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A Pastor’s Guide to Common Psychotropic Medications

Pastors spend a lot of time talking with parishioners about life’s problems. Those sharing about depression, anxiety or other mental illnesses may be taking psychotropic medications, such as an antidepressant, prescribed by a doctor or psychiatrist. The sea of names can be confusing, with brand names and generics being used interchangeably.

The National Alliance on Mental Illness has offered a helpful chart (found here) that lists all the various medications prescribed for mental health disorders. I have chosen a few of the most commonly prescribed medications to highlight here for a quick reference for pastors.

Antidepressants

While there are many classes of antidepressants, the most common category is known as the SSRIs. These are selective serotonin reuptake inhibitors that work by stopping the brain’s nerve endings from absorbing serotonin back after it has been released in the brain. This keeps more serotonin available in the brain so that the brain receives more neurotransmitters that produce positive feelings. The most commonly prescribed antidepressants are Prozac (fluoxetine), Celexa (citalopram), Lexapro (escitalopram) and Zoloft (sertraline). Effexor (venlafaxine) and Wellbutrin (bupropion) are not SSRIs but are also commonly prescribed for depression. 

Anti-Anxiety Medications

While antidepressants are often used to treat anxiety symptoms, there are other medications that can be used to treat panic or anxiety. Many of the anti-anxiety medications are habit forming, so you may want to be aware of a parishioner’s use of these medications particularly if they appear to be using more than prescribed or have a drug history. While a doctor has to have a signed release to share information about a patient, a pastor who is concerned about medication abuse can leave a message for the doctor to inform him without expecting a call back.

Common anti-anxiety medications are Klonopin (clonazepam), Ativan (lorazepam), BuSpar (buspirone) and Xanax (alprazolam).

Mood Stabilizers and Antipsychotics

This category of medication is used primarily for the treatment of Bipolar Disorder in which a person experiences both manic and depressive symptoms. Common mood stabilizers are Depakote, Lithium, Lamictal and Topamax. Antipsychotics treat psychotic disorders such as Schizophrenia. There are many older medications such as Haldol and Thorazine that are used in extreme situations, such as in a hospital setting, but are rarely prescribed to a person within a community setting. More common and modern medications, known as atypical antipsychotics include Abilify (aripiprazole), Clozaril (clozapine), Risperdal (risperidone), Seroquel (quetiapine) and Zyprexa (olanzapine).

Stimulants

Finally, stimulants are often prescribed for those experiencing symptoms of Attention Deficit Disorder. While Ritalin may be most commonly recognized, newer medications are taking the place of older ones. Adderall (amphetamine and dextroamphetamine) is frequently used as well as newer Concerta and non-stimulant Strattera.

Medications are not always used to treat mental illness. There are some non-medical interventions that can help in non-chronic situations, such as a single episode of depression, including exercise, diet changes, social support and general self-care. Professional counseling can help a person talk through issues that may be at the root of symptoms and is often a good first step prior to pursuing medication in non-dangerous situations.

 

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NEW Pastor Training Video: Making Referrals Work

Unless you are using the Church Therapy model and have an on-staff counselor at your church, most likely the pastor will refer parishioners to a nearby counselor or agency. Unfortunately, these referrals often fall apart because the counselor’s caseload is full, or they do not take a particular health insurance or they do not see clients of certain ages, etc. In this Pastor Training Video, I help pastors (or lay leaders or Christian friends) learn how to make sure that the referrals they make actually turn into people getting the help they need. Thanks for watching!

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Humility and Your Mental Health

Beginning with the premise that all truth is God’s truth, I always find it fascinating when the study of psychology proves what the Bible has said all along. Advancements in neuroscience, including the concept of neuroplasticity for example, gives us a deeper understanding as to how to “renew our minds” and demonstrates why prayer and worship are actual brain-changers.

Recently I was thinking about the biblical concept of Christ-like humility, and I came across an interesting article, “8 Psychological Benefits of Being Humble.” Just another reminder that God’s ways are always intended to benefit our lives, even though sometimes it feels like he is forcing us to do the “right” (but very unpleasant) thing. Eating broccoli enriches your life even though donuts might be tastier in the moment. However, for those who place a high value on health, eating healthy foods is not a chore but a gift.

So what is humility and how can it benefit your mental health?

 

I first turn to the Bible for definition, and I find a powerful description of humility in Philippians 2:5-11:

“You must have the same attitude that Christ Jesus had.

Though he was God,
    he did not think of equality with God
    as something to cling to.
Instead, he gave up his divine privileges;
    he took the humble position of a slave
    and was born as a human being.
When he appeared in human form,
     he humbled himself in obedience to God
    and died a criminal’s death on a cross.

