weight gain and metabolic syndrome, raising risks for diabetes and cardiovascular disease.
Loss of libido and broader emotional blunting.
Iatrogenic effects — meaning illness or injury caused by the treatment itself, such as new movement disorders, organ stress, or withdrawal syndromes.
Liver and kidney strain with years of continuous use.
Ask the psychiatrist what are the side effects and how do you support me to manage them?
What affect will it have on the rest of my body if I have to switch medications?
Many patients also develop cravings for legal stimulants like nicotine, caffeine, sugar, or alcohol, let alone all the illegal ones! When the brain’s dopamine pathways are suppressed, the body often seeks alternative sources of reward and stimulation - sometimes reinforcing unhealthy habits.
Perhaps most dangerously, when someone abruptly stops an antipsychotic that has been suppressing dopamine, the sudden flood of unregulated dopamine can trigger a psychotic episode. This is often interpreted as proof that the person “needs” the drug indefinitely, when in fact it may be a withdrawal effect - trapping people in a cycle of dependence and othering them into a sentence of a mental health label.
The Missing Piece: Support for Tapering
The most critical question is: where are the psychiatrists trained to help people safely taper off these drugs? Withdrawal needs to be managed with extraordinary care, attention, and individualized planning. Yet there are few resources, little training, and almost no systemic support for patients who want to reduce or discontinue medication.
Psychiatrist Mark Horowitz, who himself experienced the difficulty of coming off antidepressants, has written guidelines for safe tapering, emphasizing that withdrawal must often be much slower and more gradual than standard protocols suggest. His work, covered by outlets like the BBC, highlights how even prescribers can underestimate the power of these drugs - until they personally experience their effects.
Psychiatrist Joanna Moncrieff has also been outspoken about the limitations of the “chemical imbalance” model and the risks of long-term psychiatric drug use. She has faced resistance from within the psychiatric establishment for challenging entrenched beliefs, but her work has opened space for honest discussion about the true role of these medications.
Toward Compassion and Intelligent Use
The point is not to demonize psychiatric drugs. They can be lifesaving in moments of crisis, and for some people, they may provide long-term relief. But we must stop pretending they are precise solutions to well-defined medical problems. Instead, we need:
Honest conversations about both benefits and harms.
Greater investment in non-pharmaceutical supports - therapy, community, nutrition, exercise, and social connection.
Training and infrastructure for safe tapering and long-term management.
Recognition that mental distress is as much about relationships, trauma, and environment as it is about neurotransmitters.
Above all, we need compassion. People experiencing severe mental health challenges deserve care that respects their individuality, their humanity, and their right to navigate treatment with dignity. Psychiatric drugs should be tools used wisely, sparingly, and with robust oversight - not the default response to the complexity of the human mind.