When Mental Health Medications Stop Working, Residential Treatment May Be Your Best Option

Starting medication for a mental health issue can be like taking on a co-pilot. It’s a helpful guide, something to steer you along and keep you functioning. You’re still in control of the flight, but you have assistance. Sometimes, though, inexplicably and without warning, the co-pilot disappears. Warning lights start going off, clanging klaxons and the roar and clambering thuds of turbulence sound all around. You grab the controls, but after so long with help, you’ve forgotten how to fly.

This, sadly, is not uncommon. Mental health medications have been known to often stop working, suddenly or gradually. They no longer have the same effect, and for people who have grown reliant on them, the transition back can be devastating. This is something we see all the time, especially in people who have high-stress, high-level careers.

The medicine, as prescribed, can sometimes work for years. But it doesn’t always last forever, for complicated and not-always-understood reasons. Mental health is rarely a cut-and-dry issue with a quick fix. It is a nuanced and shifting problem, and a full diagnosis—and the full recovery that flows from it—can take time, patience, and professional observation. Many successful individuals feel they don’t have the time for that. But in the long run (and generally in the short term as well) relapses and suddenly-ineffectual medicine are far more consuming and dangerous. You may not want to take the long flight, but it is better than the short path, which flies directly into the swirling storm.

Think of the first time you had a cup of coffee. Chances are, it wired you up extremely quickly. But after getting used to it, you could drink four or five cups every morning and remain placid and unjittery. It’s the same with really any substance: you develop tolerance, and need to increase the dosage in order for it to work. It’s because the brain gets used to it, and incorporates its effects into its chemical makeup. It’s the trapdoor to addiction.

It is believed that there can be a similar effect with mental health medications, especially antidepressants. This is called “tachyphylaxis,” or less scientifically, the “Prozac poop-out.” But whether the name is cute or distancingly scientific, the effect is very real. The sufferer no longer has the help they need, but, unlike with coffee, you can’t just brew another pot. Dosages can’t be dramatically increased.

Why does this happen? There are a few reasons, of which tolerance is the most basic. None of these are ironclad, and none work in isolation from each other. But all can potentially weaken the impact of vital medicine.

• Aging. This is especially true with depression. The American Psychological Association believes that aging can actually worsen depression due to physical changes in the mind. When this happens, the prescribed medicine may no longer be as effective.
• Undiagnosed bipolar disorder. Many people go to their psychologists for depression, but fail to report manic episodes as well. This is common enough, especially among very busy people who just want to get to the solution right away. But many times, co-occurring disorders can be undiagnosed, or the underlying issue can be completely missed. The medicine might help temporarily, but without a complete diagnosis it will almost always fail.
• Stress. This is extremely common among busy careerists; stress can be a trigger for depression, according to the Mayo Clinic. Even if you are already treating depression, an extra and sudden amount of stress can lead to a depression breakthrough event, overwhelming the medicine.
• Substance abuse. Over 50% of people with mental health disorders also suffer from substance abuse issues, and this is very common among people with jobs that are high-paying and very stressful. These substances wreak havoc on the brain, and can possibly prevent it from receiving the medication in the proper way. It’s throwing a wrench into an engine.
• Noncompliance. Possibly the biggest reason, especially if you have been very successful in other stages of life. Once the medicine starts working, many people assume that they are better, and that they no longer need a “crutch,” or only need to take their medication when things are bad. That’s normal, and understandable, but unfortunately also wrong. Not following the medication regimen as prescribed can be even worse than not taking anything at all.

If there is any takeaway from above, it is that medications are an imperfect science. Even if someone is doing everything right, they could just stop working. There is a lot we still don’t fully understand about the complications of neurochemistry—that’s why it can be risky and counterproductive to get a rushed diagnosis, or to follow a medical regimen that doesn’t take every possible issue (such as co-occurring disorders) into account. A quick fix might provide short-term benefits, but those don’t always last.

In a residential treatment center, especially one that understands the specific lifestyle and privacy needs of busy, successful professionals, there is a chance for a more full, more holistic diagnosis. This is holistic in the true sense: it comes about through extended discussion, activities, and observations in a variety of settings. It is also rigorous and scientific: a comprehensive battery of neurological and genetic testing helps a clinic understand what, exactly, is going on in a resident’s mind.

This sort of comprehensive evaluation procedure is vital to understanding what’s really going on with the person suffering from mental disorders, so that the very best behavioral interventions can be used. A long-term stay of 45 days or more is very often needed to really get to the root of the problem, to understand the chemistry, to analyze the triggers, to evaluate a lifestyle, so that a real plan, and not a quick and easily-collapsible fix, can be put in place.

We know that this isn’t easy for people with busy, stressful jobs. They have enormous responsibilities and often feel like they can’t get away. But we see it like this: if a CEO sees a problem in their company, say a lack of qualified middle managers, does she just promote people at random and hope they work out? Or does she stick with someone long after they just stop working altogether? Of course not: that could bring terrible results and make the company suffer far more in the long term. She’d figure out why people weren’t working right, reevaluate the training and hiring process to make sure the best people were found, groomed and eventually put in the right place. That’s the only way to ensure the healthy, long-term future of the business.

It’s the same with mental health. A misdiagnosis, or one that doesn’t take into account other potential disorders, and that fails to account for trigger events, or medicine that stops working altogether, is possibly even more deleterious. Not having the time is no reason for a person not to get the care they need. That time will be saved later on, when you have already reached your destination, and aren’t struggling to fly blind and alone.

Bridges to Recovery offers comprehensive residential treatment for those who struggle with mental health disorders, combining pharmacological solutions with other treatment methods. Contact us to learn more about our innovative program and how we can help you or your loved one start on the path to sustainable wellness.

Lead Image Source: Unsplash user Rodrigo Rodriguez