General Principles of Psychiatric Medication Q and A
General Principles Of Medication Management Q and A
I believe that using psychotropic medications, that is those that have effects on mood, thinking and behavior, require a higher standard of care. This is because we are dealing with the brain, the most precious and sensitive and important organ system of the body and deserves extra special care and management. The more you know about these medications, how they work, and what they are suppose to do the more, the more you will be able to help your problems. See Principles of Med Mangement for a summary statement.
Below in questions and answer form[Q and A] are some of my rules and principles of using these medications. This is just a beginning of some general guidelines, specifics of your treatment need to be discussed with the your prescriber.
Why should I consider medication?
Mental health problem that in part have a biological, hereditary, genetic, chemical imbalance basis or cause may be helped with medication management. Often medication offers the most hope for symptom control, treating the disorder adequately and preventing relapses and complications. When you are sufficiently educated on the disorder its biochemical causes , and medication treatment, you may want to consider a carefully managed medication trial, in which you will have ultimate say and control.
I am worried about side effects, what side effect should one look for?
Most psychiatric medications if properly prescribed using the principles discussed below, should have few if any side effects. Each class of medications has its own side effect profile, as do the individual medications. These specific side effects will be discussed as we go over each class and the specific medications. The ones that you need most to be aware of are the psychiatric effects both good and bad, for it is these that will cause the most problems in telling you if you improving, staying the same of getting better.
Why are you saying good or bad effects rather than side effects?
What might be a bad effect or side effect for one person may be a good one for another. For example some anti depressants can make you sleepy and tired, and this would be good if you need to sleep, and you take it at bedtime. However if you already were sleeping too much because of your depression this tiredness would be a bad or negative effect. So it will be important for you to know the good and bad psychiatric effects as they apply to your and your situation.
What do you mean psychiatric effects good and bad?
Specifically I am referring to neuro psychiatric effects. These effects would be those affecting thinking, feelings, and mental functions such as concentration, memory, alertness, and certain aspects of behavior like speeding you up or slowing you down, or causing certain other body problems like movements, stiffness or tremors.
What should one generally look for and what should one do next?
Look for effects that change how you think, feel, change your mood, sleep, energy level, concentration, memory, speed up or slow down your mind or body, and that make the symptoms you came into treatment for worse rather than better. If anything new or unexpected happens to your mental or body functioning, that seems to be making matter worse, stop the medicine, or lower the dose until you can discuss it with your prescriber.
What is the best way for the prescriber to avoid these problems?
Four words- start low, go slow! If one start very low and goes very slow with a medication trial, and is vigilant and paying attention to the medication effects good and bad, including any serious problems can be anticipated found early and proper adjustment can be made or the medication can be safely stopped. This requires that you as patient know what to look for, and that the prescriber is available to answer any questions, and make the proper adjustments.
Why are you suggesting and calling it a medication trial?
I call it a trial because brain chemistry is very unique, and even in identical twins who are bio chemical “clones” that at is a least theoretically should have very similar brain chemistry, yet they don’t have the same responses to medications that effect the mind. If there are such differences in twins one can expect unique responses in all individuals even when one has the correct diagnosis and has history of medication responses of the individual and the family when it is available.
What will a trial of medication do?
A medication trial is not only a therapeutic process that is will begin to treat the disorder, but the response to trial aids and often helps confirms and fine tune the diagnosis. An expected treatment response is one of three parts that should fit together in making a diagnosis, the other two being the, the group of symptoms and its history, and the family history of the disorder.
What if the person is not getting better on a medication trial?
Then either the medication is the wrong dose, or it needs another medicine to help it, or the diagnosis of the individual, is wrong, either on the descriptive or biochemical level, or all three of these and possibly other reasons. The important thing is to let prescriber know what is happening or not happening, and work with them to give more history to help clarify and remedy the situation.
What if you or another prescriber won’t listen and believe what I am observing as a possible medication response?
I may know more about the medication then you, but you know your child and yourself better than I do when it comes to things like their appearance, thinking, feeling states, moods, physical signs like sleep, appetite, sensitivities to foods, dyes, and other kinds of internal and external environmental stimulations and stresses good and bad. Therefore I will almost always defer to your opinion and judgment about the medication effects and will be happy to discuss this with you during our meetings, and if it can’t wait for a scheduled meeting, call leave a message and I will try to get back to you in a timely manner.
Will I feel drugged or medicated if I take one of these medications?
On the right medication with the right dose strength and schedule and properly adjusted , you should be your normal self, but relieved of the target symptoms, not looking or feeling drugged, medicated, numbed out, zombied like, high or low You should not have to suffer through negative effects to get positive effects. The medicine should be neutral or helpful, as we adjust the dose, never should the bad effects outweigh the good effects.
How do you usually pick a medicine and how to you start to prescribe it?
We will start with the safest simplest medication with the best tack record, and start with the lowest dose. It may necessary at the beginning to use more than one medication depending on the number of problems that need to be addressed and how severe they are.
