I conduct boo-coo medication consultations with clients, and when it comes to the drugs they’ve either tried in the past or are currently taking, a common refrain is that they’ve tried “everything” and none of the prescribed medications have worked to their satisfaction. As I tick these drugs off the list they’ve provided me one-by-one, asking how and why they believed the medication has failed them, most of them ask “so what’s next, what are you going to do?” Seems like a fair question, right? Well, it is, but with these caveats:- Medication is often prescribed without regard for the full clinical picture. This happens often when psychotropics are prescribed by general practice physicians or prescribers who primarily toil in the trenches of physical medicine and have considerable time constraints. For example, a patient complaining of depression who happens not to mention their accompanying anxiety symptoms (which are actually more bothersome, and which are wearing them out and have them appearing and sounding depressed) may quite easily be prescribed antidepressants such as Effexor or Wellbutrin — both of which are fine antidepressants, but notorious for exacerbating anxiety in someone who is already experiencing it. It takes much longer than 7 to 10 minutes to obtain a complete symptom set. End result: The patient becomes discouraged and wary of medication going forward, engendering a resistant mindset — setting the stage for #2.
- Psychology affects biology. Feelings of disappointment regarding less than optimal outcomes — or even no response at all — affects attitude, which in turn promotes “psychological” resistance to medication. In other words, when a patient experiences drug failures, this deepens and strengthens their negative beliefs about medication, and this in turn, interferes with the physiological impact of those drugs. This makes sense because if people can get positive responses from a medication — influenced at least in part by believing that the drug will work for them — similarly they can also block a medication response because of disappointing experiences.
It is important then for prescribers, as well as therapists and counselors alike, to take a look at the relationship a patient has with medication. Unfortunately, most prescribers, rarely if ever, initiate such a dialogue with patients, but it’s often not even addressed by therapists — those who should be inquiring most. Too often, non-medical professionals are reluctant to get involved with medication issues, believing that this is beyond their knowledge and not within the scope of their expertise or job description. The reality though is that medication and psychotherapy are not mutually exclusive, so therapists and counselors must be attuned to the reactions and results their patients are having with medication so as to best direct and advise them regarding future appointments with their prescriber.
Psychotropic medication use extends way beyond the chemical effects of these drugs. For many people more is riding on their relationship with medication, running the gamut from hope and success to disappointment and failure.
All of us – prescribers and non-prescribers – are charged with the task of assisting patients acknowledge the often complex psychological and emotional issues associated with taking medication to generate the best possible outcomes.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.