According to statistics compiled by the CDC, more than 16 percent of adults in the U.S. take some sort of daily psychiatric medication, with depression and anxiety propelling usage rates. Some estimates are even higher.
But mental health treatment is not a one-size-fits-all fix, so medication monitoring and tailoring are critical components of successful outcomes. While this process may seem daunting, Psychiatry Connection co-founder Timothy Jeider, M.D., recently broke it down into manageable steps, explaining what patients can expect in terms of prescription management.
A Holistic, Minimalist Diagnostic Approach
“First off, to understand patients, we use what’s called a ‘biopsychosocial’ model, which is threefold,” said Jeider, a double board-certified psychiatrist who noted that psychiatrists are medical doctors who can write prescriptions to treat complex mental conditions, whereas psychologists specialize in talk-therapy and behavioral interventions. “The bio part is neurochemistry, then there are psychological aspects such as coping skills and conflict-resolution skills; can you handle stress and de-escalate or do you fly off the handle and punch a wall? And then there’s your social situation such as how you were raised, where you live, if you’re in a relationship, have children, are financially strained and those kinds of things. It’s important to look at the whole picture and put it into context, because there’s no amount of Prozac that’s going to make you happy if you’re in, say, a violent relationship.”
Jeider added that sometimes where psychiatrists go wrong is merely addressing biology and prescribing antidepressants or anti-anxiety medications without taking into account these external factors. He warned that this is a limited approach to mental health, and that talk-therapy in conjunctions with medication is vital to any treatment plan.
Jeider said the best initial approach to prescription medications is low and slow, meaning the lowest dosage that’s appropriate for a patient’s age, size and gender. As a general rule of thumb, it typically takes about four to six weeks for most medications to kick in, so assuming there are no negative side effects—which typically manifest during the first week or two—a patient should have his or her first follow-up appointment about a month later.
Keeping Tabs on Progress
At that point the psychiatrist will assess a patient’s overall response, taking several factors into consideration.
“This includes questions such as: ‘What was your response like? Did you tolerate the medication? Were there any side effects?’” he said. “If I gave you a medicine you’ve got to take three times a day, are you remembering to take it? Or maybe the medicine I thought was going to wake you up makes you kind of sleepy, and now you can’t get up for work in the morning. Well, that’s going to affect your social situation because you’re stressed because you’re tardy all the time, so let’s take the medication in the evening instead. This is where the collaborative nature and that feedback work together in a robust approach.”
Getting the Correct Medication in the Correct Dosage
Follow up is also critical to determine a patient’s correct dosage. If there have been no negative side effects but zero positive effects, adjustment might be made to the dosage. Jeider said most people don’t get a perfect response on the first low dose, and baby-steps and fine-tuning are often necessary.
On the flip side, some patients might have a great response, and it might be necessary to scale the dosage back.
If a patient experiences negative side effects, Jeider tells him or her to stop taking the medication and let it wash out of their system for a few weeks.
“At that time, we’ll kind of reset the equation and digest what happened in more detail and come up with a new strategy,” he said. “Early on, you do want more regular follow up so you have access to give that feedback: Yes, it’s working, or no, it’s not. This allows your doctor to be responsive. It’s kind of like if you break a foot you don’t go to the doctor and get a cast and then check back in six months. But the frequency of follow up for mental health treatment can go for longer intervals once stability is achieved.”
