When Your Psychiatric Medication Doesn't Seem to Be Working

You started a medication hoping to feel better. Weeks have passed, and you are not sure anything has changed. Or maybe it helped at first and now seems to have stopped working. Either way, it is discouraging, and it is easy to start thinking that nothing will help.

That conclusion is understandable, but it is rarely the whole story. Finding the right treatment often takes some adjustment, and there are many reasons a medication may not be doing what you hoped. This article walks through the questions you and your prescriber can explore together. It is general information, not a substitute for a conversation with your own prescriber.

First, give it a fair look

Many psychiatric medications take time to show their full effect, often several weeks, and sometimes longer. Some people notice early improvements in sleep or energy before their mood lifts. Others notice changes gradually and only see them clearly when they look back.

Your prescriber can tell you what timeline is typical for your medication. If you are not sure whether enough time has passed, ask. Tracking your mood, sleep and symptoms in a simple daily log can also make subtle changes easier to see.

Questions your prescriber may explore

When a medication is not working as expected, prescribers often look at several possibilities. You can help by thinking about these ahead of time:

Is the medication being taken consistently? Missed doses are very common, and they can make it hard to tell whether a medication works. Busy schedules, forgetfulness, side effects, cost or mixed feelings about medication can all play a part. Honesty here is important and will not get you in trouble.

Is the current plan the right fit? Sometimes an adjustment to the plan is needed. That decision belongs to your prescriber, based on your response, side effects and health.

Are other medications or substances interfering? Other prescriptions, over-the-counter products, supplements, alcohol, cannabis and nicotine can affect how some psychiatric medications work.

Is something else contributing? Physical health issues such as thyroid problems, anemia, sleep apnea, chronic pain or hormonal changes can cause or worsen symptoms like fatigue, low mood or poor concentration.

Is the diagnosis complete? Sometimes symptoms that look like one condition are partly explained by another, such as depression that occurs within bipolar disorder, ADHD alongside anxiety, or trauma underlying sleep and mood problems. A fresh look at the full picture can be valuable.

Has life changed? A new job, a loss, a breakup, financial strain or a move can increase symptoms even when a medication is doing its part.

Options that may follow

Depending on what you and your prescriber find, next steps might include:

• Waiting a little longer if it is early and there are signs of partial improvement
• Adjusting the current medication, as determined by your prescriber
• Switching to a different medication, often with a planned transition
• Adding another medication to support the first
• Adding or changing therapy, since approaches like CBT or DBT can help with patterns medication does not reach
• Pharmacogenetic testing, which in some situations can add information about how your body may process certain medications
• A higher level of care, such as an intensive outpatient program, if you need more structure and support than weekly visits provide
• Other treatment options for depression that has not responded to several medications, such as SPRAVATO® (esketamine), for adults who meet the criteria

Not every option will fit every person. Your prescriber can explain which ones are reasonable for your situation and why.

What not to do

When you are frustrated, it can be tempting to take matters into your own hands. Please avoid:

• Stopping your medication suddenly. Some medications can cause discontinuation symptoms or a return of symptoms when stopped abruptly.
• Taking more than prescribed. More is not always better, and it can be dangerous.
• Adding someone else's medication or a supplement without checking. Interactions can be serious.

Bring your frustration to your prescriber instead. Saying "I don't think this is working, and I'm feeling discouraged" is a perfectly good way to start the conversation.

How to prepare for the conversation

Before your appointment, jot down:

• When you started the medication and any changes since then
• Which symptoms, if any, have improved and which have not
• Any side effects
• Any missed doses
• Other medications, supplements or substances you use
• Changes in your health or life
• What matters most to you in treatment, such as sleeping better, getting back to work or feeling less numb

If you have tried other medications in the past, a list of names and what happened with each one is especially helpful.

Take care of hope, too

Living with symptoms that are not improving can wear down hope. It may help to remember that a medication not working is information, not a verdict on your future. Many people need more than one try before finding an approach that fits.

If you feel hopeless, have thoughts of suicide or self-harm, or feel unsafe, please reach out now rather than waiting for an appointment. Call or text 988 to reach the Suicide and Crisis Lifeline. If you are in immediate danger, call 911 or go to the nearest emergency room.

Support for the next step

At SOS Wellness, our psychiatrists and psychiatric nurse practitioners provide medication management with ongoing monitoring and adjustments, and our services also include therapy, pharmacogenetic testing, intensive outpatient programs and SPRAVATO® treatment. If you are in Ohio and want a fresh look at your treatment plan, you can request an appointment or contact us to talk through options.