It’s Not Just Chemistry

Trauma-informed care

invites dialogue,

not directives.

@myjourneycompasshealth1

When safety, consent, lived experiences, and personal story matter as much as symptoms, medication deserves a trauma-informed lens.

If this piece helped you rethink how we approach medication, you might also appreciate [Dear Understanding] — a reflection on self-awareness, grief, and the gentle art of making meaning after trauma

Author’s Note: This post includes discussion of trauma, medical experiences, and psychiatric medication. Please take care while reading.

“I know the meds might help, but I’m scared

I won’t feel like myself anymore.”

This is something I hear often in my practice — not because people are "non-compliant," but because they’re carrying very real, very embodied experiences of trauma. For many, the fear of being numbed, misunderstood, or retraumatized by the medication process is more immediate than the promise of symptom relief.

That’s why trauma-informed care isn’t just a therapy framework. It’s essential in prescribing too. Because when someone has survived harm — from systems, relationships, or even previous healthcare experiences — how we introduce medication matters as much as what we prescribe.

Why Medications Can Feel Unsafe for Trauma Survivors

Psychiatric medications are often presented as a straightforward solution. But for trauma survivors, the relationship to medication is layered.

Here’s why: Survival Mode Shapes Perception. When someone’s nervous system is in a prolonged state of fight, flight, freeze, or fawn, they’re not just feeling anxious — they’re protecting themselves.

In that state, the very idea of calming down or letting go can feel unsafe. Medications that alter mood, energy, or awareness can trigger fear — not relief.

Many trauma survivors have experienced being dismissed, overmedicated, or gaslit in clinical settings. Add in medical trauma, and it’s no wonder people hesitate. When the system has harmed you before, asking it for help is not a neutral act — it’s a risk.

Centering Autonomy in Prescribing

For those who’ve lived through powerlessness — in relationships, institutions, or systems — any intervention that feels imposed (even gently) can echo earlier losses of control. Medication decisions must center the person’s voice, not just clinical evidence.

What Trauma-Informed Care Teaches Us

According to a 2025 AHRQ Systematic Review, trauma-informed care (TIC) is most effective when built into the entire system, not just individual clinical encounters. They identified five core principles shared across all successful TIC models:

1. Safety

2. Trustworthiness and Transparency

3. Peer Support

4. Collaboration and Mutuality

5. Empowerment, Voice, and Choice

In programs that embedded these values through staff training, leadership support, and patient partnerships, the outcomes improved across the board. Patients felt more engaged. Staff felt more supported. Re-traumatization rates decreased.

Let’s take a closer look at how trauma-informed principles show up in real-world clinical conversations.

How Trauma-Informed Principles Show up in Medication Conversations

Medication decisions

should feel safe,

collaborative, and

grounded in trust.

@myjourneycompasshealth1

Bringing It to the Meds. Medication management is part of this larger picture. If the system doesn’t feel safe, prescribing can’t feel safe either. The Journal of Psychiatry Reform offers a clear framework for trauma-informed prescribing, naming it “trauma-informed pharmacotherapy.” It's not a new kind of medication — it's a new kind of relationship with medication.

Key elements include:

1. Relational, Not Transactional

Medication conversations should feel collaborative. Trauma-informed prescribers ask:

- “What has your past experience with medications been like?” - “Are there any effects you’re particularly worried about?” - “Would it feel better to start low and go slow?”

2. Start Extra Low, Go Extra Slow

People with trauma histories are often more sensitive to side effects. A trauma-informed approach respects that and adjusts accordingly.

3. Consent Includes Emotional Context

Informed consent isn’t just about listing side effects. It includes validating fear, past experiences, and readiness to try something new.

4. Avoid Over-Prescribing or Polypharmacy

Rather than medicating each symptom separately, take a broader look at the person’s story and context. Fewer medications with clearer goals often lead to better outcomes.

Honoring Hesitation in Their Space

Honoring hesitation

creates space for trust.

@myjourneycompasshealth1

If a trauma survivor is hesitant to start an SSRI, a trauma-informed approach might sound like:

“That makes total sense. Would it help if we started with a very low dose and checked in weekly? You’re in control of this process.” This approach fosters trust, reduces dropouts, and respects the patient’s nervous system.

Systems Matter: What the 2025 AHRQ Review Emphasized.

Systems that make room

for voice and choice

support healing

at every level.

@myjourneycompasshealth1

The AHRQ 2025 review showed that even well-meaning clinicians can’t offer trauma-informed care without support. That includes: Time for real conversations - Training in trauma sensitivity - Policies that allow for shared decision-making - Leadership committed to relationship-based care.

What if we treated medication decisions not as compliance, but as collaboration?

What I Want My Patients (and Colleagues) to Know

If you’re a trauma survivor and unsure about medication — that’s okay. Your hesitation doesn’t mean you’re resistant. It means you’re paying attention.

If you’re a clinician, remember: trauma-informed prescribing isn’t about being soft. It’s about being safe, respectful, and precise.

In Summary: Medication as Support, Not Suppression

Healing isn’t about control —

it’s about support, spaciousness, and consent.

@myjourneycompasshelth1

In trauma recovery, medication should never be about silencing someone. It should support their nervous system so healing can begin.

When pharmacotherapy is trauma-informed, it centers emotional safety, choice, and consent. And as the AHRQ review confirms, these values lead to better care — and more human outcomes.

References

- AHRQ Systematic Review on Trauma-Informed Care (2025)

-Informed Pharmacotherapy (Journal of Psychiatry Reform, 2022)