This is a big question for patients. It speaks to individual and societal expectations that we collectively heap onto medications. We see advertisements with happier faces after taking a specific drug, that we should “Talk to your doctor about.” We know of people who are taking antianxiety and antidepressant medications for mental health symptoms ranging from anxiety, fatigue and ADHD, to mood swings and even anger and aggression.
So what do medications do? People ask: Are they a cure for my problems? Will they make me feel better? Will I finally have a good night’s sleep or be free of anxiety and depression?
We come to a physician’s office with some variation of these expectations. They probably know that medication might help them from sinking further but are fearful of leaping into the unknown, tempered by curiosity and that fragment of hope that things might get better. As a practicing psychiatrist, I regularly encounter these feelings, hopes and uncertainties from my patients.
After understanding their symptoms and suffering, I view it as my primary duty to properly educate my patients about medications. That’s not easy. Over the years I have encountered deeply held prejudices, myths, piecemeal bits of information, anecdotes of bad experiences, and misconceptions that come from a patient’s circle of influence as to what a specific medication is (addictive, dangerous, ineffective, experimental, unproven).
It takes a candid and open conversation about facts in order to debunk such distorted reasoning. It also necessitates time to explain things in a way one can never get from an internet page or a non-trained professional. Of course, experience of actually having treated patients is another valuable and credible information source that gives me the confidence to recommend what I do. My motive in so doing is to help set the patient off on the right path toward recovery, not a quick fix.
What does this actually entail? It means giving realistic time frames for what symptom(s) the medication will address, how it does that at the receptor level in the brain, and what they can expect to see. At the same time, I encourage them not to write it off if they think it’s not working in the interim.
The reasons medications don’t work are manyfold: primarily time, genetics, and most importantly, the dose. Many times, a patient has told me that a medication didn’t work. When I ask what dose or how long they were on it, it soon becomes obvious that they were not dosed adequately and/or they were not on it long enough.
Another important factor is side effects. These are varied, not a given, mostly mild, will often dissipate, and rarely, not be tolerable at all. The effectiveness of medication depends on a host of factors, not all of which are entirely predictable at the outset. Based upon my clinical experience of almost two decades, I can tell you that the vast majority of medications do work for what they are intended, but only if taken, as prescribed.
Here’s where we come back to the question of what medications do and what they don’t. I’m sure you will agree that if you don’t take the medication, it will have 0 effectiveness. Yet, that is the most common reason why patients’ symptoms recur. This is such a common phenomenon that when I am training students and resident physicians, I make sure they ask this most basic question first. Of course, there may be a good reason why they stopped it, but if we don’t ask why, we may never be able to convince them to try a different dose or something else.
Sometimes (and this is more common than one might suppose), they were treated for years with the wrong medication after being misdiagnosed (like Wellbutrin® for anxiety symptoms, which typically makes it worse). They may stop taking medication altogether, walking away with a distorted, unpleasant narrative to tell others in the future.
That is why, as part of the educative process, I try to explain why it is important to take the right medication and consistently. Then, they can tell me honestly what it did and didn’t do by the time of our next appointment.
This way, the patient and I can decide if the dosing was inadequate, if there were other medications interfering with it, or if substance use (which speeds up liver metabolism) rendered the medication ineffective at that dose. Like a puzzle, we jointly figure out what road to take next, and why, testing out our hypothesis as we continue to treat symptoms.
That is how the science of medications works: individually. Even though a trial of 30,000 people may have indicated a 90% reduction in symptoms across the board, that does not mean it will necessarily work for you. But, with those odds, it would certainly be worth a try, wouldn’t you say?
We know that medications can work, provided they’re actually taken, adequately dosed, are tolerated by the patient, and that there is nothing else affecting their effectiveness (like daily marijuana or alcohol use, which is common in those “self-medicating” unbearable symptoms).
Does that mean medications work for everything and will eliminate all suffering? That fantasy is peddled by advertisements. They do reduce the intensity of symptoms and can provide meaningful relief from them over time. But they do not eliminate all symptoms. Those that work fast (Xanax, Klonopin and Ativan) tend to be addictive and sedating. It would be wrong to look for the instant fix on a regular basis.
That may sound a bit depressing, but there’s a second half to this part: the patient. Here’s where I ask them to meet me halfway. If we are to achieve recovery, they have to do their part.
Thus, a sleeping pill will not be as effective if your sleeping habits are bad. An antidepressant cannot be as effective if you continue to drink alcohol heavily. An antianxiety medication cannot make inroads into chronic anxiety if you are not practicing skills and thinking exercises learned in therapy.
There is some onus on the patient if we are to grasp the role and limitations of medications. The fantasy of not being rescued from suffering can be quite a let-down in this respect. Perhaps that’s where more efforts need to be put, in order to have the greatest yield? Does it entail responsibility of sorts? It does. Or another way of putting it: owning your own recovery. For some, this can be a lightbulb moment, whereby they feel empowered to get back in the driver’s seat of their own life.
Others may require more support and guidance as they are simply too demoralized by the time they come to see me. In such cases, we take it slower, and achieve mini victories, while I work on the medication part simultaneously. I call this my parallel tracks approach.
I take this seriously because if I can help boost their low energy as is classic in a depressive disorder, then that may help get their sleep habits on track that much faster. We’re in it together, that’s for sure.
What else don’t medications do? They are certainly not going to stop day to day stresses from coming and they may not repair a broken relationship. But, by improving overall functionality through relief of interfering symptoms, the air might clear to the extent that you can then make healthier choices, develop better communication and coping abilities and be less sensitive to hits from life.
Of course, the latter will also require therapy as an additional, powerful intervention, to help you better problem-solve the issues at hand. This is why medications should always be combined with therapy in order to achieve the best outcomes. Research has been proven this over and over again.
To conclude, I suggest we adopt a “can do” mentality to the topic of medications. There is a lot that they can do and you can help them work better by working with us on the things medications cannot.