Why do I have to take medication everyday? I want to take my medication as needed!

I’ve found that most people really want prn or as needed medications to treat their medical conditions. I feel yah. I’d prefer prn meds and not having to take a medication everyday too. Unfortunately, medications were really designed to be taken on a consistent basis, especially antidepressants like SSRIs and SNRIs. Does that mean I think we should manage psychiatric conditions as a permanent chronic illness? No, but it’s what we have access to for right now.

I do think that there are some exciting new treatments coming out that will likely be needed prn more often than taken as a daily medication. Some examples are: ketamine, zuranolone, brexanolone, d-cycloserine and maybe even nitrous oxide (laughing gas)! These medications eventually work on glutamate and cause synaptogenesis way faster than our old world antidepressants. One of the reasons why we avoided glutamate previously was side effects!

Glutamate is the dominant neurotransmitter in your brain. So if you have a medication that works with it, you’re immediately impacting a lot of things. That means it has the potential to be super impactful in treatment AND side effects. For example, hallucinations with medications like ketamine, LSD, psilocybin, MDMA are all very possible. Many psychiatrists are questioning, do you need the trip for these meds to work? The answer is perhaps, but alternatives like brexanolone or zuranolone may offer some of the same benefits without the side effects.

It’s literally a brave new world out there for psychiatric medications. Of course, all of these medications come with ethical considerations and more. For instance, what does it say about me that I recommend someone take a SSRI for the rest of their life? That’s a lot of utilization of healthcare dollars and potential profit for companies. Conversely, if I make a recommendation like ketamine that comes with its own set of risks and concerns.

What’s most important to me is that my patients feel empowered by their treatment and supported in their decisions. What’s most important to you? The consistency of a daily medication or the flexibility to take something as needed?

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