Are Medications the Answer?

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Patients often share with me the concern that too many medications are used today. They feel that health care providers have only a few goals in mind, collect the fee, see the patient as quickly as possible, write the prescription and send them on their way.

On the surface it does seem to be true. The evidence on the number of prescriptions that are written for mental health issues annually is pretty impressive. According to the American Psychological association one in five adults is now taking at least one psychotropic medication. In 2010, Americans spent more than 11 million dollars on anti-depressants. With the launch of Prozac in 1987, the research and development of medications to treat depression skyrocketed. The reasons were many, but the side effect profile was the big seller. Believe it or not prior to Prozac most anti-depressant medications caused so many side effects that only the very, very symptomatically depressed would entertain the notion of medications. Then, low side effect profiles for the new drugs made them much more palatable to a larger group of mildly/moderately depressed patients. Prescribers of all specialties also felt more comfortable writing prescriptions for these medications especially if the patient declined the idea of alternate first line psychotherapy. However, the vast majority of people would be wise to trial an experience of something called cognitive behavioral therapy first. The vast amount of science done in this area indicates that therapy is THE initial treatment for depression symptoms. Yet, most patients and prescribers don’t start with that treatment. Patients must indicate that the first line treatment is what they are looking for. First line treatment just means that the recommendations are ranked in order of priority. Practitioners should always start with first line treatment and then move down the list to more intrusive/invasive recommendations. For mood issues, Psychotherapy is almost always first line. Clearly there are patients who require medications to manage or treat the acute (short term flares) of their depression symptoms, however it shouldn’t necessarily be the first treatment.

In my experience, patients can be a little resistant to therapy for many reasons. It takes time, it takes research, it takes money and finally it takes work.
Prioritizing the time for psychotherapy on a weekly, bi-weekly or even monthly basis tends to be a barrier to treatment for some patients. It seems like a lot of effort to put in when there are pharmaceutical alternatives. Many patients prefer to take their pill in the morning and get on with their day. My recommendation is to see a therapist for a few weeks, one to three visits and get their expert opinion on whether they think medications could be helpful. Take the time to work through a few things prior to treating with medications.
Also, it can be difficult to find the right therapist. As the saying goes, you may have a kiss a few toads before you find the prince in many cases. So it is with therapists. Finding the right person to work with is key. Therefore, my recommendation is to get several recommendations from friends, family, your primary care provider and your insurance company. Then start making calls. Finding a therapist with convenient location, hours, insurance panels will inevitably cancel out a few choices. However, you’re bound to find one that works. Make a appointment and go with an open mind and heart. If you get through a couple of appointments and don’t feel like the relationship works for you. Start the above process again, and keep going until you find the one that fits your personality and needs.
Another barrier to treatment is financial, not all therapists take insurance or participate in a limited number of panels. Often therapists will take self-pay only and provide a receipt for the patient to submit to insurance to be reimbursed. Patients need to decide what kind of budget they can allow for therapy.
The final barrier to treatment is that therapy is work. Patients must commit to intensive self-study during this period. Managing symptoms often requires noticing them, noticing the responses to them and bringing that information into the session with the therapist. It’s hard work to look hard within and try to change responses to emotions. This can be a huge barrier to treatment if the patient is not ready.

Make no mistake, I am a Nurse Practitioner who prescribes medications. I often write prescriptions to help patients over the hurdles of their symptoms in their mental health issues.Yet, most medications can be trialed temporarily and managed with expert recommendations. Nothing has to be forever.

However, my treatment recommendations for mood disorders never end there. I also very often write very serious prescriptions for things like regular exercise (outdoors), a very healthy diet with limited sugar and stimulants like caffeine, quitting smoking, as well as the old fashioned hard work of meeting with a therapist regularly to work through emotions, feelings and behaviors. Because the science continually tells us that medication is only an adjunct to those treatments not in place of them.

Who should take care of you?

How to choose a Mental Health provider.

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There are so many variables in choosing the right provider for you. Do you want a psychiatrist, a therapist, a psychologist? What’s the difference? Do you want or not want medications? Might you want medications later if therapy alone doesn’t seem to be helping enough. Do you want a man or woman? Do you want to use insurance? Do you have insurance? Does your insurance cover mental health needs the way you need it toDoes the provider have availability, a waiting list, or no openings?

  • A psychiatrist is a medical doctor who specializes in mental health, they might diagnose and treat mental health disorders, provide psychological counseling and prescribe medication.
  • A psychologist is trained in psychology, the science that deals with thoughts, feelings and the behaviors that follow.  A psychologist can diagnose and treat mental health disorders, they usually do not prescribe medications. A psychologist may have relationships or referrals that she may make to another provider that evaluates and treats with medications.
  • A psychiatric nurse practitioner or physician assistant may diagnose and treat mental health disorders, they may also provide psychological counseling and prescribe medication.
  • A licensed clinical social worker and licensed professional counselor may provide assessment, diagnosis and counseling, they do not prescribe medication.

The decision for who will provide treatment for you includes several issues. First, you should think about the condition for which you need treatment. The more serious the condition, the more expertise and training will be needed for evaluation and treatment decisions. Also you need to manage thoughts about whether or not medications are needed or wanted to help with your symptoms. Most patients can benefit from a variety of treatment modalities and sometimes medications are needed at least temporarily to help manage activities of daily living. The final part of your decision making includes the issue of insurance coverage. If you have mental health benefits your coverage may be limited by the company. It is also very possible that local providers in your area do not accept insurance. Depending on the need and financial means, you may decide that paying out of pocket for this type of treatment is worth the level of care and convenience.

Next steps:

  1. Ask your health insurance for a list of providers, ask for several referrals at the first phone call. This can save you time later. It can take several calls to find a provider that is taking new patients.
  2. Ask for a referral from your primary care provider, friends, family or clergy.
  3. Check the ever present internet, there are several places to find good information about providers that might fit your needs. Check local listings for the above types of providers, check Psychology web sites. https://therapists.psychologytoday.com/rms/prof_detail.php?profid=300865
  4. Call several providers and see who is taking patients, who has convenient hours and affordable rates.
  5. Finally, meet with a provider and see if they suit your needs. If at first you don’t succeed do not lose heart, it’s not always a good fit the first time around. You must continue to seek the treatment that you need. Move to the next name on  the list.