Reasons Medications Fail

Psychotropic medications must be tried for a sufficient length of time and under appropriate psychiatric supervision. However, traditional antipsychotic medications fail initially about two-thirds of the time, requiring a change in treatment strategy. A psychiatrist may determine that a particular medication is ineffective because symptoms do not improve, side effects are intolerable, or relapse occurs (Leucht et al., 2003). Initial medication failure decreases to about 50% of the time when atypical, second-generation medications are prescribed. According to Conley and Buchanan (1997), a systematic approach to the evaluation and characterization of treatment resistance is increasingly important. Since the introduction of many new drugs, consumers are more likely than ever to be prescribed a variety of psychotropic medications if the first one tried does not work well. The need for accurate evaluation will continue to increase as even more new medications are intro duced. Psychiatrists facing the decision of when to change from one medication to another must clearly understand the appropriate length of a trial and what target symptoms respond to a particular medication in order to maximize the response in persons with treatment-resistant symptoms.

The medication challenges for both the physician and the individual usually revolve around a number of questions. First, which psychotropic medication will be most effective? Second, what dosage is needed to be effective, while at the same time not putting the person at unnecessary risk for side effects? Third, how does one cope with the long-term need to take pills regularly, possibly accompanied by frequent blood tests required for certain medications such as lithium (a mood stabilizer) and clozapine (an antipsychotic medication)? Further complicating matters, even if the right medication is prescribed, there is always some risk of symptom exacerbation and relapse.

Conley and Buchanan (1997) provided several additional reasons why people with schizophrenia have a poor response to various psychotropic medications:

• Partial compliance of person with the treatment regimen

• Inappropriate dosing or length of trial (most medications require 4 to 6 weeks to determine efficacy)

• True resistance of the disorder to the medication, simply using the wrong medication to try to bring about a therapeutic effect.

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