Six Tips for Talking to your Doctor about Medication

By Claudia L. Reardon, M.D.



In my last blog, I addressed the factors psychiatrists consider in choosing a given psychiatric medication for a patient. I emphasized the importance of medication selection being a collaborative process between the physician and the patient. In the midst of an appointment with a psychiatrist, though, it can be difficult for a patient to know what to ask, and when and how to ask it. This article includes tips for patients to help them work with their physicians in finding the best medications.

1. Ask the psychiatrist, “How did you pick that medicine?” Even if you can think of nothing else to ask during an appointment, this single question will probably lead to a wealth of useful information. For example, it might lead to a discussion of the target symptoms, how the medication affects other medications or medical conditions, and side effects.


2. Make a list of medication questions to ask your psychiatrist at your next appointment. I find it extremely useful when my patients come in with a list of questions they have made since I last saw them in my office. This way, patients are sure not to forget to ask anything important to them.


3. Take notes during your appointments. It can be difficult to remember everything your psychiatrist says during your appointment, and so bringing a note pad and pen along to take notes can be useful so that later you can remember what was discussed.


4. Read books. There are a number of excellent books available for patients on psychiatric medications. In my experience, patients find especially useful the book Instant Psychopharmacology by Ronald Diamond, M.D.


5. Visit websites. Patients should be careful about which websites they visit, as not all are reliable sources of medication information. However, in addition to www.HealthyMinds.org, another reputable site is the NAMI medication website. Go to the NAMI webpage (www.nami.org) and click on the “Medications” tab on the top toolbar.


6. Try not to be embarrassed. Many patients are embarrassed to talk about concerns they have about medications, especially side effects that they find difficult to discuss. However, remember that physicians hear about all kinds of different side effects, and it is pretty hard to embarrass a physician when it comes to talk about the human body!

In addition to these strategies, you might have found others that work for you in keeping you engaged in your medication treatment. It is imperative to keep the lines of communication open with your psychiatrist and to remember that your physician is there to answer any questions you have.

Which Medicines and When: Collaborative Process of Finding the Right Medicines

By Claudia L. Reardon, M.D.

Many patients have long and trying journeys on the way to finding medication regimens that work for their psychiatric symptoms. It isn’t always obvious why psychiatrists choose certain medications and avoid others for given patients. In this blog post, I will review the process by which a physician chooses a psychiatric medication. The more the patient knows about how the psychiatrist is thinking through the medication decision-making, the more active a role that patient can play in the process. 

Psychiatrists consider the following issues when prescribing a medication:

1. Target symptoms. A patient might have many different symptoms, for example, depressed mood, anxiety, trouble with concentration, and severe insomnia. It is important to decide which symptoms should be addressed first, since it is likely that one single medicine will not help all of the symptoms. Doctors often prefer not to start multiple medications at the same time, as it otherwise can be difficult to figure out which medicine is helping or which is causing side effects. Thus, in a patient with the above symptoms, the physician might first choose to address the patient’s depressed mood with an antidepressant. Since trouble with concentration and severe insomnia could be caused by depression, it is possible that treatment with an antidepressant will help those symptoms as well. It is important to address the symptoms in the order that makes the most sense.


2. Psychiatric diagnosis. The physician cannot simply treat a target symptom with a medication without knowing the overall psychiatric diagnosis. For example, depressed mood could be due to many different diagnoses, including major depressive disorder, bipolar disorder, schizoaffective disorder, drug or alcohol abuse, or medical problems such as low thyroid. All of these would have different treatments. Major depressive disorder would be treated with antidepressants, while antidepressants can actually sometimes worsen bipolar disorder. Likewise, if a patient’s depression is caused by a medical problem, it is essential that the medical problem be addressed rather than simply “band-aiding” the symptom of depression with an antidepressant.


3. Medical conditions and other medications. It is critical that the physician be aware of all the patients’ medical issues and other medications they are taking. Certain psychiatric medications would be dangerous if prescribed to patients with certain medical problems. For example, some medications can worsen seizure disorders, cause abnormal heart rhythms, or worsen diabetes. Additionally, some psychiatric medications can have dangerous interactions with other medications.


4. Side effects. Psychiatrists must consider how a given medication’s side effects will impact a given patient. For example, a patient who drives heavy machinery for a living should probably not take a medication that causes drowsiness. On the other hand, sometimes physicians can “take advantage” of side effects. For example, if a patient is sleeping and eating poorly, the doctor might prescribe a medication with sleepiness and increased appetite as side effects.


