Areas › Worry and anxiety › Treatment and medication
The dose that lifts low mood is often not enough for anxiety, and for obsessive symptoms it is usually well short. Needing more of it is a feature of the problem rather than anything wrong with the person taking it.
This matters because a fair trial of something has to include a fair dose. A person can spend eight weeks on a starting amount, decide the medicine does nothing for them, and never once have reached what their symptoms actually needed. Before writing something off, it is worth asking whether it was ever taken high enough for long enough.
This explains how treatments work. Never start, stop or change a medication because of something you read here.
Qur’an and Sunnah
God wants ease for you, not hardship (Quran 2:185). The aim is relief, so the amount of a remedy is set by what actually relieves.
شَهۡرُ رَمَضَانَ ٱلَّذِيٓ أُنزِلَ فِيهِ ٱلۡقُرۡءَانُ هُدࣰ ى لِّلنَّاسِ وَبَيِّنَٰتࣲ مِّنَ ٱلۡهُدَىٰ وَٱلۡفُرۡقَانِۚ فَمَن شَهِدَ مِنكُمُ ٱلشَّهۡرَ فَلۡيَصُمۡهُۖ وَمَن كَانَ مَرِيضًا أَوۡ عَلَىٰ سَفَرࣲ فَعِدَّةࣱ مِّنۡ أَيَّامٍ أُخَرَۗ يُرِيدُ ٱللَّهُ بِكُمُ ٱلۡيُسۡرَ وَلَا يُرِيدُ بِكُمُ ٱلۡعُسۡرَ وَلِتُكۡمِلُواْ ٱلۡعِدَّةَ وَلِتُكَبِّرُواْ ٱللَّهَ عَلَىٰ مَا هَدَىٰكُمۡ وَلَعَلَّكُمۡ تَشۡكُرُونَ
It was in the month of Ramadan that the Quran was revealed as guidance for mankind, clear messages giving guidance and distinguishing between right and wrong. So any one of you who is present that month should fast, and anyone who is ill or on a journey should make up for the lost days by fasting on other days later. God wants ease for you, not hardship. He wants you to complete the prescribed period and to glorify Him for having guided you, so that you may be thankful
Qur’an 2:185read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
There is a review of what to do when a first medicine has not worked in anxiety, and it found the evidence for adding a second drug limited and mixed, with no strong case for any particular combination. Adding is the move people reach for, and it turns out to be the one with the least behind it. Getting more out of what is already there has not been proved better either, but it is simpler and cheaper to check first.
Ipser JC, Carey P, Dhansay Y, Fakier N, Seedat S, Stein DJ. (2006). Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders.. The Cochrane database of systematic reviews doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
You cannot judge a treatment until it has been given at the strength the problem needs.
When not to
Dose changes belong to the prescriber, so this is a question to raise with them rather than something to act on.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
If you do not know how much of something you are taking, you cannot tell whether it is helping you. That is the honest problem with most calming products bought off the shelf, quite apart from whether the ingredient works.
Sedatives are good at damping the body down and much less good at quieting a mind that keeps going round. If the trouble is chronic worry, being made drowsy is not the same as being helped.
Something that settles a surge of panic within minutes and something that changes how often the surges come are doing two different jobs. A person can need both, and it helps to say which is which.