Why It's So Hard to Know if Your Medication Is Actually Working

I used to assume medication changes would be pretty obvious.

You take something. It either works or it doesn’t.

Simple.

Then I found myself trying to answer questions like:

• "Is this helping?"
• "Am I less anxious?"
• "Is my focus better?"
• "Did this side effect start before or after the dosage change?"
• "Why did I stop the first medication again?"

…and realized I actually had no idea.

At one point, after multiple ADHD medication changes, I seriously considered going back to the first medication I’d tried.

Not because I thought it had worked best.

But because I couldn’t remember why I’d stopped it in the first place.

• No notes.
• No timeline.
• No clear recollection of:

• what improved
• what got worse
• whether it helped at all

Just vague impressions competing with whatever happened to feel true that week.

That was probably the first time I realized how much medication management depends on memory. And how unreliable memory actually is.

I also assumed medication effects would be obvious

Another thing I didn’t understand early on was that many medications are intentionally started at doses that aren’t expected to dramatically help yet.

Which, in hindsight, makes complete sense.

Doctors often start low because they first want to know: can you tolerate this safely?

Especially with:

• ADHD medications
• antidepressants
• anxiety medications
• hormone therapies

The goal early on is often to:

• monitor side effects
• establish tolerability
• adjust gradually
• titrate toward an effective dose

Meanwhile, patients are often sitting there Googling things like:

• "how to know if my ADHD meds are working"
• "why don't I feel different on ADHD meds"
• "how long does HRT take to work"

…while quietly thinking: “I don’t really feel anything.”

Because nobody fully explained: “you might not yet.”

Some medications work quickly. Others may take:

• days
• weeks
• dosage increases
• stabilization periods

…before meaningful benefits become noticeable.

Once I understood that, I started paying attention differently.

Not just: “Do I feel dramatically better?”

But:

• Is anything new popping up?
• What's improved — even slightly?
• What's gotten worse?

Then my dental hygienist accidentally blew my mind

At a dentist appointment, my hygienist asked me to list all the medications and supplements I was taking.

So I started listing them out loud.

• ADHD medication.
• Hormones.
• Thyroid med.
• Supplements.
• A few other things.

When I stopped she said: “Ah, polypharmacy.”

Apparently there’s an actual term for the reality of taking multiple medications at the same time — and one of the reasons dentists ask is because overlapping medications can sometimes affect things like:

• dry mouth
• grinding
• gums
• oral health generally

Which was not something I had ever remotely considered.

That was the first time I really stopped and thought: “Oh. This is actually a pretty complicated system.”

Because I wasn’t trying to evaluate one medication in a stable body under stable conditions.

I was trying to evaluate:

• ADHD meds
• hormones
• supplements
• fluctuating sleep
• changing cycles
• stress
• overlapping symptoms
• possible interactions
• possible side effects

…while relying mostly on memory and vibes.

No wonder it felt impossible.

Medications rarely create one clean effect

At one point, I started testosterone and became completely fixated on the fact that it had almost immediately given me adult-onset acne.

Which felt deeply rude!

So in my head, the medication story became: testosterone = acne. Acne = bad.

Except later, when I looked back at my symptom tracking data, I realized something else had also started improving almost immediately: my libido.

Which was, objectively, the part I probably should have been paying more attention to.

I just hadn’t really registered it at the time because the acne had captured all of my attention.

That was a weirdly eye-opening moment.

Because it made me realize how easily highly visible negative side effects can overpower quieter positive changes happening at the same time.

If I hadn’t been tracking both symptoms consistently, I honestly think I would have remembered testosterone as: “the thing that gave me acne.” Full stop.

Improvement can become invisible surprisingly quickly

Another strange realization came when I started looking back at longer-term tracking data around emotional regulation and rejection sensitivity.

For most of my life, I had thought of myself as:

• emotionally reactive
• easily hurt
• overly concerned about what people thought of me
• extremely self-critical

That was just how I understood myself.

Except the reports were showing long stretches of green boxes where those symptoms had barely been showing up at all.

And I genuinely hadn’t noticed.

Not because the improvements weren’t meaningful. Because I was still thinking about myself based on older experiences instead of what was actually happening day to day.

The medication changes had affected me more than I realized. I just hadn’t been seeing the changes clearly while living inside them.

That was probably one of the clearest examples of how difficult it can be to accurately evaluate gradual internal change in real time. Especially when improvements happen slowly instead of all at once.

Medication decisions are often exercises in tradeoffs

One of the things I wish someone had explained earlier is that many medications are not: “all upside, zero downside.”

They’re tradeoffs.

The question is often not: “Is this perfect?” It’s: “Are the benefits worth the tradeoffs for me personally?”

And those tradeoffs are incredibly individual.

One person may happily tolerate:

• mild acne
• dry mouth
• appetite suppression
• sweating

…in exchange for:

• emotional stability
• better focus
• reduced anxiety
• improved sleep
• fewer executive function struggles

Someone else may decide those tradeoffs aren’t worth it.

Neither person is wrong.

But it does mean you need enough visibility into your symptoms — and side effects — to actually evaluate the balance over time.

The simplest thing that made tracking easier

One of the most practical things I learned was: when possible, change one variable at a time.

Not because life is perfectly controllable. It definitely isn’t.

But if you:

• start multiple medications simultaneously
• change hormone doses
• add supplements
• overhaul your routine
• change sleep habits

…all at once, it becomes incredibly difficult to tell what’s actually driving changes.

Whenever possible, it helps to:

• start one medication at a time
• understand the expected timeline
• track both side effects and benefits
• pay attention to gradual changes
• avoid relying purely on memory

Especially because many improvements don’t feel dramatic in real time.

They often feel more like:

• "Huh. I guess I haven't snapped at anyone this week."
• "Wait… I think I'm actually sleeping better."
• "I didn't realize that symptom had mostly disappeared."

Some patterns only became obvious in hindsight

I also started noticing patterns in my focus and executive function that felt almost embarrassingly obvious once I could actually see the data over time.

When I was building the Fine app — something I was deeply interested in — the reports showed:

• intense hyperfocus
• massive time blindness
• extremely high engagement

Meanwhile, when I shifted into marketing work, which I find significantly harder and less stimulating, the exact opposite patterns started showing up:

• executive dysfunction
• avoidance
• difficulty initiating tasks
• focus problems
• procrastination

Living through it day to day, it mostly felt like: “Why can’t I consistently function like a normal person?”

But looking at the data later, the pattern was incredibly clear.

The issue wasn’t that my attention randomly worked sometimes and failed other times. It was heavily influenced by:

• interest
• stimulation
• novelty
• emotional engagement

…something ADHD researchers have discussed for years, but that I had never fully recognized in myself until I could actually see the patterns laid out over time.

I thought medication management would feel more scientific

I expected medication management to feel much more straightforward than it actually did.

Instead, it often felt like trying to interpret a moving target while:

• hormones fluctuated
• symptoms overlapped
• side effects competed for attention
• memory quietly rewrote the past
• life kept moving

What surprised me most wasn’t that medications are complicated.

It’s that humans are surprisingly bad at noticing gradual internal change while we’re living through it. Especially without some kind of external record.

Which is probably why so many people quietly walk around wondering: “Is this actually helping?”

Even when meaningful changes are already happening.