Therapy has been shown to be instrumental in the recovery from almost every mental health concern for nearly a century. Meeting with a well-trained therapist who utilizes therapies supported by research not only significantly decreases symptoms, but is instrumental to improvement in quality of life in terms or relationships, social, and occupational goals. Although therapy is highly effective for most mental health concerns, changes in the brain as a result of therapy are often slow. Most “short term” therapy lasts about 16-20 weekly sessions and that is after assessment, diagnosis, intake, and history gathering. New research has found most people are in therapy for a year or more (and average of 52 to 75 weekly session) before they feel as though they’ve met their goals.

While therapy is incredibly effective at times a person’s distress is so immediate, they can’t wait weeks or months to begin to feel better. Some clients find that they struggle to make progress towards their goals, even when they’re putting forth maximum effort. This could be due to any number of reasons - symptom severity, a client is in crisis and needs relief faster than therapy can provide, someone is experiencing a major mental health concern (e.g., bipolar disorder, PTSD, major depressive disorder, psychosis) or their brain needs help regulating neurochemicals.

What happens when therapy isn’t enough? This is often the point at which medication(s) will be considered for clients.

Many people are hesitant when the topic of medication comes up. This is often due to mistaken beliefs about medications, how medication works, and being uninformed about the process of receiving and taking medication for mental health concerns.

Below is a conversation about medication from two different perspectives. Kris Ancho, is a Psychiatric/Mental Health Nurse Practitioner. This means he has obtained highly specialized education and licensure to be able to assess, diagnose, and treat patients utilizing medication and therapy. Kelly Anderson is licensed clinical psychologist specializing in the treatment of clients using psychotherapy. We discussed some of the most frequent questions and concerns clients have when considering medication as part of their comprehensive treatment.

When would a medication consultation be recommended for a patient?

Kris - From my perspective medications are an important component in managing and treating mental health symptoms. If non-pharmacologic approaches, such as psychotherapy, do not provide adequate response, medication consultation may be warranted.

Kelly - Yes, agreed. When I’m working with a client who has not expressed interest in medications, I don’t tend to introduce that into the conversation unless, as you said, therapy doesn’t seem working or working as well as the client may want. The other time I broach the topic of medication is when the client can’t do the therapy work. Sometimes clients have such intense symptoms that they can’t use the skills and strategies that we’re trying to implement.

Kris - Right. Research has shown us that psychotherapy is just as effective as medication, people tend to respond equally well to both. And we know that combining them together will have even better outcomes. 

Kelly - I find a lot of my clients are surprised to hear this and I love to remind them that in addition to working a bit better, the combination of medication and therapy also tends to work more quickly - so people find relief from their distress faster!

What can a patient expect at a first medication management appointment?

Kelly - I find that many of my clients who are uncomfortable with the idea of medication are pretty nervous when thinking about a first appointment. They often seem to think that someone will be forcing medication or get upset if someone is hesitant about meds. How would you describe a first appointment with you, Kris?

Kris - Your first visit will take approximately 60-75 minutes. First, I will conduct a comprehensive mental health assessment gathering your psychiatric and medical history including mental health symptoms, treatment, and medications.

Kelly - So not so much unlike a first session with a therapist.

Kris - Exactly. Second, we will establish goals and create a treatment plan that works for you. Finally, it is important that you complete the questionnaires prior to your first appointment to maximize our time. This will also assist in establishing our goals and treatment plan.  I like to have time for follow-ups with patients and will meet with most for 30-45 minutes to ensure that we have time to discuss all their concerns and that the medication is working as expected.

Should all patients expect to leave a consultation with a prescription? 

Kelly - And then after establishing goals. you prescribe medication to each patient?

Kris - Not necessarily, there are non-pharmacological treatments available in targeting mental health symptoms such as eating healthy, exercise, good sleep hygiene, and psychotherapy. Depending on the initial intake appointment, we can discuss and determine whether or not medication is needed. 

Kelly - Meaning that it isn’t unusual if someone leaves a medication management consultation, or even a follow-up without medication. Let’s talk about those folks who are prescribed a medication.

If a patient starts medication, do they stay on it forever? 

Kris - It depends on the diagnosis and medication. In regards to antidepressants the answer is no. Current guidelines recommend waiting at least 6 months from the time the patient is in remission or free of symptoms. Diagnoses that appear to be more important to manage with medication long term tend to be more serious mental health diagnoses such as Bipolar Disorder or psychosis, but every case is different which is why an individaulized treatment plan is so necessary.

Kelly - Yes, for many people, once they’ve been free of symptoms for a while, it’s typical to try to taper off the medication. I know that I’ve worked with many clients, in tandem with their prescribers, to taper off of medications while I’m there to help reinforce skills and can provide more objective assessment to see if symptoms are returning.

What if a patient tried a medication in the past and it didn't work or they had bad side effects?

Kris - Medications have their unique qualities and some are better tolerated than others. To minimize the possibility of adverse reactions, we can start the dose at the lowest possible to determine the client’s tolerability and/or they may also take the medication with food, for example.

Kelly - And this is also why there are many types of medication that treat the same symptoms, so if one is intolerable, there are often other options. I’ve often heard prescriber’s working with clients to even individualize when or how to take meds. Is that accurate?

Kris - Yes, for some people certain medications may improve your energy levels, therefore, would be best to take in the morning. Or it may cause sedation in which case would be best to take at night to help with sleep. 

Kelly - To me this reinforces the idea of finding a prescriber you trust and feel comfortable with and who can work with you to find the best medication and plan.

Is there ever a time medication would be contraindicated?

Kris - There are occasions where medication would be contraindicated. For instance, prescribing stimulants to individuals with high blood pressure or other cardiac complications. This is something we discuss as we establish the patient’s care plan. 

Kelly - This is why you find it so important to have longer initial evaluations and follow up appointments? You clients won’t be rushed in and out of appointments so you can make sure that you’re getting all information you need and clients can feel they have the space to share their concerns.

Kris - Exactly!

Medication can be a scary thing to consider. For many it is an important part of mental wellbeing and improvement. Finding a licensed and trained prescriber who is able to address you concerns in a compassionate and warm environment can often ease concerns and help you to feel comfortable talking about your medication fears. Often times the first step is booking a consultation with a provider to determine if they are a good fit for you.