Medication Management with Dr. Kevin Marra
May 30, 2019
“Do I have to take medicine as part of my treatment?”
“I’m hesitant to go on medication because I don’t want to become dependent on something that’s not already naturally in my body.”
“Lately, I’ve been feeling much better and am able to stay focused, so I’ll stop taking my medicine since I don’t need it anymore.”
“Will medication be a permanent part of my life now?”
Like many aspects of mental health, the role of medication management in holistic treatment is often misunderstood. Preconceived notions are often based on a lack of education. We all know that media, especially Hollywood, can be guilty of twisting the truth for sensationalism. So, part of our job at HopeWay, besides offering an excellent level of care, is to provide accurate education around elements of treatment like medication.
I read something the other day that was posted as part of mental health awareness month:
“My brain not making enough serotonin is no different than my pancreas not making enough insulin.”
This statement is essentially relating the biological nature of depression to the biological nature of diabetes. And here’s the thing - mental health illnesses are biological. Because they are brain diseases, treating them with medications is oftentimes recommended for the best result.
While not every client at HopeWay is on medication, it remains a key piece to many other success stories. We work individually with each client to create the right treatment plan that will work for their particular situation. Our ultimate goal is to help them find lasting success in dealing with their mental health challenges during normal everyday situations.
Step One: getting the right diagnosis.
Before any client begins treatment at HopeWay, they sit down with one of our board-certified psychiatrists for an individual consultation. This comprehensive level of service allows us to begin to identify an accurate diagnosis based on information gathered from that individual’s outside provider combined with what we see during the consultation.
An accurate diagnosis will, in turn, inform which medicines we may choose to administer to that client, if appropriate and beneficial to their treatment. For example, there are some diagnoses, like schizophrenia or bipolar disorder, where we would strongly recommend medication as part of treatment for the most effective outcomes.
Step Two: formulating a treatment plan.
From a psychiatrist’s perspective, after a complete assessment is done and a diagnosis has been determined, the clinical and medical staff work together to formulate a treatment plan that could include medication. All of our recommendations stem from evidence-based practices. We strive to prescribe the least amount of medication at the lowest effective doses for our clients so as to avoid polypharmacy – a term that refers to being on many medications which may interact with each other or cause unforeseen side effects.
We certainly get pushback from some clients, or even their family members, about incorporating medication as part of their treatment plan. We generally take the time to explore their hesitation, provide education that may clear up any misconceptions and remind them that there is reliable scientific evidence suggesting proper medication works, especially when combined with other therapies.
One common concern about taking medication is the fear of becoming “dependent” on it. To be fair, some medicines do have a physiological dependence as well as abuse potential. At HopeWay, we actively try to avoid such medications unless there is a strong inclination. We also provide education to clients who may have a goal to eventually come off meds altogether.
Step Three: medication management.
At HopeWay, part of how we monitor the client once they begin a recommended treatment plan is through medication management. We specifically watch for effectiveness and potential side effects.
Think about it this way. If someone were having an issue with their blood pressure, their primary care doctor would pick a medication that best fits the medical needs and then continually observe whether it’s effective, making adjustments as needed.
Monitoring the effectiveness of a medication truly depends on the illness and the medication. For example, antidepressants sometimes take weeks before someone notices a change while some medications that are used to treat anxiety may start to have an effect after only a couple of hours.
Once anyone begins medication as part of their mental health treatment, whether at HopeWay or elsewhere, I always recommend that they also participate in therapy. Medicine alone is not enough. Because there are many psychological components to one’s mental health, HopeWay’s individual and group therapy sessions, as well as integrative therapies, are key components to our comprehensive model of care.
As clients prepare to leave HopeWay, some of them wonder if medication will remain a permanent part of their life.
The answer is simply that it depends on the diagnosis, how many episodes they have had in their lifetime and what psychosocial stressors they expect to encounter. For example, if someone has had more than 2 episodes of major depression in their life, the chances of having a third one may be so high that we recommend antidepressant treatment indefinitely. Alternatively, if this is only their first episode, we typically recommend 9 to 12 months of stability on a medication before there is consideration for coming off of it.
When a client “graduates” from HopeWay, they are educated on the importance of consistently taking medications and participating in therapy/self-care. Unfortunately, some people will skip a dosage of their medication, or just quit all together, because they don’t feel it is important or even necessary.
I think of a prescribed medication routine as similar to wearing a seatbelt while driving a car. When a person initially stops their medication, they may not immediately see the symptoms. But if there is any kind of stressor in life, or a vulnerability a person comes up against, the protective barrier of medication is not going to be there if they are not consistently taking the proper dose. Similar to being in a car wreck without a seatbelt, this places the client at risk of a relapse.
It is important to stay on medication if it is part of treatment. The routine of it really is important and can even affect other aspects of a person’s life. For example, according to the World Health Organization, depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease. It accounts for the most days missed at work or school, a high level of lost revenue, etc. So if an individual is prone to depression, and they experience an episode that takes them to the hospital because they didn’t take their medicine, or perhaps someone misses 4 weeks of work, that would be a reason right there to stay on medication so that life can continue on as usual.
In summary, we, as psychiatrists, are here to help our clients find prolonged wellness through effective treatment plans that can potentially include medications in addition to therapy and other lifestyle changes. It is important to be open with your psychiatrist so that an accurate diagnosis and treatment plan can be made.