First...I am NOT an anti-meds person, but I don't believe that everyone should just be on them. My friend has schizophrenia and absolutely needs her meds. It's scary when she's off them because of how negatively it impacts her life.
I called out of work one day due to having an issue and in desperation made a same day appointment with a psych NP. I was surprised at how immediate and quick she was to be like "hey sure yeah you can try meds if you want". They diagnosed me with the generic "depression and anxiety" and when from there.
Well the NP immediately quit after that and they transferred me to a new NP, who has continued to prescribe different meds for me. I also recently started therapy.
With the first med I tried (an SSRI), I continued to have my episodes, so I initially thought it had zero effect. In retrospect, I do think it slightly lowered my anxiety (but not enough to really do anything). Coming off them was unpleasant and I had another episode that may have threatened my job. I'm not sure if the episode was related to the med reduction or not.
My NP specifically stated that I do NOT have bipolar disorder, but that she wanted to try lamotrigine with me. I have been slowly over many months titrating up to my therapeutic goal dose and reached it a couple weeks ago.
She also recently prescribed me PRN propranolol which I also don't know if it has any effect. I very rarely get panic attacks. My NP's idea was that if I have a stressful that happen that day to take it so I am theoretically less inclined to have an outburst of some sort later. Again, I'm not sure if this is really doing anything for me. I don't notice an effect.
I know propranolol is preventative instead of used during or after, but I can't always predict when a trigger may occur.
My episodes generally begin with a trigger. So if there are no triggers, I have minimal/no issues. The triggers are not 24/7 and there are sometimes many weeks in between. So how tf am I supposed to tell if the medication does anything???
My issue: extreme negative emotions/spiraling generally tied to a trigger; can cause me want to self harm or do dangerous things, can sometimes cause outbursts at work which threaten work interpersonal relationships and my job. For the most part, my episodes occur outside of work and I am usually (but obviously not always) able to keep it together). So it can be very distressing and unpleasant to live with...but again it's not 24/7.
Sorry that was long!!!
I think those kinds of mental problems are purely psychological. I know why it feels like something physical: it's completely uncontrollable, seemingly irrational, pointless and harmful behaviour, but I believe this just means you're not conscious of what is going on deep in your mind and that all of those behaviours actually stem from your real, perfectly rational needs - those needs are just in conflict with what the conscious part of you wants. People might be depressed because deep inside they're deprived of creative and meaningful relationship with the world or be anxious because they lack the sense of the self and thus feel absorbed by the reality. In both cases, the resultant behaviour becomes obstruent to what the day-to-day part of ourselves needs (to study, to work, to be productive and successful etc.) A panic attack doesn't particularly help at a job interview after all. So we never bother to actually think about those deep struggles and they remain a subconscious, disintegrated part of us, that appears as an external force to what constitutes our conscious self. This is when it is easy to think of your problems as just brain malfunction. But brain malfunction doesn't cause existential struggle. You might loose your sight and hearing, memory and other cognitive abilities but it's always something broader and more primitive than concrete, complex experiences that we call mental problems.
So I believe what would actually help is a deep dive into the realms of your subconsciousness to discover the hidden needs behind your panic attacks and depressive moods. Once you realise them, it will be easier to fill the gaps in your life. Neither meds nor "correct your negative thoughts" kind of therapy can do that. They leave the problem itself untouched.
P.S. I myself used to be very depressed and anxious. Suicidal thoughts and the feeling of the vanity of existence wouldn't let me. Meds didn't really help. Only after I realised my deep conflicts and started to change my whole life, did I get any better. I found what I needed to break through the alienation from life and now, although still struggling at times, I have a very strong sense of purpose in life and I actually feel self-actualised.
Well I mean I certainly know that they are psychological and not physical, but I think some people can still need them for psychological reasons if that makes sense.
I'm in therapy now to help with the mental side of things. I know that ultimately that will work best. But yeah it's gonna take a damn long time so idk if in the meantime meds are needed as an adjust treatment to therapy or how to know if they are doing anything.