Twenty Years on the Wrong Medication

You have been taking it since you were thirty-four.

The dose has moved up and down. Two of them were swapped out over the years for something in the same family. Prescriptions have been renewed by four different doctors, in three states, mostly in appointments of about twelve minutes.

Not one of those doctors ever asked why you were on it in the first place. They inherited the answer, the way you did.

How a diagnosis becomes permanent without anybody deciding it should

Somebody made a judgment about you in the nineteen-nineties, probably in under an hour, on the information available that afternoon.

That judgment was written down. From that moment it stopped being an opinion and became a fact in your file, and every clinician who saw you afterward read it before meeting you. This is not negligence. It is how records work, and no one is going to reopen a settled question in a twelve-minute appointment while you are waiting for a refill.

So the treatment is refined for twenty years while the premise underneath it is never examined once.

And you adapt. You will have organized a considerable amount of your life around that word. Career decisions, whether to have children, what you told your husband on the fourth date. It becomes an explanation for things it may have nothing to do with, and being wrong about it for two decades is not a small matter.

A dose gets reviewed every few months for twenty years. The diagnosis it rests on gets reviewed never. That is the wrong way round, and almost nobody notices because the appointments are too short to notice in.

What being on the wrong thing actually feels like

Not dramatic. That is why it goes on so long.

It feels like partial. The worst is held off. You are functioning, you go to work, nobody is worried. And you have not felt genuinely well in a very long time, and you have quietly concluded that this is what well is for you, and that the flatness is the cost of stability.

You will have mentioned it once or twice. It will have been met with a small adjustment, or with the observation that these medications take the edge off both ends, which is true and is also a way of closing a conversation.

I have written before that a great many people I meet are on more medication than they need. This is a different failure with the same root. Nobody has the time to go back to the beginning.

The woman whose life was in ruin

A woman came to me twenty years ago describing her life and her spirit as being in ruin. She had been in treatment for years already.

Inside a year she was properly medicated, her important relationships had settled, and she had started her own business.

That story needs handling, because told carelessly it becomes a fable about a clever doctor spotting what everyone else missed, and that is neither accurate nor useful to you.

What actually happened is duller. I took a history. All of it, from childhood, with her mother on the telephone for part of it. Nobody had done that in twenty years, because a full history takes several hours and no system pays for several hours.

The answer was in that history. It generally is. It was not hidden and it did not require brilliance to find. It required somebody to sit down for long enough to ask.

What I look for when reopening an old diagnosis

The order in which things happened, which is nearly everything. What came first, at what age, and what was going on around it.

What has and has not responded to treatment over twenty years, which is a large body of evidence that nobody has ever assembled.

What the family history actually is, asked properly, because people answer that question badly on a form and well in conversation.

And whether the original diagnosis was made during a period of acute crisis, or after a loss, or in a hospital, when the picture would have looked very different from how it looks across a life.

Two warnings, and I mean both

Do not stop or change anything on your own. Whatever the original label, your body has twenty years of accommodation to that molecule, and coming off badly can produce a genuine emergency. Any change happens slowly and with somebody watching.

And be prepared for the answer to be that the diagnosis was right. That happens often, and it is not a wasted appointment. Knowing that the premise has finally been checked by somebody who took the time is worth a great deal, and several patients have told me that the certainty changed more than a new prescription would have.

What the first session looks like

Long. Two hours or more, sometimes across two appointments, and it will feel excessive compared with what you are used to.

Bring what you can. Old bottles, a list of everything you have ever taken and what happened on each, any records you still have. If a parent or sibling is willing to talk to me about your teens and twenties, that is often the most valuable half hour of the whole process.

An Invitation

If you have been taking something for two decades and nobody has revisited the reason, that is worth one long appointment.

Not to come off it. To find out whether the question was ever properly asked.