When does increasing medication stop helping and start getting in the way of real healing? How can using less medication actually lead to better emotional balance and long-term outcomes? What role should medication play alongside therapy, relationships, and personal growth?
This article examines how the long-standing belief that “more medication is better” emerged in mental health treatment—and why that mindset is increasingly being challenged. By explaining the concept of the therapeutic window, this piece shows how medication is most effective when carefully calibrated, rather than pushed to eliminate every uncomfortable emotion. Too little medication can leave people suffering, but too much can dull emotional range, motivation, and connection, quietly undermining recovery.
Rather than rejecting medication, this blog argues for a more precise, collaborative approach that treats it as one tool within a broader ecosystem of healing. When medication is used thoughtfully—as a bridge that supports therapy, self-awareness, and meaningful engagement with life—it can restore function without flattening the human experience. In many cases, less medication allows people to feel, relate, and grow in ways that lead to more sustainable, authentic recovery.
“Annihilation.” It’s not a particularly nice word, is it?
But for decades, this word underpinned how medical practitioners would prescribe medication for mental health problems. The goal of prescribing a medication was the annihilation of the symptoms. Frankly, it’s a fairly blunt approach that boils down to: “if a medication helps, then more must help even more.”
Back when I was in training, an attending referred to it in how he was trained to use antipsychotic medications. It’s a mindset inherited from earlier eras of psychiatry, rooted in good intentions. But today, with everything we now understand about the brain, emotions, and how to process psychiatric pain more sustainably, it’s increasingly misaligned with the goal of achieving ongoing progress with mental health.
This isn’t to demonize medication. It remains a potent tool in our toolbox for providing mental health care.
But it’s just one tool in the toolbox, and is best deployed in concert with the other tools we have at our disposal. That’s what this piece will explore, with the hope that you’ll gain a better understanding of why the “more is better” approach to medication has evolved into something more personalized, tailored, and patient-centric.
Medication remains one of the most powerful tools in modern mental health care. It can reduce suffering, restore stability, and create the conditions for meaningful change. But like any tool, its value depends on how it’s used. In reality, medication works best within what clinicians call the therapeutic window—the specific range where it alleviates symptoms without introducing side effects that undermine the very life the patient is trying to reclaim.
The challenge is that for years, treatment culture has leaned toward the opposite: pushing medication dosages upward in the hope of extinguishing distress entirely. But mental health is not a fire to be put out at all costs; it’s a system to be balanced with care, precision, and respect for individual differences. The result is a growing recognition that, in many cases, less medication—not more—produces better and more sustainable outcomes.
This shift isn’t about rejecting medication. It’s about using it intelligently, intentionally, and in harmony with the broader context of a person’s life.
Understanding the Therapeutic Window
Medication remains one of the most powerful tools in modern mental health care. It can reduce suffering, restore stability, and create the conditions for meaningful change. But its true value depends on how it’s used.
How it’s used depends on something called the “therapeutic window.” This concept refers to the specific range where it helps alleviate symptoms while simultaneously not introducing side effects that make it harder for the patient to regain the lifestyle they are trying to reclaim.
But influenced by our desire to solve problems quickly (and perhaps a lessening of patience among us all), treatment culture has leaned toward increasing medication dosages in the hope of completely extinguishing distress in a fairly rapid fashion. The reality doesn’t quite work like that. That’s because mental health is a system to be balanced with care, precision, and respect for individual differences. Yes, it takes longer to achieve these outcomes. But the result is a growing recognition that in many cases, this approach produces better, more sustainable outcomes for the person seeking help.
The therapeutic window is where every medication does its best work. The non-medical way to think of it is as “the sweet spot” between too little and too much. It’s not a concept that only appears in pharmacology, either. Even essential substances like water, oxygen, or vitamins follow the same principle: they’re helpful within limits, but harmful beyond them (Yep, even water! Too much and you’ll damage your kidneys).
With psychiatric medication, the stakes can be higher because the known effects involve impacts on mood, cognition, and emotional processing. What does that look like in practice?
- Too little medication may leave symptoms largely unchanged. When dosages are too low, they feel abandoned by treatment that promises relief but delivers little.
