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A crisis is any event or accumulation of events that causes inner turmoil and challenges a person’s life coping skills. Whether it’s an earth-shattering, traumatic experience or a time of intense life challenges and difficulties, a crisis can shake anyone to their core, calling into question their sense of meaning and purpose.
Not surprisingly, a crisis can also impact a person’s mental health. In fact, symptoms like insomnia and anxiety are often the first signs that a crisis is impacting health. This is when many people wonder whether medication might help them manage these symptoms and help them through a crisis— or, whether a doctor would prescribe them medication in their situation. Then there are those who may not be aware that medication is even an option.
FHE Health Psychiatric Nurse Practitioner Muhummad Nawaz, PMHNP-BC, MPH, has intimate familiarity with these sorts of questions and concerns, having triaged many of them. He is responsible for psychiatric evaluations and psychiatric medication management in our detox and treatment programs and spends most of his time working in acute inpatient care.
In a recent interview, Nawaz drew from his extensive background as a psychiatric nurse in a wide array of settings, (inpatient hospitals, outpatient practices, medical detox units, nursing homes, and assisted living facilities), to share some helpful insights for those who may be in crisis and wondering about medication.
If you are experiencing a mental health crisis, dial “988” or go to your nearest emergency room.
Medicating People in Crisis – What Has Changed Since Earlier Periods?
Many of us have probably heard stories from earlier times or previous centuries when people received such terrible news or endured such catastrophes that they became hysterical and had to be sedated for days. “What’s different about how we treat those in crisis today?” we asked Nawaz. He acknowledged that “in cases of crisis in old times the medications were for sedation, such as opium and barbiturates.” The difference between then and now is that:
In the past, mental illness was often stigmatized, and people with mental health conditions may have faced discrimination. Today, there is greater acceptance of mental health treatment. We now better understand the causes of various mental health conditions and how they can be treated effectively. We try to understand how the client perceives the crisis and how it’s affecting their life. We also try to help the client develop greater resilience, with the use of techniques for handling the crisis.
Medications help the client so that he/she does not feel overwhelmed by emotions. When someone is experiencing intense emotions, it can be difficult for them to think clearly or make decisions.
Meanwhile, “through therapy, a person can feel the sadness and mourn the loss but not shut down.”
What’s the biggest difference between medicating people in crisis today versus years ago? It’s that “in the past, opium or barbiturates were used more frequently with significant side effects; however, there have been significant advances in our understanding of brain dysfunction in mental illness. New psychotropic medications are more effective with less likelihood of side effects.”
What Changes Explain These Differences in Treating People in Crisis?
Nawaz pointed to two “big changes” that help to explain these differences in how we treat and medicate people in crisis:
Less stigma and stigmatization – “In the past, there was much more stigma with mental illness as medical conditions often have visible physical symptoms, such as a rash or a broken bone, which may make them more tangible and easier for others to understand. In contrast, mental health conditions may not have visible symptoms, making them harder for others to understand and more difficult to accept., however, now with advancement in our understanding of mental illness, there is less stigma and more acceptance of mental illness.
Much more knowledge about brain function – “Thanks to progress in biology, we know about the underlying mechanisms of the brain through functional MRIs and PET scans. These technologies allow us to tangibly evaluate the brain and see how the brain of a healthy person is different from the brain of a person in crisis.”
Crises That Cause People to Become Hysterical or Severely Anxious/Depressed to So That They Need Medication?
“Crisis is subjective.” That theme emerges more than once in our conversation with Nawaz. By that, he means that two people with very different histories can experience the very same mental health effects. As an illustration, Nawaz used the example of someone returning from the Vietnam War, comparing their crisis to that of someone who may have been bullied extensively at school and home. “Over time, the latter trauma of bullying can be equal or worse than the trauma of war, in terms of the mental health impact it can cause.”
Nawaz was also quick to point out that “even a ‘small’ trauma can be as impactful as a crisis, so you can’t say that someone’s trauma is less than another person’s trauma … If it’s affecting the quality of life, that’s really it. Pain and crisis are subjective.”
When to Intervene if Someone You Love Is in Crisis
This last point about quality of life is important. It helps to answer the question of when to intervene if someone you love is in crisis. Nawaz puts it simply: “When a person’s quality of life is impacted, there should be a need for therapy and medications.” He again used the metaphor of allergies, cough, or an injured leg. Just as you wouldn’t wait 10 years before treating one of these conditions, he said, it is crucial to seek help promptly for mental health symptoms.
What to Know About Acute Moments of Crisis and When Medication Is Prescribed
In acute moments of crisis, Nawaz emphasized the importance of not underestimating the potential impact of witnessing traumatic events:
Mirror neurons are special brain cells that help us to imitate and understand the actions, intentions, and emotions of other people. They were first discovered in monkeys and are thought to be important for social interaction and learning. When we see someone doing something or feeling a certain emotion, our mirror neurons may become active and help us to understand what they are doing or feeling. This might also make us feel the same way.
There is further evidence to suggest that mirror neurons may contribute to the development of emotional distress in certain circumstances.
For example, if a person is exposed to repeated or prolonged exposure to negative or traumatic experiences, their mirror neurons may become “overloaded” and start to amplify their emotional response to these experiences. This can lead to the development of negative emotions such as fear, anxiety, and depression.
Mirror neurons may also be involved in the process of rumination, which is when a person becomes stuck in a cycle of negative thoughts and emotions. Rumination is a risk factor for the development of depression and other mental health conditions.
Sometimes those feelings can be as overwhelming for the person witnessing a crisis as they are for the person experiencing the crisis.
With respect to when medication may be the next right step, Nawaz recommended consulting a psychiatrist and letting them answer that question. That is because people in crisis often may not realize they need help or medication.
The bottom line: “Many people who struggle with mental health difficulties may not realize that they need help or may resist seeking it out. Whether it’s due to a lack of awareness, stigma, denial, or a lack of access to care, this can be a dangerous and potentially life-threatening situation.”
Advice for Someone Struggling with Anxiety and Depression and Unsure About Medication
“People with mental illness can take a number of steps to manage their symptoms and improve their overall wellbeing,” Nawaz said. “Seeking treatment, practicing self-care, building a support network, managing stress, and learning about your condition can all be helpful in managing mental health. It is important to work with a mental health professional to determine the most appropriate treatment plan and to remember that recovery is a journey and that it is normal to have ups and downs along the way.”
Nawaz also emphasized the hope that groundbreaking advances in brain technologies and techniques represent. He was speaking from experience about how neurorehabilitation services have boosted treatment outcomes at FHE.
“At FHE, we’ve helped many clients in their journey, through psychiatric medications, individual and group therapies, and neurostimulation, biofeedback, and other neurorehabilitative treatments,” he said.
Wondering whether medication might help you through a crisis? Our counselors are available 24/7 to offer resources and support.
