How Doctors Think About Medication

This article is written primarily from Robin’s general perspective as a family physician.  It is NOT medical advice.  You need to talk with your own doctor about your specific situation.  This is just a framework for understanding medication.

We’re going to do a series on medication.  We are not “pro” medication or “anti” medication.  We are in favor of each person living their best life.  For some people this means with medication and for some people it means without medication.  

Robin has asthma.  Without medication she can’t run or play tennis and she coughs all night.  With medication you can’t tell she has asthma unless the air quality is bad or she has a cold.  For Robin, her best quality of life is DEFINITELY with several daily medications for her asthma and allergies.  

Charlie seems to have inherited some of her reactive airways and Eleanor inherited pretty annoying allergies–but both of them do well without medication most of the time.  Eleanor uses saline rinses sometimes and Charlie uses an inhaler once every few months, but Eleanor’s allergy symptoms are only mildly annoying and don’t bother her as much as having to take medication every day.

Today’s post will cover how doctors think about medication so that everyone can understand each other a bit better.  When people say they don’t believe in medication or have expectations for medication that don’t match reality, doctors often don’t know how to explain.  So let’s talk about it here.

Today We’ll Discuss:

General Categories

The dosing of some medications is very easy.  Antibiotics will have a set amount of time you’re supposed to take them depending on your diagnosis and the antibiotic.  For example, you might take 500mg of amoxicillin three times a day for 10 days.  Easy peasy.

It gets more complicated when we start talking about other classes of medications for other conditions. We’re going to lump them into two main categories: medications used to treat numbers and medications used to treat symptoms.

Medications Used to Treat Numbers

A medication used to treat numbers would be something like a high blood pressure medication, cholesterol medication, or blood sugar medication.  With those, we know whether or not they’re working based on your numbers.  What’s you blood pressure?  What’s your cholesterol?  What are your blood sugars?  

For those medication, you typically will start medication when lifestyle changes aren’t working.  That doesn’t mean that you’re somehow a bad person or lazy.  Part of it is genetic, part of it is lifestyle, and part of it is due to less tangible factors like childhood trauma or your mother’s health when she was pregnant with you.  

How We Were Raised Sticks With Us

Also, be kind to yourself.  If you were raised in a family that ate a lot of fruits and vegetables and exercised regularly than that sort of lifestyle will be a lot easier for you, not because you’re a better person, just because of the family you were born in.  If your family lived a different way, it’s not your fault that it’s harder for you.  

They’ve done studies on mice that demonstrate this really clearly– Robin remembers one in particular that she read about years ago and we can’t find to cite it.  They raised one group in a healthy mouse environment (good food, cuddly beds, exercise wheels for running, ramps for climbing, toys) and another group in an unhealthy mouse environment (bare of anything fun or interesting to do).  Then they opened things up so mice could access either environment.  Mice raised in the healthy mouse environment never bothered to go into the deprived environment.  Mice raised in the deprived environment went back and forth between them but preferred the improved environment.  But when the mice were stressed (for example, when a researcher banged on the cages), the mice RAN BACK TO WHERE THEY WERE RAISED.  So the mice who were raised in an environment without exercise wheels or cuddy beds ran right back there.  

Don’t we do the same thing?  How many of us learned to comfort ourselves with food as children and do it as adults when we’re stressed?  Or watch TV instead of exercising?

It’s good to make changes, especially so that your children have a different start in life, but also give yourself grace.  Robin is going to need to start blood pressure medication in the next few years because she’s reached the limit of what she thinks she can reasonably do.  She’s exercising as regularly and intensely as she’s willing, she’s eating pretty healthy.  She could definitely do better but at this point in her life that’s just not reasonable. That’s okay.  It’s not giving up; it’s doing what’s best for her body so that she doesn’t end up having a heart attack or stroke due to high blood pressure.  It’s okay to do that.

