Do Antidepressants Work?

Did the med not work? Or did you not take it correctly?

Part 3 of 5 part series – The compliance issue and why Medications fail

Never has there been an area more argued in the fields of science and medicine than that of the effectiveness of medications for treating common mental health issues such as depression, anxiety, and suicidal thoughts and feelings. Even strong advocates of treatment with medication will say that it may take several different medications or combinations of medications before finding one that works for a particular individual. On the individual level, it does not take long to find many that claim no medications have ever helped them at all, and even  claims of medication making it worse.

Treating Depression and Mental Illness

Looking at the inherent problems in treating mental health conditions and determining effectiveness of drug therapies brings the biggest issue to the forefront. Since the vast majority of all mental health issues are just a set of subjective symptoms, with no defining test to say when a person “has it”, it is equally difficult to determine if a person is cured. Unlike most physical illnesses where there are visible signs and scientific tests that measure both the existence of and the seriousness of an illness, mental illness has no such markers.

Many people spend considerable time trying to determine if they do in fact have a mental health issue. That same consideration comes into play when determining if a treatment is working, at what point is it no longer depression and just some sad days? This also contributes to the larger problem of patient expectations when being treated for things like depression or anxiety. These issues are not about feelings that people should never have, all people feel anxious or depressed on occasion. If the expectation is to never feel those things again, then there would never be a “success” in treating these conditions.

What do Anti Depressants Do?

Medications for mental illness are not designed to make a person “happy” or extra easy going. Many people have expectations of the false euphoria one would get from recreational drugs that cause giddiness, happiness, of sense of supreme well-being. This would be similar to believing that taking medicine to cure an illness or infection that left your weak and bedridden should give you super strength and physical abilities you did not possess before.  The sole purpose is to make extreme feelings more manageable or to help eliminate or control the false feelings or doom or despair caused by some conditions.

The successful treatment of depression does not result in “happy”, it results in the ability to control the tears and/or hopelessness that results in inability to do anything that can result in happiness or making changes to get to a better place. The absence or reduction of depression can still be “sad but able to function” for example if the situation or circumstance would result in sad in a “normal” person (for example following a loss of a loved one). It is the false expectation in results that leads many to not take medication as directed or to believe it is not working so they stop taking it. Even if when they stop taking it things are noticeably worse, many often try to argue ineffectiveness as opposed to compliance with taking being the issue.

 

Handout to physicians discussing need to remind patients of compliance needs
Handout to physicians discussing need to remind patients of compliance needs

Being Medication Compliant

With antidepressants and the issues of despondency as a symptom, treatment compliance is often as low as 25% of patients. If only one in four take the medications as prescribed for the duration of treatment, expectations of optimal results in benefits are going to be substantially reduced. While it takes compliance to see the benefits, the adverse effects are usually much easier to see and may even result due to not taking as prescribed, which greatly increases the reports of adverse side effects compared to benefits in real world use compared to controlled clinical trials.

Another common issue is the use of “extra medication” on bad days in desperation to get some effect- much like if taken and aspirin did not fix a headache then taken 2 might. This not only does not gain any benefit from most mental health medications, it ensures that the monthly prescribed amount will not last and results in a constantly changing level of medication ion the system that increases adverse effects and reduces benefit over all.

Maximise the Potential Benefits of your Medications

While the “real world results” as they are often called are diminished by many reports from controlled studies, this is also completely controllable for the majority of patients. Having another responsible household member assist by monitoring compliance is the most effective method. When that is not possible, the use of daily dosage pill boxes, and setting alarm reminders on phones and other devices can dramatically increase compliance among individuals that live alone. Daily semi-skilled care visits are available in some communities or by some agencies which should be considered in some instances.

Feel Better now or feel better always?
Feel Better now or feel better always?

Another area that drastically effects the effectiveness of mental health medications is the use of alcohol or mind altering recreational drugs. Often termed “self-medicating”, the abuse of alcohol and even the often considered “mild” drugs like marijuana have a dramatic effect on the success rate of depression and anxiety medications. Alcohol is a very strong depressant. Drinking a large quantity of depressant measured in ounces and liters is obviously going to limit the effect of an antidepressant measured in thousandths of a gram. With marijuana, one of the most common side effects of usage is paranoia and anxiety, which clearly is not going to benefit anybody being treated for anxiety. People too often sacrifice the majority of their time for the benefit of a few short hours of impaired or altered perception of their situation.

Once again, while this often causes people to proclaim medication to be ineffective for them, the real issue is one of taking the medication in compliance with directions. Honesty with the health care providers can allow them to try to find better formulations if alcohol or drug use is an issue, or may change the risk vs benefit of even prescribing the medication in favor of not prescribing. If use of other substance drastically reduces potential benefits while leaving the same or even potentially increasing the risk of adverse reactions to or side effects from medication, the issue of compliance may make prescribing contraindicated. This can only be determined by honestly answering the provider’s questions about drug and alcohol use.

In the end, not all medications will work for everybody all the time. It is very common to try several different medications or combinations to get the best overall benefit. With full compliance and given a reasonable time period, over 70% of people will experience a significant reduction or even complete relief from symptoms through the use of medication. If compliance is an issue the results will be much lower, and in some cases may make medications completely useless while still leaving serious potential for adverse effects. This must be taken into consideration by both the provider and the patient when making a treatment plan.

 

Part 1-    Using Medication to treat Depression, Anxiety, and Other Mental Health Issues

Part 2 – Side Effects of Depression Medication- Fact vs Fiction

Part 3 – Do Antidepressants Work?

Part 4 – Explanation of common medication classes and the uses

Part 5 – Is it time to come off my medication? Am I cured?

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