5. History of response. If a patient or his or her family member has had a good response to a medication in the past, that might be a good reason to choose that medicine now.


6. Patient preferences. Finally, and most importantly, the physician must make sure that the patient is willing and able to take the medication being prescribed. If the patient feels that the side effects are intolerable, or simply cannot afford it, it doesn’t matter how reasonable the choice of medication might be since the patient will not take it. The physician should check with patient to ensure they are comfortable with the medication being prescribed. Likewise, patients should not hesitate to speak up if they have concerns about a medication being prescribed for them.

In summary, physicians consider a multitude of factors in choosing a psychiatric medication for a patient. Ultimately, the decision about a medication should be a collaborative one between the psychiatrist and the patient.

Where to go for Mental Health

By Sara Coffey, D.O.



Sara Coffey, D.O.



Trying to find the right doctor for you? With so many specialties and titles it can be confusing to navigate the complex array of mental health professionals. So, where do patients with mental illness start?

Understanding a doctors training and background may be the first place. Patients with mental illness may be seen by their primary care doctors, counselors, psychiatrists, or psychologists. But, what makes these professionals different? All physicians, either M.D.’s or D.O.’s (Osteopathic Doctors), have similar training. Most often, they have completed four years of undergraduate school, with an emphasis on science courses including biology and chemistry. Then they must pass an entrance exam to start a four-year medical school program where they will receive two more years of core science training as well as other courses to help them understand the human body, disease, and prevention. The last two years of medical school focus on clinical rotations through surgery, OB/GYN, psychiatry, internal medicine, family medicine, and include several months of extra training in a specialty area.

Upon completion of medical school, you are officially referred to as “doctor,” but a psychiatrist’s training does not end there. A residency program comes next with hands-on training under the guidance of a more seasoned physician. Take my background for example. As a psychiatry resident, my first year of residency training included two months working on an inpatient pediatric floor, two months on an inpatient general medical hospital floor, and two months on a neurology service. These rotations are important in psychiatry training because psychiatric patients often have other medical issues in addition to mental health problems. A physician should know the difference between anxiety and a heart attack.

It takes eight years or more of school and four to six years additional years of training to become a fully practicing psychiatrist. I’m on that path, and now I will be able to focus on my psychiatry specialty. That will give me the opportunity to learn the science and art of treating patients from experienced psychiatrists. My integrative medical training will also provide a solid foundation to work with a variety of patients and their mental illnesses.

It's Not Your Fault

Healthy Minds. Healthy Lives. blogger Gariane Phillips Gunter, MD, talks about how individuals with mental illnesses cannot be blamed for mental illness and how to get help for someone struggling with mental health issues.

Getting Help Gets a Good Customer Review

By Molly McVoy, M.D.



A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.



The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).

 

This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.





In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.



The bottom line is, treatment works and, it appears, most of the public knows it!

Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;


• community mental health centers;


• hospital psychiatry departments, outpatient clinics and/or inpatient units;


• family services, social agencies, or clergy;


• peer support groups;


• private clinics and facilities;


• employee assistance program; or


• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

Maintaining Health in Stressful Jobs

By Bill Callahan, M.D.



I have been asked frequently in the past 10 days how psychiatrists deal with their own reactions to what they hear every day and what its impact is on them.







When I became a psychiatrist after five years as a flight surgeon in the military, I was struck by how much of the four years it takes after medical school to become a psychiatrist was spent on making sure that we dealt with our emotions, knew our own warning signs for stress, and would set limits on a reasonable work load. We are also trained to know when to ask for a consultation with a colleague, or to get additional training for ourselves. Our educational requirements are life-long and part of our commitment to do our best for you.



A big part of my role is to be the “personal trainer for emotions.” At the end of each day, after spending eight hours immersed in the emotions and struggles of other people, I spend some time experiencing the different emotions that work caused in me. That will mean being able to cry to relieve sadness that is created, feeling the full impact of anger, as well as the affection I feel for the people I work with. This process lowers anxiety and stress and prevents a toxic buildup of emotion every day.



In future posts I will talk about how to feel healthy anger, since I find this is the most misunderstood emotion, and the fear of feeling it is a major source of stress for many.



I already had the fundamentals of a healthy life from my military flight surgeon experiences. Daily exercise for at least 45 minutes, combining aerobic and weight training, sleeping from 7 to 9 hours a day, moderate alcohol use and avoiding it all together when under increased stress or emotional strain, and making sure I took time to have fun with family and friends are things we can all do as well.



Please leave your own tips for what you do to relieve stress in the comment section.