Is it harmful to go on and off medications for my mood?

By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth

The question:
 
I only want to take medication during more difficult or stressful moments in my life. Is it harmful to go on and off medication for my mood depending on how I’m feeling?
 
The answer:
 
It really depends. It depends on what medications you are taking; on their intended usage; on how you do when you are off the medications; and on your long-term personal and health goals. Your medication usage should always be discussed with an appropriate professional (family physician, pharmacist, or psychiatrist).
 
The first consideration is the class of medications. Certain medications (anxiolytics, sleeping medications) are intended for short-term, as-needed usage (listed as “prn” on the prescription). They are often medications that lead to increased tolerance over time and as such it is generally recommended that you only take them when needed. Other medications (antidepressants, mood stabilizers, antipsychotics) are intended for longer-term (at minimum several months usage). Going on and off these medications impacts their effectiveness, as it often takes weeks for the medication to build up in the body to what is called a therapeutic or effective level.
 
The intended or prescribed usage of a medication is also important – for example, an antipsychotic when used to target psychotic symptoms needs to be taken daily to be effective. An antipsychotic medication in low dosages may also be prescribed for sleep, and as such daily usage may not be necessary. It is vital that you speak to your doctor or pharmacist about the usage.
 
Pay attention to how you do when you are on versus off medications. When you have gone off medication in the past, do you feel better and are side effects lessened? Does your mood remain stable? Or does mood become worse, is quality of life lessened, and is there an impact on your ability to carry out other day-to-day functions and obligations?
 
Consider your longer-term personal and health goals. Is your ultimate goal to try to remain off medications? Are you trying to get pregnant? Do you have other health considerations that may be negatively impacted by the medications you are taking? All of these are important factors in your bigger-picture decision-making .
 
Be mindful that no medication is benign. All prescription medications have an impact on important organ systems, with heart, kidney and liver being the main body systems affected. Side effects are significant for many medications. And, most medications result in increased tolerance over time and associated withdrawal symptoms when one attempts to reduce or stop usage. Many people are also able to effectively manage mood in the long-term without medications – through diet, exercise, sleep hygiene, and use of other evidence-based, non-pharmacological interventions (e.g., cognitive behavioural therapy).
 
Ultimately, most of us continue to engage in a behaviour if the overall benefits outweigh the cons, and as such your medication usage needs to be a decision that is informed by multiple factors, including candid and informed communication with your treatment providers.

Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail.