It is very important that you know about your prescriptions and that you take them as directed. ALWAYS Read the med information document that comes with it every time you get a new bottle, even if you have been on it for a long time. There are important side effects, interactions, and instructions on how to take the medication. You need to know this information. The information may change over time. If you have strange symptoms and you have not learned the side effects of your medication, you may not recognize it as a serious side effect that you should report to us for your own safety. So reading and knowing that information is really important. It also helps to know which common side effects are not harmful, so that you know what can be expected when you start medication.
READ THE LABEL EVERY TIME YOU TAKE A PILL OUT
Always take a moment to check the label on the bottle to to be sure you are taking it correctly. It is also important to know that with subsequent refills we may increase the strength of your tablet or capsule to "titrate up" your dose. So you may need to go back to one cap / tab daily. It is a common mistake to start the higher dose and take too much medication because the label was not checked. So always making sure you are taking the right dose is important for your safety.
IT IS VERY IMPORTANT THAT YOU ARE AWARE OF ANY SERIOUS WARNINGS REGARDING THE MEDICATION. THESE ARE GENERALLY CALLED "BLACK BOX WARNINGS". And will be in your medication pamphlet that comes with your medication. There is an example below.
TITRATION
Starting medications at a lower dose and then increasing the dose over time, is called titration. This allows your body to gradually get accustomed to the medication. It is also an important safety measure because some medication can cause serious adverse effects if the dose is not increased gradually and slowly over time. Never take medication differently that prescribed.
WEANING
When you are stopping medication it is important to know that a lot of factors go into planning this. Some medication doses need to be slowly and gradually reduced over time to prevent withdrawal side effects. Certain medication can cause these. For some medications this may make you feel badly but won't harm you. For others you can become seriously ill if you stop your medication abruptly. Some medications can be stopped abruptly with no problems. And with others you can directly switch to another medication. And with others, you may need to gradually decrease one medication while the new one is gradually increased. So it is always important to follow the instructions for medication changes.
A little overwhelming isn't it! And this is why you are paying for the guidance of a mental health professional to; #1 keep you safe, and #2 make sure your treatment not only helps you feel better, but also gets you into remission or very close to it. This way the symptoms still present are improved as much as possible.
Many PCPs are having to treat patients until they can see a psychiatric provider, or sometimes ongoing if the patient cannot see a mental health specialist because none are available. Many PCPs also don't have solid psychiatric training and experience like psychiatric nurses and psychiatrists. Unfortunately what often happens is that patients are given a starter dose that will be too low to optimize your care.
They will also give 6 or 12 months of medication at the start. Then they will not have patients return for follow up appointments for a long period of time. They may not check in frequently with the patient until they are doing very well. I will typically see someone in the beginning every two weeks to a month depending on the particular details. And after that 2-3 months between visits. Without those frequent check ins and medication adjustments, patients often are under treated, not on the right medication at all, and not monitored for side effects. This can cause serious adverse effects, symptoms to continue, get worse, or relapse when a patient gives up and stops the medication. And often they stop without any medication weaning plan in place.
LEARN ABOUT YOUR MEDICATIONS
Learn about your medications by visiting the National Alliance of Mental Illness (NAMI) webpage on medications->https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications
If you are taking physical health medications, and/or vitamins and supplements, you should learn about them here ->https://medlineplus.gov/druginformation.html
KNOW ABOUT INTERACTIONS
You can and should always check interactions between all you medications. And remember, every time you see a medical provider, you should make sure they have your complete list of prescriptions, over the counter meds, vitamins, supplements, herbals, alternative therapies, etc. so that they can check for interactions. For this same reason it is always best to use the same pharmacy for all prescriptions when possible. And you should also check for interactions yourself by running them through the interaction checker on WebMD. This is very important for your safety. Please update us anytime you stop or start anything you take.
HOW TO START NEW MEDICATIONS OR CHANGE DOSES
When you start a new medication for your mood, or change doses, make sure you plan ahead. You should plan this when you have a day or two when you do not have to work, drive, operate heavy machinery, care for small children, or make important decisions.
Sometimes when you start a new medication for your mood you may feel extra fatigue, wooziness, "out of it", or have nausea, headache, etc.. Typically these side effects go away or you get used to them within a few days.
