Although some psychiatric conditions are acute and transient, most are chronic. They may wax and wane, but most of them do not go away. Likewise, psychiatric medications can significantly improve people’s functioning and quality of life, but they manage, not cure, mental illness.

It’s therefore not surprising that a common conversation that patients and psychiatrists have revolves around the question, “Do I have to be on this medication ‘forever’?”

I’ve previously written about how patients, especially those new to taking psychiatric medication, often have negative psychologic reactions to the idea that a pill has helped them to feel “normal.” People want to feel “normal,” but most would prefer to feel this way without having to rely on putting a substance into their bodies.

But, in my experience most patients do accept the trade-off of taking medication to feel better, at least temporarily. However, after a few months many people start to grow impatient. Often they’re no longer suffering from the initial symptoms that brought them into treatment. Understandably, they’re wanting to know how much longer they’re going to have to take their medications.

The answer to this question varies considerably depending on several factors, some of which include the diagnosis, the severity of symptoms, and the person’s own past history. But, quite frequently due to the chronic nature of the patient’s symptoms, my recommendation is for indefinite treatment.

I do my best to work collaboratively with them. I will clearly give them my recommendations, but if they are unsure that they want to remain on their medications (which is almost always their choice), I have an approach that I usually use that some patients have found helpful.

I typically suggest that they think of a time-frame during which they are comfortable staying on their medication. For example, if they can agree to return to see me in three months and not stop their medication in the meantime, then they know that we will be revisiting the issue then. We essentially agree with each other that we will continue to have this ongoing discussion, but after our appointment, we defer discussion of it until the next appointment.

This approach helps to prevent some patients from feeling as though they need to decide now, which usually means between appointments, whether or not they are going to take their medication “forever.” It helps them break this ongoing dialogue (both within themselves and with me) into more manageable chunks of time.

And if I do not use this approach with patients, I have found that when faced with this daunting “forever” decision, many patients decide simply to stop taking medication altogether.

So, if you treat patients in some capacity, consider breaking important decisions about chronic maintenance treatment into smaller chunks of time. I’ve even heard some patients say that they’ve found this approach useful for other non-medication life decisions as well.

Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc.

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