Peeling The Onion–More Is Not Always Better

Once again . . . I find I am on the receiving end of another doc’s desperate attempt to control symptoms.  The layering of medicine on top of medicine is an inherent problem in Western Medicine.  After all, we are spending more and more of our hard earned dollars to go to see someone for a problem.  And when we go we expect that SOMETHING MUST BE DONE!!!  The docs on the receiving end of this mentality are at a distinct disadvantage.  We get a limited amount of time with any particular patient and the patient is typically pushing for a solution . . . often a medicine that will provide for a quick fix to the problem.  And who doesn’t want a quick fix.  Who the hell wants to wait to get better?? But how often does the addition of yet another medicine make the huge difference?  Not often enough.  It is worse when certain common-sense guidelines are not followed.

Here are a few that I try to keep in mind:

Common Sense Guideline #1:  Receptors are receptors . . . If one medicine ain’t doin’ it, adding another with the same mechanism ain’t gonna do it either.  An example of this (one that I see all too commonly) is the addition of multiple SSRIs.  For example . . . if someone is taking Lexapro (a standard SSRI) you DO NOT add another SSRI (Prozac, Zoloft etc.).  Doing that can not only be a waste of time . . . it can be dangerous.


Common Sense Guideline #2:  Long enough and high enough . . . Many of these medicines take a while to have full effect.  Starting someone on a medicine then switching it in a few days or a few weeks because it is not working is counterproductive.  This often happens in the hospital because of a severe lack of time to get people better before discharging them, but just as common in the outpatient world, too.  This is especially true with antidepressants that can take several months to take full effect.  I really DO understand that it sucks to be depressed, but the medicine takes time.  The exception to a quick switch is, of course, intolerable side effects.  Side effects can minimize over time, but if they are bad enough, it will get in the way of compliance and a medicine not taken is not really likely to work.


Common Sense Guideline #3:  It ain’t all about the medicine . . . If you are waiting for the magic pill to dispel all feelings of anxiety, depression, confusion and uncertainty . . . you are going to be waiting for a long, long time.  The key to medicine working is often the ancillary interventions that help support it.  Exercising your body . . . exercising your mind . . . exercising your spirit . . . all play a role in recovery from any mental health issue . . . and play a role in remaining mentally sound.

So with my patient who is on four . . . yes four . . . antidepressants and three . . . yes three . . . mood stabilizers . . . it will be a long and slow process of tapering some of these medicines, and trying to guestimate the logistics of this, so that he gets some relief from the side effects of way too much medicine, but still gets the chemical support that he likely needs for now.  The longer I am in this business, the more I understand the limitations of what medicine has to offer.  They can be lifesaving and profoundly beneficial, but they must be used intelligently and sensibly, and within the context of a comprehensive plan of intervention that includes treating body, mind and spirit.  Only then can the truly beneficial results of treatment be manifest.

–Dan Hartman, MD

Leave a Reply