Let us know if any red flag or significantly bothersome side effects occur. But you want to know about loading side effects. You should plan ahead, so that you can be safe and have time to adjust.
IT'S SO MUCH BETTER ON THE OTHER SIDE
Many medications for mood may take a few weeks to a few months to feel effects or the full effects. I heard someone describe it as having to get through the forest to get to the other side. So don't expect to magically feel better as soon as you start. It is a process. The non-medication interventions discussed in my blog start pretty quickly though! So focus on learning and maximizing your use of these tools and ramping up to living the healthiest lifestyle you can.
Some things to do include; learn about your conditions and how to manage your symptoms, check with your health insurance to find out what counseling/coaching/therapy/groups are covered by your insurance and establish care right away. This too will help tremendously. And you should really learn about CBT, and DBT for optimal results. You cannot build a house with just a hammer. And medication alone may help, but to get better in a big way, you need to make some big life changes. It sounds like a lot, but trust me that the little things add up, so keep doing as much as you can to get better every day. One day you will see that things are much improved and it was worth all of the effort.
SPECIFIC SIDE EFFECTS AND INTERACTIONS TO BE CONCERNED WITH
If you have any side effects that bother you a lot, you should always let us know right away. There are some that are particularly concerning that you need to know about so that you know to stop your medication, seek medical care immediately, and then let us know right after. That would include: SEROTONIN SYNDROME (click here to read more on this) SEIZURES, NEW/UNUSUAL/WORSENING SUICIDAL FEELINGS
SEEK HELP IMMEDIATELY FOR ANY SERIOUS SIDE EFFECTS. AND IF YOU FEEL LIKE YOU WOULD BE BETTER OFF DEAD OR HAVE SUICIDAL THOUGHTS
read this blog post for information and resources to help right away! https://virtualnpcg.wixsite.com/advancedwellnesspa/post/in-crisis-read-this-first
It is also important that you know that EXCESSIVE SEDATION can occur.
LIMIT DRIVING OR OPERATING HEAVY MACHINERY AND OTHER ACTIVITIES REQUIRING ALERTNESS!
REPRODUCTION AND FERTILITY
If you are attempting to become pregnant, are or think you may be pregnant, are having sex without any or inadequate contraception, or you are breastfeeding or planning to, it is important for you to know that some medications can cause harm to a fetus, or you, when pregnant. Certain medications are safer to use in pregnancy. But others may cause serious pregnancy complications. I always recommend that everyone prevent unplanned pregnancy. This is true regardless of which partner is carrying the baby. Having a pregnancy that is unplanned at minimum creates many layers of complexity in your life. And when you are coping with uncontrolled symptoms of anxiety, depression, etc. having an unplanned pregnancy can sometimes cause your life to get very stressful. So everyone should be ready, very prepared and plan ahead for conception when the time is right. That does not always happen. Actually most pregnancies are unplanned. So it is important that if you are at risk of becoming pregnant that you are using a highly effective form of birth control. Talk with your primary care provider, gynecologist, or urologist about the most effective ways to prevent an unplanned pregnancy for your specific needs and about how to achieve a safe health conception when you are ready. And if you may or do become pregnant or plan to start breastfeeding, you should always speak to your primary care provider and all specialists like me about this ASAP. Your prescriptions, over the counter preparations, vitamins, supplements, herbals and alternative therapies should be discussed as some may not be safe to continue taking. If you are planning to become pregnant, you may need to stop or switch certain medications. And those who are pregnant had safer treatment options to choose from. So you don't have to stop treatment in most cases which helps you stay on your path to mental and physical wellness. WHAT IF MY MEDICATION IS NOT WORKING? Like I mentioned above, it takes a few months to reach optimal effect. That is why in many cases we increase your dose after a week or so to get you there faster when we can. But sometimes the first, second, third, etc. medication you try does not work well. The good thing is that there is a very long list of medications to try. There are different categories to try too. And sometimes certain medications can be combined for better effect. It is important for you to know this because we don't want you to feel like things are hopeless if the first thing we try does not work. Getting on the right medication plan for you can sometimes be a process. It is important to stick with it so that eventually things can get better. And if you try a few medications and they do not work, sometimes you will then qualify for more advanced treatments. As we work through the process, we will make adjustments and consider referring you for more advanced care and treatments if you are not improving.
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