Therefore, God elevated him to the place of highest honor
    and gave him the name above all other names,
 that at the name of Jesus every knee should bow,
    in heaven and on earth and under the earth,
and every tongue declare that Jesus Christ is Lord,
    to the glory of God the Father” (NLT).

I have left the formatting of these verses as they appear in Scripture to highlight that this seems to be a quote of a song or poem. Some have suggested that this may have been a song that Paul and Silas sang together in prison. Humility as described here is something so central to the identity of Christ that it is the key trait that enabled him to save us. In considering this, I find that there is tremendous spiritual power in Christ-like humility when we adopt a willingness to serve others even when it costs us greatly.

So far, this idea would seem like a horrible life of suffering. Under such a heavy weight, one’s mental health would surely crumble. And yet in the article I mentioned earlier, humility is cited as being soothing to one’s soul, increasing one’s capacity for self-control, increasing work and school performance and improving a person’s relationships. How is this possible?

Matthew 11:28-30 comes to mind here: “Then Jesus said, “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest. Take my yoke upon you. Let me teach you, because I am humble and gentle at heart, and you will find rest for your souls. For my yoke is easy to bear, and the burden I give you is light” (NLT).

When we truly accept and embrace humility without fighting against it, we enter into a level of spiritual peace that God designed for us to have. Our bodies and our minds can be at rest when we do not consider ourselves better, wiser, or more “right” than others. When we take time to acknowledge our own blind spots, we have a greater level of grace for others. We re-align ourselves with God and with community and we release all our instincts to have something to prove.

If Jesus’ burden is light, then we are actually relieved when we follow his example. He didn’t spend his time on earth complaining or telling his disciples of all the great things he had given up for them. He had no resentment. He knew that his choice to come to earth was freely given, for a purpose and for a season that would end in a victory. Perhaps we would all find peace and rest if we released resentment and humbled ourselves as servants of all. May God give us grace to do so today and restore our minds and hearts as we trust in him.

 

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Defending the Marginalized

We live in an increasingly volatile world, and the current political climate has stirred debate in multiple sectors. As Christians, we have an ethical responsibility to engage with social issues as they fundamentally relate to how we engage with the world. The age old question, “But who is my neighbor?” is poignant right now as we wrestle with whose interests to protect most.

If you follow me on Twitter, you will see that I have taken a stand to defend the cause of the refugee after the entire refugee program was suspended for 120 days. I specifically chose to speak loudly on this issue because of my calling to advocate for and defend the marginalized. The global refugee crisis is a mental health crisis, as trauma significantly impacts those fleeing from war-torn countries.

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When we rise up to defend the marginalized, it is helpful not to lose ourselves in the process and become antagonistic or even hateful in our approach. Here are some of my personal guidelines for engaging in advocacy:

Humanize Rather Than Hype

When a hot-button issue rises in the media, it is easy to get pulled into the hype. Too often we get sloppy and we forget to do our homework (remember primary sources, not secondary sources??). We have to make sure we have our facts in order. But even more than that, we need a human connection. Have you ever met a refugee? Have you developed a relationship with a homeless person? Are you serving the poor in your community? Are there any poor people in your community? What are their names? Have you listened to their stories?

When we surround ourselves with others who look and sound just like us, we can become comfortable and complacent. There have been refugees struggling around the world for a lot longer than the past week. Were we up in arms about their plight then? Every day marginalized people suffer, and the only way to humanize the issues that face us is to know the people for whom we advocate. In my city, refugees have faces and names. Far beyond an issue, this week has reminded me of the couple from Sudan that I knew for a while until they had to move (when their meager government support ran out and they could no longer afford their apartment). That couple knew English, were Christians, and did all they could to find work. Hardly a picture of a “drain” on the system that some like to proclaim. But they were traumatized, deeply in conflict with each other after all they had been through and they could not find a way to make ends meet. And when I tweet about refugees, it is for them and so many like them, regardless of country of origin or religious affiliation.

Be Meek But Not Weak

Humility is hard to come by in our culture, since it is a trait devalued by Americans. Being meek means that you maintain a constant awareness that you are no better than anyone else. But that does not mean we are weak when it comes to advocating for others. In fact, when we set aside our own personal interests in order to take up the cause of another, it is one of the most meek and loving things we could do.

