Given the volume of e-mails I receive weekly, it is increasingly apparent to me that far too little information regarding the length of use of certain psychotropic medication classes is being transmitted from the prescriber to the patient.
Length of use is important because inevitably, medication bites back. And when I say drugs bite back, I’m not referring to initial side effects – which are part and parcel of every medication ever to make it to market, to some extent. Instead, I’m referring to a lack of observable efficacy or ramifications of long-term use, as evidenced by messages stating that the medication “isn’t working as it used to” or “I’ve recently developed a tic or other involuntary adverse event that I’ve never had before.”
Here’s the down and dirty when it comes to psychiatric medication. In the VAST majority of instances, the dose, the frequency of use or even the initial medication(s) employed will have to change such that the user will continue to derive the results intended in the first place. And that beat will go on and on.
People writing me with any of the issues I’ve outlined above often approach medication use with a sort of blind faith. The drug is prescribed, often without a clear rationale, the patient takes it, often not knowing what to expect from it, the prescription is refilled and this process merely repeats itself with the patient eventually becoming dissatisfied with something.
Much of this could be circumvented if the purpose for prescribing the drug would be adequately explained by the prescriber, along with a discussion regarding length of use. And patients should take it upon themselves to inquire about alternatives to drug use – which are most always available to them.
When a prescriber presents a prescription to a patient, there’s a contract, so to speak. The prescriber writes the order and the patient agrees to try the medication. Too often though, communication regarding the terms of the contract are inadequate, leaving the patient vulnerable to the vagaries of medication use.
Every medication “buyer” should be aware of this and ask clarifying questions when the prescription is originally generated, with a mindset of taking the medication(s) for a specified length of time and an eye on other ways to address the problem at hand.
