Help! my Meds aren't Working!
Today we’re going to talk about psychiatric medications, when they work, when they don’t, and when you need to wait before making a decision. A brief word of warning and waiver, please talk to your doctor before making any and all medical decisions, and as I am not necessarily your doctor (although some of my patients may be listening…) this discussion is for information and education only and should not legally be taken as medical advice. Now that I’ve made my attorney happy, let’s get down to it!
There are a lot of patients that come to me for second opinions, or those folks who had previously been being seen by their primary care doc or OB/GYN for psychiatric medications because they either couldn’t get in to see a psychiatrist or their insurance didn’t cover the cost of getting in with a psychiatrist. Sometimes people come to me from other retiring docs or just wanting a second opinion.
Frequently my new patients’ first statement to me is: “MY MEDS DON’T WORK!” Well, first of all, that’s a bit of a loaded statement. Let’s break that down a little bit. There are a lot of questions I need you to answer before we can unpack it:
What condition are you being treated for and do you understand that you’re being treated for? You may on medications for bipolar but not actually have bipolar disorder but you told your primary doc you had “mood swings,” for instance. Did you just take what the doctor prescribed because you were in a crisis state and didn’t ask them questions about it?
Do you actually have the condition that you’re being treated for? Sometimes to ferret out the correct diagnosis, we need to spend a bit more time with the patient and that can’t necessarily be done in a primary care setting. There are a LOT of conditions that have overlapping symptoms. For instance, poor concentration and attention could be secondary to PTSD, ADHD, generalized anxiety, adjustment disorder, hormonal imbalance, certain eating disorders, and even dehydration! So not only do we need to know about your mental health history, it’s important to know what’s been going on with you physically as well!
We don’t live in a vacuum. Symptoms typically don’t just appear overnight. What’s happening in your social sphere? What’s going on with your work? Your family? Even medication changes to your normal routine can change the way a psychiatric medication behaves! You may have been fine on Zoloft for years, for instance, but your doctor may have prescribed you steroids and an antibiotic and now you’re shaking like a leaf and not sleeping through the night! Or…alternatively…you may have been fine on Prozac for the past year but are going through peri-menopause, or you and your husband are on the verge of divorce. All these things need to be taken into account when we’re looking at your medication regimen.
What if it’s something else that “looks” like a psychiatric diagnosis? Low thyroid, iron-deficiency anemia, low testosterone or progesterone hormones, steroid use, and adrenal fatigue can all MIMIC the symptoms of a depressive disorder! Asthma, COPD, hyperthyroidism, stimulant overuse, and certain adrenal tumors can mimic the symptoms of anxiety! Know your family history, and get to your primary care doctor to make sure all of these common issues are ruled out prior to getting frustrated with antidepressant medication failing you! You may need tests and or treatment with another specialist.
What were your expectations? If your goal is to never have problems or never be unhappy or never to feel stress again, you may have unrealistic expectations about what the medication can do for you. Sometimes under these circumstances, both medication AND psychotherapy are warranted because you need assistance with coping skills and affective regulation more than you need your senses to be dulled.
Have you given it what we call “an adequate trial?” All that means is, when you onboard a medication, you may have side effects initially but these may go away. There are other types of side effects that only get worse the higher dose you go. An adequate trial means that you have given at least 6-8 weeks at the maximum dose you could tolerate and if it didn’t work for you to alleviate symptoms, or it’s causing more problems that it’s relieving, OR you have an allergic reaction, then the medication is likely not for you, obviously NO BUENO. But it’s really important to talk to your doctor or provider about what types of symptoms you are experiencing after having taken a medication. In the case of SSRI antidepressants for instance, you may have stomach troubles: upset, nausea, vomiting, diarrhea, or constipation. But these symptoms of initiation rarely last longer than 5 days. But if you experience sexual side effects, loss of libido, or weight gain when you FIRST start to take a medication, then things will likely only get worse the higher dose you go. If you’re experiencing side effects how do you know which side effect is which? Ask your doctor!
Don’t lose hope. Nothing is effective instantaneously. But if you’re being treated with the right med for the right diagnosis, and it’s still not working or it’s causing more problems than it’s solving, there are LITERALLY HUNDREDS of options available to you! Sometimes it can take upwards of two years to find the right combination of therapy and medication, especially if it is a complicated problem, or you have more than one!
If you feel you’ve tried ALL. THE. MEDS. and want to try something different? There are so many options available! There is standard TMS, Personalized, TMS, ECT, and ketamine infusion therapy, which we discussed a bit in earlier podcasts. The main thing here is to keep trying and if you don’t feel like you have it in you to try anymore, talk to your doctor or provider immediately! There are ways we can work together to help you solve your problems that aren’t necessarily medical in origin.
If you feel like you’ve been through the mill with other meds and don’t like the side effects, don’t feel like you’re being heard by your provider, maybe it’s time you find a new provider! Don’t suffer needlessly. This is the time to advocate for yourself.
So, if you found this information helpful, please like, subscribe, and follow us! Tell your friends. We’re @AndersonClinicCincy on Facebook, Instagram, and TikTok. And you can find our Psych Waves podcast on Apple and Spotify. And if you happen to be in the Cincinnati area and are looking for assistance with treatment-resistant depression, anxiety, concussions, or PTSD, give us a call at (513) 321-1753. Start feeling better faster.