Do your ever have to use more than one medication to start?
In cases of multiple diagnoses or multiple problems with one diagnosis, more than one medication may be needed for adequate treatment and control, but even here the goal is to use one medication if it will do the job or the fewest number needed for the shortest length of time.
Why do you start with the lowest dose?
Why lowest dose? for at least two reasons to find low end responders that people who only need smaller doses to get helpful effects, and where starting at the “normal” even a low dose may be too much to start and secondly to minimize any negative effects.
Will I feel good effects right away?
Because we are starting with a very low dose, the initial response may be neutral or only mildly helpful. This is normal and is too be expected. We can always increase both the dose strength and the rapidity at which we increase the dose if the symptoms warrant such. At the beginning it is best to be patient and wait.
What if the medication seems to be making matters worse?
If the medication is doing more bad then good, making matters worse it is best to consult with the prescriber. It may not be the medicine but the disorder itself getting worse and the medicine may be an innocent bystander. If you have been on the medicine a while, it may need to be adjusted up, down or discontinued. Most medicines should be tapered according to your needs, the length of tapper depends on the specific person, their disorder and the medication or medications being used. If you are on more than one medicine it may be a drug-drug interaction, and one of the medicines may need to be adjusted or stopped. One needs to consider at least three possibilities, is it the treatment, the disorder itself, or is there a new problem. An updated evaluation may be in order.
How will the dose be increased?
The dose will be slowly increased on a scheduled determined by your need and your response. At the beginning it is best to start low and go slow. Once you know what effect the medicine is having good or bad, it can be adjusted more rapidly depending on your individual needs. Some medications like stimulants work quickly like within an hour, and can be adjusted more quickly, and other like mood stabilizing medications , though showing some immediate effects may take weeks before you see their total helpful effects, should be increased more slowly.
How do you determine the correct dose?
Correct dosage of the medication is very individual specific, based on your unique brain chemistry. Some people require small doses, other require larger doses, some require a shorter duration of treatment , others may require a long time before you see some good effects.
How much of dose is based on age or weight?
Dosage is based more on your unique brain chemistry, rather than age, weight, or symptom severity though all of these play a part in picking the medication, its dosage and how rapidly it will be increased or adjusted.
What is the final determining factor for the correct dose of a medicine?
Remember more medications or higher doses are not necessarily better, your unique response is the final determining factor. In fact lower doses, or less medicine or no medicine may in fact be in your best interest. It all depends on your unique brain chemistry and its response to an adequate and carefully managed medications trial.
How will I know if the medicine is helping my problems?
Specific targets such as behavior, concentration, moods, anxieties, thinking, physical symptoms i.e. headaches, sleep, and other should be picked as things needing improvement. They then need to be assessed on a regular basis to see if they are improving , and changing the dosing or the medication based on these things getting better or not.
What if I am getting better but at the same time I start getting some negative effects?
Improvement in targets must always be balance with your needs and possible negative effects both short and long term.
Are there some general rules about adjusting the dose according to good or bad effects?
As the dose is increased, if the lower dose was better, return to the lower dose. If unexpected bad effects occur, go back to the lower dose, or stop the medication, if your not sure call the prescriber.
How long does it take for the medicines to work?
Medication effects may be seen a soon as 3 to 7 days once the right medicine and dose is found though one my see initial effects as sooner. With stimulants for ADHD, effects may be seen within an hour, lasting up to 12 hours.
What about long term effects?
Long term and long lasting effects depend more on the type of problem you have and the course of the disorder than the individual effects of a medication.
What can make my treatment as brief as possible?
The shortest duration of treatment is best guaranteed by treatment beginning at the earliest age, with the proper dose of medication being used for the appropriate length of time to ensure adequate treatment.
What is adequate treatment?
Treatment is adequate when it not only addresses symptom relief, but prevents relapses, and complications. Most if not all symptoms and problems need to in control, not only to improve function and decrease distress, but also so they don’t fuel re occurrences or the disorder or lead to complications. For example a worried and depressed person is having headaches and these are not treated as a primary symptom of depression, though otherwise the person is back to their old self, the headaches if not also treated to remission will continue to fuel the depression and cause relapses.
How long will I need to take medications?
Hardly anyone needs medication for ever. Some disorders like unstable moods are episodic that is they come and go, and you want to stay on the medication long enough to stop the episodes, say 6 to 12 months, and then taper off the medications. Other disorders are more continuous like anxiety problems with Panic Attacks, and here medicine may be needed on and off for a longer period of time, and even when symptom free for long periods of time, may reoccur and medication may be needed again. Other continuous disorders like ADHD may require medication for years, but after that the medication may be stopped the brain may have in a sense “healed itself” and no medications may be needed. Longer treatment is necessary if there is a personal or family history of re-occurring biologically based mental health disorder, especially if environmental, drug and alcohol, or physical illness continue to be present complicating the disorder.