This is my term for when a mood-disorder patient is put on a medication, the dosage is raised, then another is tried, the dosage of that one raised, etc., in a fast-and-furious effort to find something — anything — that works. While providers often have good intentions behind putting a patient on the “medication mill,” ultimately, they’re more likely to do harm, than good.

People on the “medication mill” usually get there by being hospitalized, frequently due to a suicide attempt. The worry is that the person needs to have some improvement — soon — if they’re to be allowed to return home. There’s a very real sense, on the part of providers, as well as the patient’s family and friends, that something must be done quick, or all may be lost.

Generally there’s merit to this urgency; but the problem is that, even under the best conditions, it can take weeks for a medication to begin lifting or controlling someone’s mood. Not giving a medication ample time to “do its thing” and begin working, may end up putting off an improvement, as one after another is tried, none of them having been given long enough to do any good.

Look at it this way: Let’s say you are started on a medication. After 1 week, it appears not to work, so the dosage is raised. After another week, it’s still not working, so another medication is tried, repeating the same pattern. This might go on for 8 weeks or even more; but for all anyone knows, the first medication might have worked, had it been tried for a solid 4 weeks.

In psychiatry, giving a medication sufficient time to work is called a “fair trial.” Medical journals decry that providers aren’t allowing for a fair trial for any given drug a patient tries. So in this instance, I’m not the only one pointing out the problems with the “medication mill.”

One factor encouraging the medication mill, is managed care and government-insured medicine. Patients who are covered by managed care or government insurance (Medicare, Medicaid) are often pushed out the hospital doors as soon as possible. These companies and agencies pressure providers into taking chances, in order to get a patient just barely good enough to get out of the hospital. After that, they couldn’t give a damn what happens. All they know is that they aren’t paying a thousand dollars a day for the patient to be in the hospital.

What they fail to figure, however, is the long-term cost. Sure, getting someone improved enough to go home, quickly, is all well and good … but if, after that, they don’t improve much more, they stand a greater chance of relapsing into another depressive episode, and another, and so on.

What’s much better, in the long run, both emotionally for the patient and financially for the bill-payer, is to ensure that patients get “fair trials,” in a safe environment; this way they’ll be less likely to return to the hospital.

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