Are My Meds Working Really Well or Do I No Longer Need Them?

Medications, along with psychotherapy, healthy activities, and other interventions, can make a lot of people feel better. This is obviously a good thing, but after some time can set up an important but difficult question. When someone is taking medications and feeling back to normal after a period of months or even longer, a logical question often arises: Am I feeling better because these medications are working really well, or because they are no longer needed?

Getting an answer to this question can be very challenging. Some people try to make that determination by observing how they feel on days they miss a dose or two, either by mistake or on purpose. For some medications, like stimulant medications used for ADHD, this can provide some useful information. For other medications, however, like antidepressants, how you feel after a missed dose often does not reflect your actual baseline but can be related to “discontinuation” symptoms, both physical and emotional, that can occur from stopping a medication abruptly. Some medications can actually be dangerous if stopped suddenly, so it's advisable to talk to your clinician (I really dislike the term “prescriber,” so don’t use it) before taking any “drug holidays,” even briefly.

There can also be real value in a conversation with the clinician who prescribes your medication about the question of whether to continue the medications or to attempt a slow taper to see if they might no longer be needed. I have this discussion a lot with patients and families and, as clinicians, we welcome it. As mentioned, it can be a tough call. In trying to make a collaborative decision, there can be many things to consider such as:

1. The diagnosis
2. How bad the mental health problems were initially
3. Whether or not there are any current side effects
4. Possible long-term risks of continuing the medication
5. Cost and convenience.

There is an inaccurate stereotype out there about psychiatrists as people who “push” medications on people. In my experience, I’ve actually found that I encounter more hesitancy from patients when it comes to cutting back on medications than there is from starting or continuing them. This is quite understandable: people don’t want to go back to the level of suffering they or their child have felt. At the same time, people can give medications more “credit” for their improvement than they deserve. There are many reasons folks no longer need medications. Sometimes, the natural course of a condition has passed. Sometimes, a person’s life situation and level of stress has changed. Sometimes, a person has developed new skills and capacities, either through deliberate work in therapy or just through regular development and maturation.

In many cases, it is reasonable to attempt to slowly cut back on medications, often going one at a time by reducing the dose slowly over a period of weeks and even months. Often, these tapers are successful. Sometimes, they aren’t, and we need to reverse course, which can provoke a feeling of having “failed” the attempt. It’s not, however, a failure, but rather simply an indication that someone still needs the medication, for now. Most of the time when a medication is put back a person returns to feeling better again, but it is not a guarantee, and something to consider in the decision-making process.

The bottom line here is that people who take mental health medications and benefit from them can and should wonder about how long they are necessary. The answer, no surprise, can be very different for different people, and the research that exists on this important topic often falls short of providing specific guidelines. If you or a loved one are in this situation and wondering what to do, an open conversation with the person prescribing your medication is often the best next step.