As I continue within my own medication ramp up, I want to take a moment to pause and remind everyone (people who take psychiatric medication AND those who don’t) that medication is not THE fix. I think people who take medication can sometimes feel like medication is their last ditch effort and if it doesn’t help, nothing will. I think people who don’t take medication think that people who do should automatically be “cured” in a way. Like this will solve all issues and the person they know will be back to their “normal” selves. Not all people think this way but I would like to point out some stereotypes and stigma around medication. Medication is a single tool in a very large tool box of ways to manage mental illness.
So how do you know if a medication is working? Over years of work with psychiatrists and trying out several different regimens I think the better question to ask is how do you know if a medication is NOT working? In my experience it is a lot easier to distinguish when something isn’t working. Take side effects for example. It is very likely that you will have side effects at some point during the duration of treatment. Whether that is ramping up a drug or if you have been on a drug for a long period of time. The line that you have to decide as an individual is when are those side effects having a larger disruption on your life than the condition you are treating it for? This is the part where you need to be completely open and honest with your doctors. Maybe the side effects are moderate but they will even out after a month or so. Maybe they won’t. It is a learning process for every individual but your psychiatrist can only help you if you are willing to share your experience honestly. With that said you always need to advocate for how you are feeling. If the side effects are too much be honest.
How about other signs a medication is not working? Sometimes this can take a lot of time to parse out but in the case of bipolar disorder you generally get stuck in either a depressive or hypomanic episode for a longer amount of time than usual. Or you rapid swing between the two poles and there is never a settling out period. If you don’t reach the space of stability over a period of months it is likely something isn’t dialed in right. And did I mention ramp ups for some meds can take weeks to get to a therapeutic dose? And you have to constantly be monitored with labs to make sure you don’t get to toxic levels in the blood. This is one of the many reasons that people have a difficult time finding and staying on medication. It isn’t always a quick process and you may have to try several combinations before finding one that works. That sounds highly daunting to anyone in the grips of mental torment. That is why I urge you to find a psychiatrist you trust and can work through this process with. Along with a support system you can help you determine if medications are making positive changes. A strong support system around you who realize this isn’t an easy fix all process is key. A caveat that I would like to point out is that to know if medication is working or not you have to take it consistently and as prescribed. I know that can be an issue for many and so make sure you have a system in place to be consistent.
Another issue that could come up is misdiagnosis. Maybe the medication you were prescribed isn’t working because you don’t need that type of medication to begin with. I was started on medication because of my depression. Unfortunately at the time I was not diagnosed as bipolar and the anti-depressant I was placed on caused an increase in self harm and suicidal ideation. This eventually led to another psychiatrist who diagnosed me fairly soon after that. In some ways I was lucky to have this reaction to a medication because it showed that I was likely suffering from bipolar and not unipolar depression. It didn’t feel like a lucky experience but looking back I was diagnosed at a younger age and in a timely manner compared to a lot of other folks. I was also lucky because one of the first medications I was placed on is one that still works for me to this day. I have had it as part of many regimens but it has been the one consistent. The reason I don’t name the medication is because everyone is an individual and the whole point of this post is to reassure you that the partnership between you and your psychiatrist and the support of your family and friends is how to find what works for you. If you don’t feel like you have a partnership with your doctor I urge you to find another. That relationship is one of the most important you will have as you navigate all the ups and downs of a life.
Most importantly be patient with the process. Easier said than done but if you take it a step at a time and are diligent about keeping notes about your process, patterns do arise and you can start to dial in what is working and what isn’t. When something isn’t working, be vocal about it. When something is working, be vocal about it. Communication is key throughout the process. And if you are reading this and don’t take medication, I hope this has been helpful to realize there is a multitude of factors that go into finding a medication right for someone and we need your patience too.