Information that is complex, possibly difficult to understand, and sometimes theoretical in nature is better explained via the use of examples, relevant stories, or metaphors. People tend to better understand difficult concepts when they can identify and visualize them. Such is the case, I think, when clients are seeking explanations about the science or theory behind their disorders and medications. Understanding the underpinnings involved in how the disorder took shape and the medications used to treat it, not only better informs clients, but also helps them understand why it’s important to adhere to recommended treatment approaches, whether medicinal or behavioral.

Here are a couple of examples:

  1. How to educate clients about an opioid use disorder.
  2. How the selective serotonin reuptake inhibitors (SSRIs) antidepressants work.

Opioid Use Disorder

I’ll begin by telling the client, “all of the opioids act like naturally occurring chemicals in the brain – chemicals like dopamine. It goes like this: Let’s say you just got a promotion, made a good grade on an exam, or just shot your lowest golf score ever. Well, the brain rewards you with a shot of the “feel good” chemical dopamine because accomplishment should feel satisfying. But when you start using opioids, you find out that you can obtain this GREAT feeling without having accomplished anything, so it’s essentially a false high but you continue to chase it anyway. The problem is the brain wisely limits the amount of reward you will receive as a way of keeping you in balance and   you then start feeling worse. So it becomes harder and harder to enjoy even life’s simple pleasures, and life becomes gray and dull. Then as the bad feelings grow, the more likely you’ll keep using opioids even more often to feel pleasure again.”

After this explanation, I’ll check for understanding and invite any questions from the client. Then I’ll conclude with “once you stop the opioids you will go into withdrawal, which can be managed, and after this runs its course, if you remain opioid-free, your brain will get back on track and things will normalize.”

How the SSRIs Work

This one is bit trickier, because clinical thinking as to how the SSRIs actually work is changing, in that the serotonin reuptake theory doesn’t actually account for the actions of these antidepressants. So I broach this subject this way, “Let’s begin with the reason for your depression. Nerve cells control brain function, so it’s likely that some of these cells are shrinking a bit. Don’t be alarmed by what I just said, this is not an indication of serious brain disease or even a loss of nerve cells. It’s more like a thinning process, similar to what happens to a lawn when it gets a bit brown and less thick and you then spread some fertilizer on it. In a similar way, the Zoloft (or any other SSRI) you’re taking acts like a fertilizer by stimulating your nerve cells to grow and spread out. Gradually then, over a few weeks you’ll start feeling better.”

Sometimes when I offer this explanation clients will ask, “I thought SSRIs increase serotonin and correct brain chemistry, so is this inaccurate?” And I’ll answer, “it’s true that the Zoloft you’re taking works on serotonin, but the idea that there’s not enough serotonin in the brain when someone is depressed and more when they’re treated has not proven to be true. It’s more about the cells shrinking like I described.”

Clients WILL ask about the science not only out of curiosity, but also out of a sense for their own safety and prognosis.  I strongly suggest keeping discussions simple and straightforward. Once you get into the weeds when educating patients about scientific principles, it can be quite difficult to get back on track. Don’t tell them everything you know, tell them what they need to know in terms they can identify with, visualize and then understand.

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Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.

To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.