The dictionary on BibleGateway.com defines meekness as, “An attitude of humble, submissive and expectant trust in God, and a loving, patient and gentle attitude towards others.” When we defend the marginalized, we must demonstrate humility, submit ourselves first and foremost to God, have expectant trust in God and be loving, patient and gentle to those who disagree with us. If we merely like to hear ourselves talk, then by all means let’s gather a group of people who already agree with us and have at it with the issues. But if we want to effect change, then in humility, love and boldness we must engage with those who have strong opinions on the other side. Even if we do not convince them, we will create change simply through the counter-cultural way we choose to behave.

Think Globally, Love Locally

In the age of the Internet, everyone on the planet is our neighbor. Christians must consider the global impact of our actions and beliefs individually and as a nation. We confuse the world when we say we are (or want to be) a Christian nation and then engage in preemptive war or close our doors in senseless fear. So we must think about our global impact. We must also remember that the Church is a global Church, and we stand as one body and one bride of Christ. We would do well to listen to Christians around the world rather than to American public policy.

As we think globally, possibly the most influential thing we can do is to love locally. Look around your neighborhood. Who needs the love of Christ today? Who needs to be served without strings attached? Who are the marginalized in your community? Find them. Get to know them. Love them. Relationships dispel fear because we become familiar with someone else’s context. We learn to trust the unfamiliar. We discover the beauty that others bring to the world. Instead of random acts of kindness, build intentional and purposeful relationships that last far longer than a passing smile. Random acts of kindness make you feel good, but they do little to actually help those who are truly in need. Who can you love unconditionally and humbly today? Whose story can you hear and whose life is so different from your own that it takes intentional work to connect? May the Church rise up in love to ignite a supernatural change around the world.

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Pastor Training Video: Pastors and Counselors on a Team

In the Church Therapy model, pastors and counselors work closely together on a team. While there are many forms of Christian counseling, this model emphasizes that multiple people in differing roles can work towards common goals, providing a strong healing affect.

In the Church as a whole, pastors and counselors have sometimes been at odds, with pastors feeling that counselors may lead parishioners astray and counselors feeling that pastors may be too heavy-handed or insensitive.

In this Pastor Training Video, I explain how our different roles serve important purposes when we work together.

Enjoy and thanks for watching!

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2017 Freedom Workshops

Join me in Lynn, Massachusetts for 4 dynamic workshops this year! Coming in March, “Understanding Mental Illness” — a must for all Christians as we need to be ready to respond well to those who suffer in our midst. Our June workshop will feature great content on communication and conflict resolution and in September we will explore how to deal with regret and shame. We’ll wrap it up in November with some helpful tools for managing life, incorporating information from my book “Getting Your Life Under Control.”

Please share this post to spread the word!

Tickets and special online savings can be found at mkt.com/freedomworkshops or you can Like us on Facebook!freedom-workshops-2017-frontfreedom-workshops-2017-back

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Love

Our final week of Advent anticipation focuses on the greatest of all eternal things: Love. Perhaps the most backwards concept in our society, love in God’s kingdom is something that is described as a definition of God Himself. God is love. Not God has love, not God is loving, but God is the very definition of love.

advent-love-candle-3

On earth we think of love as something we give. In God’s kingdom love is something He is. We think of love as something that makes us feel good. In God’s kingdom the spirit opposes the flesh and conquers sin through sacrifice. We think of love as something you fall into. In God’s kingdom love is something you enter into intentionally.

This Christmas, what does it mean for us to love? First, let us embody love as God does. Let’s not just do “random acts of kindness” or loving things, but rather may love pour out of us continually as a definition of our character. Second, let us love in ways that do not bring comfort to our own flesh. When it’s hard, we love. When it requires sacrifice, we love. When it means we put ourselves last, we love. When what we want conflicts with what would protect another person, we set our selfishness and pride aside. Humility is required for this kind of love. And this must be cultivated and matured. One cannot “fall into” this love any more than one can get in shape accidentally. Real love requires continual training and refining of our inner lives through the work of the Holy Spirit.

Jesus said to love your enemies. Jesus gave up a position of power to be made weak. Jesus poured into a man he knew would eventually betray him. Jesus restrained his tongue when false accusations were thrown at him. Jesus resisted temptation and got to the very end of Himself when in His hour of deepest need His Father no longer seemed present. Forsaken, despised, rejected. Only in God’s kingdom is love possible in such circumstances. In the coming year may each one of us be stretched to love farther than we have ever loved before.

