If you have ever experienced symptoms of anxiety or depression, you may have considered taking a psychiatric medication. Perhaps, an antidepressant has been recommended. Maybe you are already seeing a therapist to help with these symptoms and the therapist has suggested you consider medication. But you don’t want to take medication. Or maybe you want to know more about them before you start a new prescription.
Psychiatric medications include a variety of types of medicines including antidepressants, anxiolytics, antipsychotics and mood stabilizers. People may be hesitant to try psychiatric medications for several reasons including the stigma attached to mental illness. But if you try a psychotropic medication, you are not alone. According to JAMA Internal Medicine, in 2013 16.7% of American adults had a prescription for at least one psychiatric drug. Most of these were antidepressants.
Antidepressants include medications like Prozac, Zoloft, Lexapro, and Wellbutrin. These medications are generally the first line medication for depression and anxiety. How effective are they? The largest study regarding the efficacy of antidepressants is the Star*D study. This study included several steps starting with a single antidepressant medication. Switching or adding an additional medication were follow-up steps. 70% of participants that completed the study became symptom-free. Not everyone will experience complete resolution of symptoms. Some will have a reduction of symptoms and a few will not respond at all. The good news is that if a patient is persistent and continues treatment, good results are likely. Those that participate in therapy along with medication usually experience the best outcomes.
Naturally, people are worried about side effects. It’s important to realize that side effects are possible but that most people tolerate antidepressants quite well. My prescribing practice is to inform patients about potential and most likely side effects. The most common side effect of antidepressants is mild nausea within the first week. Rarely will a person need to discontinue an antidepressant because of this. I also start medications at a conservative and low dose. This minimizes the risk of side effects occurring. As your body gets used to the medication, the dose can be gradually increased to a therapeutic dose. The goal is to use the least amount of medication to achieve the desired benefits.
If the first medication cannot be tolerated at all or isn’t effective, switching to a different medication is usually the next step. Switching antidepressants is usually not difficult if done properly. Switching is usually done by what is known as a cross-titration. This simply means reducing the dose of one medication while increasing the dose of the second medication. However, depending on the doses and medications involved, a direct switch can sometimes be just as well tolerated.
If a patient tries two or more medications that are either not effective or cause intolerable side effects, it could be that they have genetic variability causing problems metabolizing medications. Pharmacogenetic testing can be quickly and easily done in the office using a cheek swab. The results of this test tell us if a patient might do better with specific medications. Look for a follow-up post for more details about DNA testing.
How long should you take a medication? There are plenty of patients that take psychotropic medications for their entire lifetime. However, many can take them for a short period of time. I usually start with the premise that we will use a medication for 6-12 months. Depending on how well the patient is doing and the psychiatric history, medications may be discontinued after the treatment period. Medications can be easily and successfully stopped. Weaning slowly helps to minimize the risk of discontinuation syndrome or return of symptoms. Always talk to your healthcare provider about starting or stopping any medication. Don’t try to do it by yourself.
Psychiatric medications are a helpful tool in the toolbox for anyone dealing with mental health issues. Medications along with therapy give patients the best possible mental health results. If you are already in therapy, ask your therapist if they think medication might be helpful for you. While a primary care physician can prescribe psychotropic medications, a psychiatrist, nurse practitioner or psychiatric PA will have more detailed knowledge about mental health and the medications that will help. Bull City Psychotherapy offers a full range of mental health services including a variety of therapies and medication management.
Kristie Ashton is a board certified PA-C practicing psychiatry under the direction and care of her collaborating psychiatrist. Ms. Ashton has a license to practice medicine in the state of North Carolina and as such is able to order imaging, labs, tests, and has full unrestricted prescriptive rights. She is able to evaluate, diagnose, formulate treatment plans, and provide follow up care. Referrals to other specialists, subspecialists, psychotherapists, psychologists, and any other treating providers can and will be made if necessary. Her approach involves psychoeducation, wellness, and complementary therapies. In addition, she utilizes pharmacogenetic (DNA) testing to more efficiently choose medications. To schedule an appointment with Ms. Ashton, please email directly at pakristie@gmail.com or call 919-896-5281