Psychotropic Medication – Guidelines for Successful Use

Part 3: Notes on Using Medications

               This post is the third and final post in a series about medications.  If you have not done so already, I suggest you read part one in which I discussed how to recognize symptoms and walked through making the decision to take medications and part two which explores the process of starting on medications.  This third portion will explore how long you can expect to stay on your medications, as well as discussing a variety of other aspects of using medications to treat mental health issues.

How Long Should I Take These Medications?

               One of the main questions people have when considering whether or not to use a medication to address mental health issues is how long they will have to take it.  I often hear people say “I don’t want to start something that I will then have to take for the rest of my life.”  That is a valid concern, but let’s explore your options.

               Most importantly, there is no pre-determined amount of time that you should be on your medication(s).  That will ultimately be a decision that you make along with your prescribing doctor and it will vary from person to person and depend on the specifics of what you are dealing with, your preferences, and the medication(s) that are being prescribed.  That said, there are some general things to keep in mind.

               I find that people will usually have one of the 3 following experiences with medications: 1) They will go on medications for a set amount of time and then go off of them and not use them again, 2) They will plan to be on the medications for some time and then go off with the plan of going back on them if/when the need arises, or 3) To go on and plan to stay on the medications indefinitely.  I often encourage for this to be one of the things that you discuss with your prescriber when starting a medication.  Knowing what the long-term plan is at the beginning can help you to have clear expectations.

               If you plan on either option one or two, it is generally suggested that you stay on the medication(s) for a period of six months after the time where you would like to discontinue them.  The thought behind this is that it allows enough time for the changes the medications have made within your brain and body to take hold and increases the chance that your body will be able to naturally maintain these changes once the medication has stopped.

Communication Is Key

As you have read, creating a relationship with your prescribing doctor where you are working together to get you the best response from and experience with medication is a key factor.  In addition to you being clear about what you share with your doctor (in Part One of this series, I discussed being focused on and descriptive about your symptoms), there are some other things you might want to consider:  

  • Have a list of important info and questions – in the heat of the moment of your appointment with your doctor, it can be easy to forget to discuss important things.  Having these things written down is a great way to be sure that you cover all of the important information and get to ask any questions you may have.
  • Keep a record of your progress – finding ways to track your symptoms can be really helpful to your doctor.  The better the data that we can provide them, the more information they have to make informed clinical decisions about managing your medications.  There are lots of great apps that can aid you in tracking your symptoms and mood.  Your doctor may have some suggested apps or other methods that they have found helpful to them.

Beware Dr. Google

While the internet can be a great source of knowledge, it is not without a few drawbacks.  When it comes to seeking ways to be an informed consumer of medications and healthcare, a google search of symptoms or medications can yield lots of valuable information.  However, it is important that we keep in mind the nature of the information available online.  It is not always accurate and it can be a misleading representation of information.  So, keep that in mind when you turn to the google search bar.  Checking out the information you find with your prescribing doctor or pharmacist can be a useful way to be sure that you are making your decisions based on accurate and current information from an expert rather than an unverified, anonymous online source.

I Was Prescribed an “Anti-Depressant”, But I Don’t Have Depression

This is an issue that comes up fairly frequently.  If you have been prescribed an “anti-depressant” and are not sure why, it is likely because that label is not fully accurate.  It is an easy shortcut to refer to a fairly diverse class of medications.  “Anti-Depressant” is often used because the terms “Selective Serotonin (or Norepinephrine) Reuptake Inhibitor” or “SSRI” are not as easily understandable.  However, they are more accurate because they describe the way that the medication is working.  While we will skip the details, the bottom line is that “anti-depressants” are useful to treat a wide range of symptoms beyond depression.  So, it is not that you are being prescribed the wrong class of medication, it is that the medication is used to treat a variety of conditions beyond depression. 

