SHOULD I TAKE MEDICATION?

The most common thing I hear from my patients a few weeks or months after starting medication is that they only wish they had started treatment a lot sooner. Usually they say this with tears of relief and joy in their eyes. It's bittersweet. They did not have to suffer from their symptoms for so long. They did not have to work SO HARD EVERY DAY to keep on keeping on. They did not have to pull up those bootstraps constantly to get through moment to moment coping with all they had to handle.

They also tell me their only regret about treatment is letting things go on for so long untreated. That it really has helped. That it makes everything so much easier with that support for their mood. Yes, it is always worth trying therapy if you are not certain that you want to be on medication. As I say here, I always recommend weekly therapy anyway. But if you are not improving with therapy alone pretty fast (off medication), you may want to think about being on treatment with medication for at least 9-12m. Studies have shown us that stopping sooner, most patients will start to feel the same symptoms as before. And while you are taking medication, that is a great time to learn the tools and skills you need like those here. That way you have them in place when you do stop. Then you will know how to manage your moods with, or without medication. When ready to stop, you should work with your prescriber on a weaning plan. Your dose is gradually decreased over time so that you don't have significant withdrawal symptoms and so that you gradually adjust to being off the mood support the medication provides. However, you would never want to start unless you felt 100% certain that it was the right thing for you. And, I hate to see people suffer year after year, decade after decade without help that makes things easier. If you want to try without medication it is critical that you modify your lifestyle drastically so that you are doing all the other things. What can make this difficult is that when you are having problems with your mood, often you have very little motivation, energy, focus, ....all the things we need to launch such a huge effort. If you are on the fence about taking medication, I want you to have the benefit of knowing this information as you make decisions about how to proceed. The decision is always up to YOU.  I will support your decision regardless of if you decide medication is for you or not.  You CAN continue to see me for visits to check in. That way you have access to ask me any questions you have about treatment. You can do all the other things listed on this website for now and I know that it will help in some way.  If you find that isn't working, I suggest you schedule a follow up soon to talk it out and consider medication again. 

It is very important that you know about your prescriptions and that you take them as directed.   

ALWAYS Read the med information document that comes with it every time you get a new bottle, even if you have been on it for a long time. There are important side effects, interactions, and instructions on how to take the medication. You need to know this information. The information may change over time. If you have strange symptoms, if you have not learned the side effects of your medication, you may not recognize it as a serious side effect that you should report to us for your own safety. So reading and knowing that information is really important.  It also helps to know which common side effects that are not harmful, so that you know what can be expected when you start medication.

IT IS VERY IMPORTANT THAT YOU ARE AWARE OF ANY WARNINGS REGARDING THE MEDICATION.

THESE ARE GENERALLY CALLED "BLACK BOX WARNINGS".  

READ THE LABEL EVERY TIME YOU TAKE A PILL OUT

Always take a moment to check the label on the bottle too to be sure you are taking it correctly. Sometimes when you start at a lower dose and then increase it over time, with subsequent refills we will increase the strength of your tablet or capsule and drop you back down to 1 daily. So making sure you are taking the right dose is important for your safety. 

On most platforms, you will eventually see your list and info for each med on your profile. If you do not have access to the medication information yet, WebMD is a great resource to look it up.

You can and should always check interactions between medications and can easily do so there.   

And remember, every time you see a medical provider you should make sure they have your complete list of prescriptions, over the counter meds, vitamins, supplements, herbals, alternative therapies, etc. so that they can check for interactions. For this same reason it is always best to use the same pharmacy for all prescriptions when possible. And you should also check for interactions yourself by running them through the interaction checker on WebMD. This is very important for your safety.  Please update us anytime you stop or start anything you take.    

HOW TO START NEW MEDICATIONS OR CHANGE DOSES

When you start a new medication for your mood, or change doses, make sure you plan ahead. You should plan this when you have a day or two when you do not have to work, drive, operate heavy machinery, care for small children, or make important decisions. Sometimes when you start a new medication for your mood you may feel extra fatigue, wooziness, "out of it", or have nausea, headache, etc.. Typically these side effects go away or you get used to them within a few days. Let us know if any red flag or significantly bothersome side effects occur. But you want to know this and plan ahead, so that you can be safe and have time to adjust.     

