Do I have to take meds for psychosis?

The decision about whether to take medications for any mental health condition—including psychosis—is up to you. You shouldn’t be forced into treatment that you’re not comfortable with. There are a lot of people who choose to take medications and others who choose not to. Your decision may change over time, as your symptoms and circumstances change.

It’s completely valid to feel nervous about taking medications. But they can be very helpful for many people, especially those who have a hard time functioning day-to-day because of their symptoms.

Deciding whether to try medication

Think about the kinds of voices, hallucinations, or unwanted thoughts you have. Ask yourself:

• Are they disturbing you?
• Do you want them to go away?
• Are some of them pleasant?
• Are some of the voices or visions trying to tell you something?
• Can you learn from them?
• Do they make it harder to function day-to-day?
• Can you tell the difference between the outside world and what’s happening inside your mind?

Some people interpret their voices or hallucinations as communicating with ghosts or spirits. Or you might see them as parts of your subconscious mind, which may provide helpful information if you know how to listen. Some people are able to talk back to spirits to control the intrusiveness of the voices, or allow the voices to speak only when they want to engage.

If that sounds like you, you may not want to completely eliminate your symptoms. You may be able to learn to cope without medications—or you might take a lower dose of medication to help make these experiences more manageable.

However, if you are losing touch with reality, having a hard time living your day-to-day life, or feeling scared or disturbed by the things you experience, you may want to consider medication.

Other ways to cope with psychosis

Medications aren’t the only way to treat psychosis. Some other coping skills include:

• Lifestyle changes that help manage stress
• Working through past trauma with a therapist
• Finding a support group such as the Hearing Voices Network
• Talking directly to the voices to learn from them or manage them

These are good skills to use, whether you decide to take medications or not! The question is, are these coping skills working well enough on their own?

If your symptoms are really strong, there’s a risk you will get sick and not know you’re sick. For some people, the things they see, hear, or think become absolutely real—even though it’s just in their mind. This experience can be scary and really impact your work life, home life, and relationships. It’s good to have one person you trust who can be your reality tester. If this person tells you “something is wrong,” try to listen to them rather than get defensive. Talk to them about what to do so you can be well.

Be sure to create a safety plan that you can use in a crisis. Share your plan with your support system—including your reality tester. Are there certain situations where you may be willing to receive medications if your psychosis gets really severe? You can outline these and other treatment preferences in a psychiatric advance directive.

What to expect from trying medication

You may be considering trying medications, but still feel nervous about it. Maybe you’ve never taken them before and have no idea what to expect. Or maybe you had a bad experience with them in the past.

People don’t know how medications will impact them until they try them. Typically, antipsychotics work faster than other meds like antidepressants. Within about a week of starting to take them, you should have a sense of how effective they are for your symptoms, as well as what side effects you’ll experience.

You may have to try multiple medications and dosages before you find something you really like. If this is the case, you might want to seek out a doctor who specializes in mental health, if possible. This is usually a psychiatrist, but there are also nurse practitioners and physician assistants who specialize in mental health.

A good health care provider should talk to you about distressing and non-distressing symptoms, side effects, your life goals, and how your meds fit into your overall treatment. They should not just talk about getting rid of symptoms! You don’t want someone who’s so laser-focused on getting rid of symptoms that the medications start causing more problems than they solve.

New medications come out all the time. They often have fewer side effects or target different symptoms. If medications didn’t work for you in the past, there may be new options out there that might work better for you.

Even with medications, some people find that symptoms remain, but the voices, visions, or thoughts are less intense—and then a person is better able to cope.