The Worried Well and the Worried Unwell: Life Management or Medication

I just received an interesting question on medication vs. management skills for college students. When do students deserve medication for stress and when would students benefit from management skills training?

To answer that difficult question let's first look at what's normal. Many may disagree with my definition of normal human behavior, but here it is anyway. We are normal if we are able to:

• Love that includes:
• Love of self = wishing ourselves well, accepting ourselves despite our frailties, and developing our talents.
• Love of others = extending (but not overextending) ourselves for the other's emotional, intellectual, and physical growth.
• Love of God = a spiritual relationship with a supreme being or in my case, and the case of many others, a personal relationship with Jesus Christ.
• Work = providing for ourselves in a way that benefits others.
• Recreate and Relax = enjoy ourselves in a way that brings no harm to ourself or others.

All of us have distractions, desires, disappointments, despairs, despondencies to some extent at sometime in our lives. (If we don't have a few of these characteristics at one time or another, we are in denial and most likely abnormal.) 

So to answer to the first part of the question is easy. In my view all of us would benefit from management skill coaching and most certainly all college students would benefit from intra-and interpersonal skill training. If I were running the world,  Life Management 101 would be a required course for every high school and college student. 

Two decades ago I wrote a little book---Leverage Your Time, Balance Your Life---that I hoped would help all of us live more useful lives. Since we can purchase the book on the internet for one cent it obviously didn't help as many as I would have hoped. 

Now to answer the difficult part of the question: What students deserve medication and what students don't? With a few exceptions, the prevalence of mental illness in college students is similar to the prevalence of mental illness in non-students. Those with schizophrenia and other psychoses, bipolar disorder, posttraumatic stress disorder, severe panic disorder with agoraphobia, and major depression benefit from medication and medical treatment. Medical treatment does not exclude these students from Life Management 101.   

Now let's get to two hazy areas: social anxiety and attention deficit disorder.

Attention Deficient Disorder seems to be on the rise. This diagnosis provides a huge dilemma for me. Who to treat and who not to treat? College students (and the rest of us) love Adderall for reasons all on this planet know. Adderall is a miracle drug for those with ADD. Unfortunately students can fake the symptoms of ADD very easily. In an ideal world those claiming ADD would have a battery of extensive psychological tests. Unfortunately these tests are extremely expensive or may be unavailable.  

Right or wrong this is a nutshell summary of what I do: After an extensive history and mental status examination, I administer (in person) a pen and paper test that contains the symptoms of ADD, bipolar illness, depression and the major physical illnesses. I then, if possible, talk with some significant other about the student's symptoms. I discuss in detail the side effects and abuses of Adderall and have the student sign that I have done so. If all seems appropriate, I give a low dose trail of Adderall and reassess a week later. The patient's report dictates options. To continue to receive Adderall the student must show improved grades. (There is much, much more to a treatment decision and followup than is written here.) 

Now to social anxiety, another college student illness on the rise. First and foremost these students benefit from Life Management 101. Some may require psychotherapy and in certain severe cases I may prescribe an SSRI and, on some extremely rare cases, a very low dose benzodiazepine. In my experience, the vast majority of social anxiety students require no medication.  

Thanks again, reader, for this extremely difficult question that merits a book to answer. 

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Please comment: A personal story you would like to share? Any ideas you would like to contribute? Any disagreements?