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Joy

Have you ever seen the movie Inside Out? If not, you absolutely must watch it immediately after reading this post. The movie is brilliant in capturing what is going on inside the human mind. A main character is Joy, who acts as a leader among all of the emotion characters. There has never been a more accurate depiction of my inner life than in the character of Joy. She is fiercely determined to maintain her optimism and the harmony of the group. She has endless positive energy (though this is tested in the challenges she faces) and others look to her when decisions need to be made.

large_advent-the-dawning-of-indestructible-joy

As much as I love that movie, I have to pause to ask myself, “Is that what the Bible means by joy?” Certainly we know that joy is not the same as happiness… In James 1 we are told to “consider it pure joy when you face trials of many kinds…” Few of us would be happy under challenging circumstances, but we can have joy. Just as we discussed last week regarding peace, joy is a product of the Spirit and not something we can achieve ourselves. Valuing what God values in his kingdom will determine whether or not you can connect with joy — things like suffering and hardship are seen as valuable gifts in the life of a Christ follower.

So what is this joy to which we can connect this Advent? If it is perhaps not quite energetic optimism and it isn’t happiness, what is it? I would define joy as an attachment to long-term hope. Regardless of my circumstance right now, God is still good. He will overcome in the end. He will guide me and mold me into his likeness if I allow him to. I do not think joy has to be expressed with energy or extroversion, though this is often the assumption. Perhaps true joy is something that cannot be expressed and is most keenly experienced in intimacy with the Spirit. Like a quick glance between friends, when a look is reassuring and confident all by itself, joy is the experience of the Spirit giving us a wink. “Just watch what I’m going to do with this one…” his presence assures us. Confidence in God’s strategy that works all things out for our good… Christmas reminds us that God has always had great and surprising plans up his sleeve and he always will. In this Advent season, no matter what you are going through, I encourage you to watch and wait with joyful anticipation as his plan unfolds.

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Peace

As we continue to reflect this Advent season, the concept of “peace” is one that has tremendous significance in the conversation about mental illness. Anxiety and peace are often seen in opposition. Those who experience symptoms of Bipolar Disorder, Major Depression or Schizophrenia may also seem to lack peace. So is peace a feeling or perhaps something much more?

peace

Peace is listed in the Bible as evidence of the Holy Spirit (called the “fruit of the Spirit” in Galatians 5). Therefore we can conclude that peace is not a feeling, as feelings are temporary and affected by a lot of environmental and biological factors. Peace is not something that stems from deep inside ourselves nor is it an earthly phenomenon. True peace can only be manifest when the Holy Spirit is at work in a person’s life.

Philippians 4:7 talks about the “peace that passes understanding,” or as I have often suggested to my clients, “peace that doesn’t make any sense.” This supernatural peace extends far beyond a flimsy feeling. Rather it is a direct outpouring of God in the midst of circumstances or disorders that come with worry, fear or anxiety.

Think of peace like a room. You can enter into it when you make a decision to seek it. It is outside yourself and is much more of a place than a feeling. God offers us ways to partake of his peace through holding on to the truth of his Word, or encountering his Spirit in prayer. This place we enter is not of ourselves, and thus it can be accessed by anyone. It does not depend on our ability to achieve it. Peace is simply a gift from God that comes when we begin to grasp the idea that he is so much bigger than us and he loves us greatly.

This Advent season, take a moment to reflect on peace. Is it a room you can enter today? Consider it an alternative to the Hectic Room or the Conflict Room. No matter your struggle, symptom or circumstance, pause to enter the place of peace.

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Hope

As we begin Advent, I consider the themes of Hope, Peace, Joy and Love. Each week of Advent I will post a brief devotional thought connecting the struggles of emotional/mental health with one of these themes.

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Psalm 119:147 (NLT) – “I rise before dawn and cry for help; I have put my hope in your word.”

Have you ever experienced a season in which your life sounds like this verse? You wake while it is still dark, you are in desperate need of help before the day even begins, and the only thing you have left is some flickering hope that maybe God will come through on what He has said He will do. For some, these struggles last for more than just a season, and it is in this wrestling that we truly understand hope.

Hope is not a feeling. When we mistakenly treat it like a feeling, we rely on the wrong things to make us feel better. Hope is an attachment to something outside yourself that is bigger than you. Hope is a belief that something might get better someday. Hope is the idea that today’s struggle is not the end of your story.

This week as we begin Advent, take a moment to reflect on what brings you hope. Is there anything you cling to in the midst of pain and struggle that keeps you in the fight? We know that one symptom of depression is hopelessness — when the depth of darkness is so severe that you have no strength left to cling to anything. If that is your experience, please reach out to a professional counselor for help. These symptoms are treatable and can get better with guidance, self-care and sometimes medication. New Life Ministries (1-800-NEW-LIFE) keeps a national list of Christian counselors and may be a helpful starting point. At times I tell my clients that when they are unable to carry hope for themselves, I will carry it awhile for them. May we all as Christian brothers and sisters extend this grace to each other daily.