As far as coming off those kinds of medications, that again depends on the number.  It’s not that if your numbers are normal you come off of it.  That would be lovely, but that’s not how it works.  If your numbers are normal on medication then they will be too high off medication.  It’s only if your numbers are so good and you’ve made some other changes in your life such that your clinician thinks that your body can maintain good numbers without medication that you’ll start weaning off and monitoring numbers to see how it’s going.  If your numbers are merely perfect while you’re on medication, that just means that the medication is doing its job.  That medication is there to keep those numbers perfect.  

Medications Used to Treat Symptoms

The other type of medication is medications that treat symptoms.  This can be anything from asthma and allergy medications, to depression and anxiety medications.  While there are some objective measures (for example, pulmonary function testing for asthma or functional imaging of the brains of people with ADHD), these usually aren’t available to use for routine monitoring and they certainly aren’t used to decide whether to start medication and the dosing.  The important factor is how your symptoms are affecting your life.  That’s often a lot harder for some people because it’s somewhat subjective.  

Robin’s own experience is that she was diagnosed with asthma as a young adult.  She had spent her childhood thinking that she was lazy and out of shape and that it was all her fault that she was short of breath.  It took her a long time to accept the fact that her symptoms were real.  That also happens to people with depression, anxiety, ADHD, or other conditions that can’t be objectively measured.  It’s important to know that your symptoms are real and they are worth treating.  Your quality of life is important.

Are Supplements Better?

Treatments can be medications or lifestyle or supplements.  Supplements are just as much medications as medication so don’t feel like you’re somehow avoiding medication if you’re taking a handful of supplements!  Your goal is exactly the same–to feel and function better.  And there’s nothing more natural about taking a pill of something from the supplement section than there is about taking a pill of something from the pharmacy.  In fact, Robin has multiple times seen far worse liver damage from supplements than she’s ever seen from prescriptions–in fact the only time she’s seen permanent liver damage from a medication made by a pharmaceutical company was a person who intentionally overdosed.  

The Goal of Treatment

The goal is not “to avoid medication” or “to get off medication.”  The goal of my asthma medication is not to get off of it.  The goal of Robin’s asthma medication is to hike and bike and do all the fun things she loves to do.  If her asthma symptoms prevent her from doing those things, it means she needs to adjust her medication.  Or if she’s doing great and she and her doctor decide to take her off the medication and she does worse again, she needs to get back on.  That’s okay.

Medication for depression, anxiety, ADHD, or other struggles is very similar.  The goal is not to get off the medication; the goal is to do well.  So it’s very important to stay on your treatment plan until you and your trusted clinician decide together that it’s time to change.  And you may not decide to change.  Once Robin starts blood pressure medication, she’s planning on staying on it for the rest of her life because she’s planning on NOT having a heart attack, stroke, eye damage, or any of the other things untreated high blood pressure can cause. 

In the same way, we have family members who are planning on staying on their antidepressant or anti-anxiety medication for the rest of their lives.  Because their life plan is to enjoy life, be productive, have fun, and do all the things they can do when their depression and anxiety symptoms are under control.  Some people are able to get off their their medication.  That’s more likely to happen when they can get the support they need and make the lifestyle changes necessary to improve their symptoms in other ways.  Once you’ve had three or more bouts of a problem, it’s more hard-wired into your brain and you’re less likely to be able to successfully stop medication.  And that’s okay.  Remember what your goal is!

When it’s time to stop your medication, it’s important to do that in partnership with your clinician. That could be your doctor or therapist, but it has to be someone monitoring you closely.  The reason is that if you go off your medication and your problems come back, you want someone who can help you get back on medication.  The very nature of depression, anxiety, ADHD, and other conditions is that when they are getting bad, they make it harder for you to get help. So have that help already built in.  Whether or not you go back on medications or stay off medications is fine so long as your symptoms are managed and you’re living a full life and able to do what you want and need to do and able to truly enjoy yourself.  

Most people agree it’s a terrible idea to go on and off medication repeatedly because you’ll be getting all the problems of starting and stopping and only a fraction of the benefit of a stable and well-adjusted dose.

Coming Up

In the future we’ll be discussing language around treatments and why it’s important as well as ways to make sure you remember to take any supplements or medication you’ve been prescribed.

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