- Too much medication can flatten affect, reduce motivation, impair cognition, or introduce physical side effects that make long-term well-being harder to achieve. When dosages are too high, people often describe feeling less themselves, not depressed, but not alive either.
Consider lithium, one of the most well-studied mood stabilizers in medicine. Its therapeutic window is very narrow. So narrow in fact that small changes in blood concentration can shift a person from stable and functioning to numbed or even having an acute kidney injury. The example is deliberately chosen to illustrate the point; lithium is an extreme case with a very finely balanced therapeutic window. Most prescribed drugs don’t have anything like that effect and have much wider therapeutic windows.
The therapeutic window is a concept that reminds us that medication is not a blunt instrument. It’s a finely calibrated intervention that must work with a person’s biology and psychology, not overwhelm them.
The Historical Push for Maximum Dosing
The idea that we should push medication “to the limit” did not appear out of nowhere. It has roots in the psychiatric practices of the 1960s and 1970s, a time when the field was wrestling with severe illness and had far fewer tools than it does today. Back then, the prevailing philosophy was guided by the idea of a “maximum tolerated dose.” This was underpinned by the belief that the most effective treatment came from pushing medication to the edge of what the patient could physically handle.
The goal was symptom annihilation. Any lingering trace of delusions, panic, intrusive thoughts, or low mood was considered evidence that the medication needed to be increased further. There’s a kernel of logic to this. This approach made sense when the primary aim was hospital stabilization or rapid containment of acute crises. But outside that situation, it came at a cost in the form of emotional blunting, cognitive dulling, and a level of sedation that often impaired a person’s ability to engage with a meaningful and productive life.
Our more modern understanding sits below this extreme. Today, we understand that while intense symptoms can be destabilizing, total suppression can be equally harmful. Emotional range is a part of recovery, and mood variability (within a range) is a natural part of being human. When medication is used as a sledgehammer rather than a scalpel, people can lose access to the emotional abilities they need to make therapy, relationships, and daily living meaningful. It even fed a false mindset that somehow we could insulate ourselves from any negative emotions with enough meds, no matter how bad life was getting.
Modern psychiatry increasingly recognizes that medication should support engagement with life, not mute it. The shift away from maximum dosing is part of a broader movement toward precision, personalization, and functional well-being. Relatedly, we next have to examine the issue of polypharmacy—being prescribed multiple medications at once as an attempt to control all the issues with meds.
The Cost of Overmedication: Emotional Numbing and Disconnection
Medication can be a life-restoring intervention, but like any potent tool, it carries trade-offs when used without sufficient precision and care. One of the most common consequences of excessive dosing is not dramatic sedation but subtle emotional numbing. People describe it in different ways. Some report feeling muted, as if colors are dimmer or being “stuck” in a neutral or mildly pleasant state that lacks range. More noticeable examples include noticing that they no longer cry at things that used to move them.
This emotional blunting matters because feelings are a form of information, and we can use that information to help people build sustainable foundations for their mental health. For example, sadness can signal that something that was loved was lost, and anxiety can be a valuable signal of danger.
When those signals are flattened, the person loses important guidance about what needs attending. If the person is also engaging in therapy, this bluntness can feel like trying to tune a radio that’s slightly off-frequency. The music is there, but the emotional detail that makes it meaningful is missing. Relationships can suffer too, and it’s the people who are closest to the patient who are able to discern the shift. Partners or children may report that someone is “there” physically but emotionally hard to access. They might also be less responsive to joy or sorrow. But here’s the thing that every experienced practitioner, and most people who have overcome mental health challenges, can tell you: personal growth actually relies on engaging with discomfort as much as comfort. That means that numbing removes the raw material that we need for change. This isn’t to say that inability to access emotions is always due to medication—defense and coping mechanisms are more often to blame for those who are “emotionally unavailable.” But for those who were lost in their emotions before, lack of availability while medicated might indicate the dose is too high.
It’s important to stress that overmedication isn’t always dramatic or permanent. More often, people experience a quieter drift away from authentic feeling that’s enough to interfere with connection, curiosity, and motivation, but not so much that it’s obvious from across the room. The antidote is not demonizing medication but recognizing that a balance point is out of sync, and responding by recalibrating treatment.
