It would be really nice if there was one perfect medication for every mental health concern. “Depressed? Just take Happy PillsTM!” Unfortunately, it doesn’t really work that way.
There are many different types of medications, and they all work differently. On top of that, everybody’s brain is different. So is each person’s mental health. The same medication may affect you one way, but have a totally different effect on me!
There’s always some trial and error involved in finding the right medication (or combination of meds). But we do have a pretty good understanding of how certain medications work, and what factors might make them more or less helpful.
Why do medications work differently for different people?
There are many reasons why medications affect people differently.
By far the most important factor overall is which mental health condition you are experiencing. The treatments for PTSD are very different from the treatments for ADHD. (Although some meds do treat multiple different conditions.) Mental health conditions are often misdiagnosed, so getting this right is really important!
Some of the other things that affect the way meds work:
- Your genes: The DNA we inherit from our parents determines lots of things about our brains and body. It’s not just the color of your eyes or the shape of your nose—your genes affect things like which meds will work, how quickly they’ll work, and which side effects you’ll be most sensitive to.
- Allergies: Just like foods, animals, and plants, you can be allergic to medications. Allergies can show up as a rash, hives, a fever, or even anaphylaxis (think of people who have to use an epi-pen when they get stung by a bee).
- Weight: Sometimes, a person who weighs more needs more of the same medication to get the same effect. Some medications are stored in fat cells, and may stick around longer if you have more body fat. 
- Age: As people get older, they often become more sensitive to medications. 
- Other medications: Medications don’t just interact with your body—they can also interact with each other!  For example, some painkillers (like ibuprofen) can increase the levels of lithium in your body. Many people take lithium as a mood stabilizer. Taking lithium and ibuprofen together can be dangerous.
- Other substances: Caffeine, alcohol, tobacco, and recreational drugs can all interact with medications.  Be careful with these substances while you are trying a new medication. For example, some medications make it so that the same amount of alcohol can get you drunk much more quickly.
- Food: When you take a medication with food, it usually takes longer for your body to absorb it. That can be good or bad—some medications should be taken with food, while others should be taken on an empty stomach. Medications can also interact with certain foods, the same way meds can interact with each other. Some medications have a special diet you have to follow while you are taking them. 
- Drinking water: Some medications can cause dehydration. Make sure you drink plenty of water when you use any of these substances.
- Taking your meds consistently. There are some medications that you can take as-needed—for example, if you’re experiencing a panic attack. But most mental health meds need to be taken every day. It will often take at least a few weeks to see an improvement. If you skip days or suddenly stop taking a medication, you can experience withdrawals. Ask your doctor about the best way to take your meds—and what to do if you decide to stop taking them.
What can I do to make this process easier?
The whole trial-and-error process can be frustrating. But there are some things you can do to make it easier:
- Find a treatment team you trust. Some doctors are better than others. Some doctors are great, but don’t know much about mental health. Try to see someone who specializes in mental health. And talk to a therapist if you can—they’ll spend a lot more time with you than a doctor will. That can help with getting the right diagnosis. (Plus, meds usually work better if you’re also in therapy!) If you’re not sure about something your doctor has told you, get a second opinion.
- Ask for recommendations. If you have friends or family members who have experienced similar mental health challenges, ask them about the meds they’ve tried. Of course, your experiences may be very different from theirs. But it’s nice to have a starting point. There are also online support groups where people can talk about their experiences with medication.
- Keep a medication journal. This can be as detailed as you want—if you have the time and energy to track your mood every day, that’s perfect. But if all you can do is write down the meds you’ve taken in the past and anything you remember about how they made you feel, that’s a great start. Some things to keep track of: your mood, your sleep, and any side effects.
- Get your genes looked at, if you can. Your genes can give some clues about how medications will affect you. You doctor can order a DNA test—kind of like 23andme, but for medications! These tests can’t tell you exactly which medication is going to work best, but they can give your doctor an idea of which medications might be more promising—and which ones to avoid. Check out this article for more information on genetic testing for mental health meds.
Above all, be patient and don’t give up! Your mental health is worth it. And remember: medications are just one of the many ways to treat mental health conditions.
- Le. (2020). Drug Distribution. Merck Manual: Consumer Version. Retrieved from https://www.merckmanuals.com/home/drugs/administration-and-kinetics-of-drugs/drug-distribution
- Demler. (2012). Psychiatric Drug-Drug Interactions: A Refresher. US Pharmacist 37(11), pp. HS16-HS19. Retrieved from https://www.uspharmacist.com/article/psychiatric-drug-drug-interactions-a-refresher
- Donovan & DeVane. (2001). A primer on caffeine pharmacology and its drug interactions in clinical psychopharmacology. Psychopharmacological Bulletin 35(3), pp. 30-48. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12397877/
- Chan & Anderson. (2014). Pharmacokinetic and Pharmacodynamic Drug Interactions with Ethanol (Alcohol). Clinical Pharmacokinetics 53, pp. 1115-1136. Retrieved from https://doi.org/10.1007/s40262-014-0190-x
- Desai et al. (2001). Smoking in patients receiving psychotropic medications: a pharmacokinetic perspective. CNS Drugs 15(6), pp. 469-94. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11524025/
- Bushra et al. (2011). Food-Drug Interactions. Oman Medical Journal 26(2), pp. 77-83. Retrieved from https://dx.doi.org/10.5001%2Fomj.2011.21