Know Your Treatment Team

It is important to realize that there are a number of professionals who should be included in your treatment when you are using medications to treat a mental health issue.  The following is a list of the most common professionals that are involved in treating a mental health issue:

  • Primary Care Physician (PCP) or General Practitioner (GP) – This is the doctor who looks out for the bigger picture, or overview, of your health.  Some women utilize their OB doctor to fulfill this function.  Having a physical before beginning medication(s) is often recommended to ensure that we are treating an actual mental health issue rather than a physical issue that may present with mental health symptoms.  Typically getting blood work to check your thyroid, vitamin and hormone levels is in order.  Often times your PCP/GP/OB will start or manage your medications if they feel comfortable and confident in doing so.  You will typically see this provider for about 15 minutes once a month at first, then being stretched out to 3 to 6 months apart.
  • Psychiatrist – This is a doctor who is focused on medication management for a mental health issue.  They are specialists who will monitor your symptoms, response to medication(s), and any side effects you may experience.  Some people may not need to see this specialist if their PCP/GP/OB is managing the medication(s).  However, you will want to work with a psychiatrist if you are not responding adequately to the medication(s) prescribed by your PCP/GP/OB, or if there are other complicating factors in your treatment. You will typically see this provider for about 15 minutes once a month at first, then being stretched out to 3 to 6 months apart.  Some psychiatrists may see you for longer or do talk therapy as well as medication management, but that is fairly rare.
  • Counselor/Therapist – This is the professional you see who does talk therapy with you.  Your counselor/therapist helps you with the emotional, behavioral, and thought oriented aspects of your mental health issue.  You will typically see this provider for 45-60 minute sessions weekly or fortnightly.  As you will spend the most time with this provider, they can often be a good source of information for the other members of your treatment team, so you can inquire about how to have these members be able to talk to each other and work together to provide you with the best care possible. 
  • Pharmacist – This is the professional who dispenses your medication(s).  While they may not traditionally be thought of as a member of your treatment team, they are often very accessible and have good information about your medications.  You can often rely on them for answers to questions like: “What do I do if I forget a dose?” or “Will this medication interact with any of the other medications that I take?”

Balance Efficacy with Tolerability

               I think that this is the bottom line to consider when pondering if a medication should be used.  Are you getting more out of it than it is causing problems?  Often medications will have side effects.  Sometimes they will be severe enough that you will consider not taking that medication.  But you have to ask if the benefit you get from it outweighs the cost or vice versa.

Breakthrough symptoms

               If you have been stable on a medication for some time and then start to experience some of your symptoms again, this is called breakthrough symptoms.  It is not cause for alarm, but it is cause for you to contact your prescribing doctor in order to talk about this issue and see what adjustments might need to be made.

Take home message

               My hope if that these last 3 posts have helped you to make the best decision for yourself on whether or not to use medications to help you address your mental health concern.  In my experience, people can fall into a few categories where they do not get the most benefit from medication(s) as possible, so I hope you now feel prepared to avoid the following pitfalls:

  • Unsure – this is where someone does not fill their prescriptions or tart taking them due to having unanswered questions.  I hope you now feel adequately prepared to have a thorough discussion with your prescribing doctor.
  • Forgetful – this is where someone becomes hit or miss in taking their medication(s).  I hope that you now understand why taking your medication(s) consistently as prescribed is vital in getting the most from your medication(s).       
  • Blindly adhering – this is where someone is not sure why they are prescribed what they are (what symptoms does the medication target, what side effects to look out for, what benefit they can expect to see), but they faithfully take what they have been prescribed.  I hope that you now feel prepared to ask your prescribing doctor these questions in order to know the ins and outs of what you are being prescribed and can be an informed consumer.
  • Unrealistic expectations – this is where people have a skewed view of what their medication can and should be doing for them.  I often hear people say things like “if I don’t take my ‘happy pills’ I feel off all day.”  While there may be some placebo effect at play in these situations, most medications will not have a noticeable impact if you miss a dose.  Having a clear picture of what medications will (and won’t) do is a key ingredient to being an informed consumer.

Hopefully you get good benefit from your medication regiment and now feel better prepared to navigate the medical care system.

EDITED BY DR. JACQUELINE FULCHER @ https://paintedowlpsychology.com

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