Finding the Sweet Spot: Collaboration and Personalization
Finding the right role for medication requires patience and partnership. The best outcomes occur when clinicians and patients set clear goals together, track their effects carefully, and make changes based on lived experience rather than assumptions.
A practical approach that I think works well is guided by this simple idea: start low, go slow. Begin with the smallest effective dose, then assess clinically and subjectively how the individual responds.
In this phase, asking or being asked concrete questions is helpful: Is your sleep improving? Is your mood lifting in a way that allows engagement in everyday life? Are side effects tolerable? Do you feel like yourself? Are your emotions still accessible?
Adjustments should be iterative. If a dose reduces panic but also blunts joy, then considering small reductions or alternative strategies such as combining a lower dose with psychotherapy, for example, or shifting to a medication with a different side-effect profile might yield better results. In this model, patient feedback is the north star. When individuals articulate personal goals such as returning to creative work, parenting with presence, or simply being able to get out of bed, those goals should shape dosing decisions more than abstract symptom checklists.
Another principle that I believe is incredibly valuable is the idea of medication as a bridge, not a destination. For many people, medication creates the stability needed to participate in therapeutic work, rebuild sleep, or re-engage with exercise and social life. Once those pillars are strengthened, the dose can sometimes be reduced. For others, longer-term medication is the right choice, particularly when biological vulnerability or recurrent episodes make ongoing prevention the wisest course.
Finally, adding medication to address the side effects of another, or increasing doses reflexively without reconsidering the overall plan, often compounds problems. Periodic review, using a “blank slate” mentality and asking why each medication is being used, as well as whether the current regimen still aligns with the patient’s goals, is part of good practice.
The sweet spot doesn’t have to be guessed at or stumbled upon by accident. In fact, it can be deliberately found through attentive listening, collaborative goal-setting, careful monitoring, and a willingness to adjust. Less medication is a strategy of precision, of using just enough to restore function and preserve feeling, while always keeping the person’s experience at the center of care.
Beyond Medication: Restoring Connection and Function
Medication, when used wisely and in balance, is not meant to replace the deeper work of healing, but instead, to support it. The real goal is not to silence the inner world but to make it navigable. The right dose of medication creates just enough stability for someone to think clearly, feel safe, and step back into the relationships, routines, and reflections that ultimately drive long-term change.
At its best, medication is a scaffolding. It steadies the nervous system so that therapy can go deeper. It reduces panic enough for someone to have a difficult conversation they’ve been avoiding. It softens depression just enough for a person to reconnect with a friend, step outside, or try something meaningful again.
When the balance is right, people regain access to the full emotional spectrum. They can experience joy without feeling overwhelmed or anxiety without spiraling out of control. Emotions become manageable signals rather than threats. And because the goal is function, not flattening, people can participate more fully in their own healing.
This is how medication fits into a broader ecosystem of health: as one piece of a larger framework that includes self-awareness, therapy, community, lifestyle, purpose, and connection. When the dosage is moderate and attuned, medication becomes a bridge back to these essential human experiences.
Key Messages
The central insight of modern mental health treatment is simple but profound: healing is less about eliminating symptoms and more about restoring balance. The old mindset of “more medication equals more relief” ignores how sensitive the human mind is to nuance. Too much medication can muffle the very experiences that help people understand themselves, grow, and connect with the world.
Sometimes, less medication is more effective precisely because it preserves authenticity, emotional clarity, and the ability to engage in the inner and outer work of recovery.
When people can feel, they can adjust. When they can think clearly, they can make informed choices. When they can participate in their lives, they can heal.
This perspective offers hope. It reframes treatment not as a battle to extinguish symptoms but as a journey toward alignment that begins with finding the dose, the practices, and the supports that allow someone to function, relate, and grow. It recognizes that progress often comes from subtle adjustments, not dramatic interventions. And it empowers individuals to actively participate in their care, rather than simply receiving it.
In the end, the aim is a life that feels lived. In this pursuit, medication can provide stability and leave room for meaning, connection, allowing the patient to walk the pathway to genuine, sustainable healing.