Many medications for mood may take a few weeks to a few months to feel effects or the full effects.  I heard someone describe it as having to get through the forest to the other side.  So don't expect to magically feel better as soon as you start.  It is a process.   The non-medication interventions discussed below start pretty quickly though! So focus on maximizing your use of  these tools and ramping up to living the healthiest lifestyle you can. Get started on learning about your conditions and how to manage symptoms. Get into counseling/coaching/therapy/groups right away. They too will help tremendously. Remember, you cannot build a house with only a hammer. And medication alone may help, but to get better in a big way, you need to make some big life changes. It sounds like a lot, but trust me that the little things add up, so keep doing as much as you can to get better every day. One day you will see that things are much improved and it was worth all of the effort.

SPECIFIC SIDE EFFECTS AND INTERACTIONS TO BE CONCERNED WITH

If you have any side effects that bother you a lot, you should always let us know right away. There are some that are particularly concerning that you need to know about so that you know to stop your medication, seek medical care immediately, and then let us know right after. That would include:

SEROTONIN SYNDROME (click here to read more on this) 

SEIZURES

NEW , UNUSUAL or WORSENING SUICIDAL FEELINGS

UNUSUAL RASHES  

SEEK HELP IMMEDIATELY!

It is also important that you know that EXCESSIVE SEDATION can occur.

LIMIT DRIVING OPERATING HEAVY MACHINERY AND OTHER ACTIVITIES REQUIRING ALERTNESS! 

REPRODUCTION AND FERTILITY

If you are attempting to become pregnant, are or think you may be pregnant, are having sex without any or inadequate contraception, or you are breastfeeding or planning to, it is important for you to know that some medications can cause harm to a fetus, or you, when pregnant. Certain medications are safer to use in pregnancy. But others may cause serious pregnancy complications. I always recommend that everyone prevent unplanned pregnancy. This is true regardless of which partner is carrying the baby. Having a pregnancy that is unplanned at minimum creates many layers of complexity in your life. And when you are coping with uncontrolled symptoms of anxiety, depression, etc. having an unplanned pregnancy can sometimes cause your life to get very stressful. So everyone should be ready, very prepared and plan ahead for conception when the time is right. That does not always happen. Actually most pregnancies are unplanned. So it is important that if you are at risk of becoming pregnant that you are using a highly effective form of birth control. Talk with your primary care provider, gynecologist, or urologist about the most effective ways to prevent an unplanned pregnancy for your specific needs and about how to achieve a safe health conception when you are ready. And if you may or do become pregnant or plan to start breastfeeding, you should always speak to your primary care provider and all specialists like me about this ASAP. Your prescriptions, over the counter preparations, vitamins, supplements, herbals and alternative therapies should be discussed as some may not be safe to continue taking. If you are planning to become pregnant, you may need to stop or switch certain medications. And those who are pregnant had safer treatment options to choose from. So you don't have to stop treatment in most cases which helps you stay on your path to mental and physical wellness. 

WHAT IF MY MEDICATION IS NOT WORKING? 

Like I mentioned above, it takes a few months to reach optimal effect. That is why in many cases we increase your dose after a week or so to get you there faster when we can. But sometimes the first, second, third, etc. medication you try does not work well. The good thing is that there is a very long list of medications to try. There are different categories to try too. And sometimes certain medications can be combined for better effect. It is important for you to know this because we don't want you to feel like things are hopeless if the first thing we try does not work. Getting on the right medication plan for you can sometimes be a process.   It is important to stick with it so that eventually things can get better. And if you try a few medications and they do not work, sometimes you will then qualify for more advanced treatments. As we work through the process, we will make adjustments and consider referring you for more advanced care and treatments if you are not improving.