The Limits of Medication

Prescription treatment for mental health conditions can often be helpful. Depending upon the symptoms, medication is sometimes a necessity, but medication alone often has significant limitations.

Generally speaking, most psychiatric medications serve to safely improve symptoms of mental health conditions to some degree. Unfortunately, without a well-rounded approach to diagnosis and treatment in addition to medication, overall outcomes are seldom great. Without adjunct therapeutic treatment, medications may leave a large gap of unimproved symptoms and suffering. Medications also do little to reverse the poor habits and behavioral patterns common to many mental conditions, which have built up over time. This is where the CNS concept of multi-faceted care comes in: in addition to traditional care, we carefully assess each individual’s overall functioning and specific areas of need; our treatment team then creates a plan to target improvement in each area.

Whatever the diagnosis is, if medication is warranted it is usually only a part of the solution.

In a recent, national study on the treatment of depression (STAR-D), the results showed:

  • After the doctor prescribed the first anti-depressant, only about 35% of patients had significant improvement.
  • For those who did not respond, when the doctor switched to a different prescription, a total of about 60% of patients showed significant improvement.
  • Further attempts with different prescriptions resulted in only modest improvement.
  • Ultimately, nearly 40% of people with depression did not improve with medication. Even among those individuals for whom medication was effective, there remained many unimproved residual symptoms.

Another example of the limits of medication can be seen in patients with bipolar disorder.

  • The majority of individuals with bipolar disorder, roughly 70%, need multiple medications (sometimes 2, 3, or even more) to maintain their health. Even with multiple medications, people with bipolar disorder require supportive therapy to optimize coping skills and functioning.
  • Students with bipolar disorder often require educational accommodations or the help of educational consultants in choosing an appropriate school environment.

ADHD medications also have their limitations:

  • One common class of medication treatments results in only 30-50% improvement rates;
  • Another type of medication results in approximately 50-70% improvement rates;
  • A third class of treatment results in 70-90% improvement, but can lead to more adverse side-effects.
  • Importantly, there are symptoms that typically do not respond well to medication. For example, even with the highly effective drug treatment options, hyperactivity does not tend to improve as much as inattention. Certainly, none of these medications do anything to reverse the problematic habits that have built up over time: the poor study or work habits, explosive fights in relationships, and nonexistent time management skills.

As can be seen in our “Science of CNS” webpage, the use of non-medication therapies in combination with medication and traditional care, results in better outcomes for individuals struggling with these difficult conditions. Better outcomes lead to better functioning, more overall improvement, and sometimes, less need for medications over time.