To Medicate or Not-Part Two

Things You Should Think About When Considering Medication

 Despite the positive experience I had getting on medication, I don’t immediately push the idea of medication at my clients. If someone has been in therapy with me for six months or longer and they haven’t seen a reduction of their significant depression and/or anxiety I may suggest it but as it was with me, the decision is theirs. I may push harder if someone has severe depression/anxiety.

 If a client decides to go forward I suggest a psychiatrist who I know to be proficient presuming their insurance will cover. If not, I have the client develop a list of three providers that will accept their insurance and I research them. If the client is in recovery, I make sure that they agree to tell their psychiatrist this important information up front. I encourage the client to understand that the overall goal is to find the right medication at the right dose. I counsel patience knowing that many medications may take six to eight weeks to build to therapeutic benefit. Often a medication is ineffective at a starting dose, so a higher one is tried. If there is still no or minimal benefit, then a new medication may be tried. It can be a difficult and lengthy process of trial and error that requires patience and frustration tolerance.

 I encourage clients to take their medication consistently and precisely as directed. Clients with addictions issues need to understand the importance of not free-styling their dose by taking an extra pill because they’re struggling with an anxious day. If the directions are to take the medication at night on a full stomach, then that’s what you do. Nor should clients quit a medication at the first sign of a side effect. Often side effects resolve over time. If they don’t then perhaps a dose should be lowered or the medication has to be abandoned all together.

 What Does Success Look Like?

 Success means a significant reduction of symptoms and either no side effects or side effects one can live with.  Any side effect is outweighed by the benefit of the medication. Success means you feel like yourself just less depressed or anxious. Not amped or tranquilized. The reduction of symptoms enables you to better deal with your symptoms effectively.

 You may still have symptoms but they are less likely to negatively affect you because the medication is enabling you to manage. As one insightful friend described it, “my analogy is my anxiety was like really loud music playing all the time. It jacked up my emotions, my anxiety of course, but my anger, and my defensiveness too. Medication has turned the music way down so I can think about what I should do rather than just reacting to things all the time.”

I added, “When the music is really loud it distorts our ability to hear clearly what others are saying to us.” With the music roaring we exist in a constant state of fight or flight. Constructive criticism comes across as mean-spirited, threatening or insulting and we react accordingly. With effective medication we can hear the message as it's intended and take it to heart. Our relationships improve accordingly.

 Pre-Seroquel and Lexapro, my anxiety often overwhelmed me to the point where I often avoided social contact, had sleepless nights and it affected my relationships adversely. I was irritable and then felt guilty for not treating people better. Today that’s rarely the case. With my anxiety consistently at the lower end of the scale, I can easily put my coping skills in play. I am more emotionally stout and just plain happier. If you decide to go on medication, I hope your experience is like mine!

A quick Checklist of Factors to Consider About Going on Medication

1. Remember it's your decision to go medication. You can stop anytime. It's your body and your life.
2. If possible, see a psychiatrist to evaluate you and formulate a prescription. If you can't see a psychiatrist, perhaps your practitioner is willing to prescribe. Many doctors/NP's are proficient in managing mild to moderate depression or anxiety. If you're dealing with BiPolar, severe depression or anxiety or other then you should find a psychiatrist or psychiatric nurse.
3. If you are in recovery from addictions, ALL your providers need to know from the outset that you're recovering. This should include your therapist, PCP, psychiatrist, dentist and providers in the emergency room. This is to prevent you from being prescribed addictive drugs such as benzodiazepine, opiates etc. If you have severe pain it can be carefully managed on an as-needed basis.
4. Take your medication exactly as prescribed. If the medication is to be taken at night on a full stomach, then stick to that routine. Develop a system to take your medication consistently. There are inexpensive pill organizers to help organize you at most pharmacies. Do not skip doses because you feel good or add doses because you don't.
5. Make sure you give the medication a trial equivalent to what the provider says is the time required to build to therapeutic levels. If this information isn't volunteered, ask! If you experience severe side effects, call your provider right away and he will advise you on how to proceed. You may experience mild side effects but these may resolve over time. Try to give the medication a chance.
6. Understand that providers may need to titrate your medication to help remit your symptoms so be patient.
7. Continue all self-care routines including maintaining work/life balance, getting sufficient sleep, good nutrition and exercise.