The Role of Medication in Treatment
Psychiatric medications, also known as psychotropics, play a key role in treating serious mental illness. They reduce symptoms by regulating complex processes in the brain that affect emotions and thought patterns. In some cases, psychiatric medication may be a short-term aid taken only for a few months. In others, medication may be long-term, or even lifelong.
Although psychiatric medications cannot cure mental illness, they can often significantly improve symptoms of mental illness. Psychotropics can help make other treatments, such as psychotherapy, more effective by increasing an individual’s energy level and concentration. Some mental health conditions can be managed with psychotherapy alone, but if illness is more serious, the ideal is a combination of psychotherapy and medication. Some people are afraid that taking a medication will change their personality, but most find that medication allows them to take charge of their lives.
However, predicting who will respond to what medication can be difficult because different medications may work better for one person than for another. Doctors usually review clinical records to see if evidence exists for recommending one medicine over another. They also consider family history and side effects when prescribing medication.
Your provider often starts at a low dose and slowly increases dosage to achieve a level that improves symptoms. Following your provider’s instructions will reduce side effects and discomfort when possible. Understand the role medicines can play for key symptoms.
Treatment typically consists of pills or capsules, taken daily. Some medications can also be available as liquids, injections, patches or dissolvable tablets. People who have difficulty remembering to take medications daily or people with a history of stopping medication may have better results by taking medication as a shot or long acting injectable at the doctor’s office once or twice a month.
How long does it take for medications to work?
Examining the patient’s previous response to a psychotropic, fine-tuning a dose, evaluating a current response and monitoring side effects takes time. There is a great deal of variation in an individual’s response to a specific drug. Some therapeutic effects are immediate but most take weeks or months to achieve. In the interim, the provider needs the patient or family to describe reactions to the medication so that a beneficial dose can be achieved.
Be persistent until you find the medication, or combination of medications, that works for you. If you feel as though a medication is not working, or you are having side effects, discuss possible adjustments with your provider. Side effects typically go away within a few weeks but, if they continue, changing medications or dosage may be necessary.
General side effects of meds and when to call a doctor
There are many possible side effects to psychiatric medications.
Some patients may have no to minimal side effects while others may report intolerable side effects. In general, expect side effects first and then as benefits gradually increase, side effects usually subside. Expect your provider to discuss possible side effects with you for the specific medication that you are taking. It’s important to let the provider know how you are responding to the medication, whether you have a lessening of symptoms of the illness or if you have questions about side effects.
Check a specific medication’s side effects and more serious adverse effects at www.drugs.com or with handout from your pharmacy. Side effects are common, often predictable, and usually refer to symptoms that are less harmful than adverse reactions, while adverse effects are unexpected and usually harmful. An adverse effect usually requires discontinuation of the drug, and switching to another drug or a dose reduction. Additional medication information is available through the online Physicians’ Desk Reference (PDR).
Importance of staying on medication unless advised by a doctor
Sometimes when a patient has been on medication for some time and feels better, they may believe that they no longer need medication. Always discuss your concerns with your doctor before considering medication changes. Stopping medication suddenly can result in uncomfortable side effects or a return of symptoms of the illness. If your provider advises stopping a medication, it is essential to taper off slowly under your provider’s supervision to avoid uncomfortable side effects.
Keeping a record of medications
It is important for patients to keep a detailed record of prescribed medications. Sometimes, depending on a patient’s limitations, this may be difficult to accomplish. A family member can play a vital role in keeping records about a medication history.
Following are key parts of that history:
- Name of drug prescribed and dose
- Length of time taken, months or years
(These records are available from the patient’s pharmacy)
- Was the medication taken as instructed?
- History of medication response
- Was the medication effective? How?
- Did the patient report side effects?
- Prescriber name & contact info
Such a record can be a huge help to your loved one’s provider and prevent the patient from being prescribed something that they took before and either did not work or had intolerable side effects. Too often when a patient is admitted to the hospital, there are no records or incomplete records about medication history. Supplying this information can help achieve a better outcome for your loved one.
As the family advocate for the patient, record keeping of medications and other pertinent history, e.g. dates of previous hospitalizations in a permanent file is an important task.
