Question: I have been on the same four medications for years. I am happy to say that I have been doing well and am back to work. I hardly even think about my symptoms unless it’s time to see my psychiatrist once every 6 months, or go and get a refill.
My girlfriend and I are getting pretty serious. I felt I had to tell her about my meds and why I take them. I am on two antidepressants and two medicines for anxiety. She was OK with it. She called it a “medication cocktail.” I’ve heard that before, and I figured it just means a combination of medicines that works well together. But then I started wondering why I have two of the same kind of medicine? Wouldn’t one of each be enough?
Anne Fenton, MD: My patients often ask me this question, and it is an excellent one. There are several reasons that people are given more than one medication for the same condition.
Sometimes, people respond only partially to one medication and need to enhance it with another of the same kind. Sometimes, they might have a partial response to a certain medication at a certain dose but can’t tolerate the side effects of a higher dose. Adding a different medicine helps achieve a better response without added side effects.
We often try after a while to streamline the “cocktail” by eliminating apparent duplications. However, this is easier said than done. One reason is that, even though more than one medication, (like your antidepressants), treat the same condition, it does not mean that they treat it in exactly the same way. And even medications which are in the same “family” have differences in chemical structure which offer different benefits.
We tend to “lump together” a variety of symptoms into one word that describes the overall condition, like “depression”. We forget that behind the general condition may be several different mechanisms that are going on in the brain. You can see how one medication alone may not always provide the best treatment for a condition that represents more than one symptom, or is caused by more than one change in the brain’s chemistry.
In many cases, the balance created by a combination of medications in the system seems to provide a benefit beyond that of any individual medication. This may be akin to the adage that “the sum is greater than its parts”. If we tamper with that balance, we often find that symptoms recur. It appears that the balance itself is an important factor not only for achieving, but also maintaining emotional stability.