• September 12, 2025
• Center for Developmental Psychiatry

Isn’t Medication Just a Crutch?

By Jason Dean, MD

 

 

“Isn’t medication just a crutch?”

I hear this question all the time – and it’s an entirely valid concern.

Parents want their children to learn to face life’s challenges head-on, manage emotional difficulties, and come out on the other end stronger and more confident.

My adult patients want to know that they can thrive at work and in their personal life without turning to a pill to cope.

Others are concerned that taking medication and relying on a substance could one day set them up for disaster if the medication no longer works or if a new issue arises, if they haven’t learned how to manage things without it.

Some feel that taking medication is unnatural, and they don’t like the idea of an external substance altering who they are as a person.

My own professional view on this topic is somewhat complex.

On the one hand, I am probably the farthest thing from a pill-mill. I don’t push medication, and I am a huge proponent of psychotherapy.

At the same time, I prescribe medication literally all day long, and I have seen countless examples of transformative effects.

As with most things, being too extreme or dogmatic in either direction is unhelpful. An overemphasis on medication is not correct, but neither is a nihilistic approach where medication is inappropriately avoided or rejected as an option.

The question is: How do we strike the correct balance? How do we validate the very real and reasonable concerns that patients and parents have about medication while also reducing stigma?

In my view, medication is not a crutch, it is a tool that, when used wisely and correctly, can unlock incredible potential for change.

But it depends how it’s used.

Numerous studies have confirmed that the combination of medication and therapy is more effective than either modality alone in the treatment of depression and anxiety.

Therapy alone can be effective, but in many cases therapy is actually more effective when medication is on-board.

This is because when emotions are so strong that they become unbearable, it’s impossible to work through them. If you’d like to work on social anxiety, but you have a panic attack every time you try to talk to somebody, you’re not going to get very far.

In these situations, medication is actually the opposite of a crutch because intolerable and unbearable emotions can preclude their own treatment.

At that point you’re absolutely stuck. But if you can judiciously use a medication to lower the temperature a bit, bringing the intensity of your emotions down to a tolerable level, then you get to a point where you can work on learning to manage them.

Can medication be used inappropriately or in a way that is detrimental? Absolutely.

If somebody develops the habit of constantly reaching for “PRN” medications, which are medications taken as needed for anxiety, then they might rob themselves of the opportunity to learn to manage those feelings.

Similarly, if somebody takes a pill, sits on the couch, and looks around waiting for their life to become happier, they may be waiting for a long time.

It is true that medication alone can bring symptomatic relief, but when it comes to the real change that people are looking for, deep changes in their relationships, a sense of purpose and meaning, and general fulfillment in life, it’s still necessary to put in the work.

In fact, the research on the effect of these medications bears this out.

There is research that shows that medications like fluoxetine, which is a selective serotonin reuptake inhibitor, works by potentiating change in the brain.

Individuals with depression and anxiety have been found to have reduced neuroplasticity, which is the ability of the brain to physically change its connections.

As our environment, responsibilities, and relationships are constantly changing, sometimes very rapidly, our brain physically needs to adapt and change. The brain accomplishes this by altering its interconnections.

However, individuals with reduced neuroplasticity, with physically rigid brains, cannot keep up. Overwhelm sets in, leading to depression or anxiety.

What’s amazing is that selective serotonin reuptake inhibitors have been shown to increase neuroplasticity.

In a certain sense, they provide a type of neurological rejuvenation, allowing the brain to make new interconnections, leading to healthier adaptation.

What this means is that fluoxetine, for instance, is not a happy pill.

It’s a tool that potentiates change.

But it doesn’t cause that change directly.

Without the medication, an individual may be physically incapable of making the neurological changes necessary. The pill provides the physical potential for that change to happen, but that’s it.

The rest is up to you.

If you take a pill and wait for things to change, you may feel better, but you won’t get the most out of the medication.

If you take a medication and gain the essential neurological adaptibility, your brain will now be capable of making new interconnections. If you then engage in a prolonged period of therapy, working on your relationships and improving your life, it is the personal work and therapy that actually cause those new interconnections to form.

You may find after a year or two that you are an entirely different person.

At that point, you may actually no longer need the medication, and you can go off it. I’ve certainly seen that many times with my patients.

So while medication is not a crutch, it’s also not a cure-all or a quick fix.

When used correctly, medication can unlock the potential for transformative change, but it only opens the door.

The rest is really up to you.

Thanks for reading,

Jason Dean, MD

Clinical Instructor, Yale School of Medicine

Founder, The Center for Developmental Psychiatry