Role of substance use on effectiveness of medications
People with both a mental illness and a substance use disorder – called dual diagnosis or co-occurring disorders – may abuse substances in an effort to relieve symptoms that cause distress.
- When two or more drugs are taken at the same time (whether they are legal or illegal) it is likely that one drug will change the effects of the other. Sometimes this may cause a toxic result. Depending on the specific drugs, their effects may become increased or decreased. For example, consuming alcohol, a central nervous system depressant, may reverse or weaken the effect of an antidepressant.
- Chronic substance use makes a mental illness that would have been treatable more severe and disabling, and is an obstacle to recovery.
Generic vs. name brand
Generic medications are copies of brand name medications that cost the consumer significantly less. These copies are made to work like the brand name medication in form (capsules, tablet, shot), strength, safety, how they are given, quality, and what they do. They are checked by the FDA just like the brand name medications. It is important to know that generic medications will look different than the brand name. Differences may include size, shape, and color. These differences are not supposed to change how the drug works.
A generic medication is supposed to work in the same way and give the same benefit as the brand name version. However, sometimes patients report a particular generic medication does not act as expected. Generics made by different manufacturers may have slight differences that result in undesirable effects in people who are more sensitive to these differences. In this case, one should discuss this with the pharmacist and request an authorized generic medication.
An authorized generic is identical to the brand name because it’s made by the same manufacturer sold under a private label at generic prices.
Who can prescribe medications
The following health care professionals can prescribe medication. They may also offer assessments, diagnoses and therapy.
Psychiatrists are licensed medical doctors who have completed psychiatric training. They can diagnose mental health conditions, prescribe and monitor medications and provide therapy. Some have completed additional training in child and adolescent mental health, substance use disorders or geriatric psychiatry.
Degree requirements: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), plus completion of residency training in psychiatry.
Licensure & credentials: Licensed physician in the state where they are practicing; may also be designated as a Board Certified Psychiatrist by the Board of Neurology and Psychiatry.
Psychiatric or Mental Health Nurse Practitioners
Psychiatric or mental health nurse practitioners can provide assessment, diagnosis and therapy for mental health conditions or substance use disorders. In some states, they are also qualified to prescribe and monitor medications. Requirements also vary by state as to the degree of supervision necessary by a licensed psychiatrist.
Degree requirements: Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with specialized focus on psychiatry.
Licensure & credentials: Licensed nurse in the state where they are practicing. Examples of credentials include, but are not limited to:
- NCLEX, National Council Licensure Examination
- PMHNP-BC, Board Certification in psychiatric nursing through the American Academy of Nurses Credentialing Center
Primary Care Physicians
Primary care physicians and pediatricians can prescribe medication, but you might consider visiting someone who specializes in mental health care. Primary care and mental health professionals should work together to determine an individual’s best treatment plan.
Degree requirements: Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (DO).
Licensure & credentials: Licensed physician in the state where they are practicing.
Family Nurse Practitioners
Family nurse practitioners (FNP) can provide general medical services like those of a primary care physician, based on each state’s laws. Like primary care physicians, they can prescribe medication, but you might consider visiting someone who specializes in mental health care. Family nurse practitioners and mental health professionals should work together to determine an individual’s best treatment plan.
Degree requirements: Master of Science (M.S.) or Doctor of Philosophy (Ph.D.) in nursing.
Licensure & credentials: Licensed nurse in the state where they are practicing. Examples of credentials include:
- NCLEX, National Council Licensure Examination
- FNP-BC, Family Nurse Practitioner Board Certified
Psychiatrist pharmacists are advanced-practice pharmacists who specialize in mental health care. They can prescribe or recommend appropriate medications if allowed in their state and practice setting. They are skilled at medication management—meaning they evaluate responses and modify treatment, manage medication reactions and drug interactions, and provide education about medications. Many have completed additional training in child/adolescent psychiatry, substance use disorders or geriatric psychiatry.
Degree requirements: Doctor of Pharmacy (PharmD). Completion of residency training in psychiatric pharmacy is not required, but is common.
Licensure & credentials: Licensed pharmacist in the state where they practice; may also be designated a Board Certified Psychiatric Pharmacist by the Board of Pharmacy Specialties.