- When was the last time I saw my primary care doctor?
Contrary to popular belief, psychiatric diagnoses are not doled out like candy on Valentine’s Day. In fact, a psychiatric diagnosis should only be made when medical conditions that share common symptoms with psychiatric disorders have been ruled out. If you haven’t had a thorough physical exam and routine labs in the last 6 to 12 months your primary care physician should be your next stop.
There are common medical conditions with symptoms that can look a lot like psychiatric disorders. In order to treat the root cause of the ailment, and not just the symptoms it is important to have a basic medical work up. Let’s take depression for example. Symptoms typically include: fatigue, weight gain, lethargy, lack of interest in activities previously enjoyed, low energy, poor concentration, sleep disturbance, and lack of motivation. Medical conditions like hypothyroidism, anemia, pregnancy, heart disease, uncontrolled diabetes, excessive alcohol or drug use, etc. can masquerade as depression. By treating the depression alone, that may help with the symptoms, but doesn’t address the root cause which could have a significant impact on your long term health.
- What symptoms am I having and when?
Take note of the symptoms you have been experiencing. Write them down and bring them into your appointment. There are many medical and psychiatric disorders that can be identified based on clusters of symptoms. A timeline of when each symptom started, any inciting triggers, what makes the symptom worse or better, and if the symptom changes throughout the day or throughout the year can be very helpful to your medical provider.
An example seen commonly in practice is chest pain. Chest pain related to heart disease presents differently than chest pain associated with panic attacks. Context and history of your symptoms helps providers get you feeling better faster.
- Do I really need medication?
During your appointment your provider should discuss with you what they are seeing clinically, propose a diagnosis, and discuss the risks, benefits, side effects, and alternatives to evidence based and off label treatments for your condition. The decision to take medication or not is a personal one, and nobody can make the decision for you. If you’re not sure whether or not you want to start a medication, and your condition is non-life threatening and non-urgent take some time to think about it. Do your research and make a follow up appointment to discuss your concerns.
- What can I do to get healthier if I decide I don’t want to start medication right away?
Good nutrition, adequate restful sleep, staying away from drugs and alcohol, and regular exercise are the best non-pharmacological ways to improve both physical health and mood symptoms. If lab tests reveal abnormalities like iron-deficiency anemia, or low vitamin D talk to your doctor about supplements you can take to help your body function optimally. Stress also plays a big role in overall physical and mental health. Relaxation techniques like meditation, guided relaxation, decreasing time on electronic devices, and improving sleep habits are other effective ways to boost your health without taking a medication.
- So, my doctor suggested that I try medication… now what?
Be honest about addiction. If you have a history of addiction, be sure to share this with your doctor. There are medications that are clinically indicated for short term use, that can increase risk of addiction, particularly in someone who is genetically predisposed. There are often alternatives to potentially addictive medications that can be used instead.
Be patient. Sometimes it takes time to notice if the medication is helping or not. Frequently medication needs to be adjusted over time to be sure that you are taking a therapeutic dose and having minimal side effects. Medication is not a one size fit all process. Every person metabolizes medication differently, which means that a particular medication may work very well for one person, but cause significant side effects in another. Although medication can help with psychiatric symptoms, there is no “magic pill” that will make all your problems or worries go away. You will still need to put in work to help yourself get better.
Take medication as prescribed. All medications come with specific instructions. It is important to follow the directions on the prescription to maximize benefit of the medication and mitigate side effects. Therapeutic effect of a medication depends on the level of medication in your bloodstream. The goal is to keep that level steady over time. Taking the medicine at the same time every day without skipping doses is ideal. If it’s hard for you to remember to take your medicine set an alarm on your phone. It is also a good idea to carry one or two pills in a small pillbox on your person just in case you leave the house and forget to take it.
Don’t increase or stop medication on your own without talking to your doctor. As tempting as it may be to want to adjust your own medication, don’t. Playing with your medication dosing can put you at risk for serious side effects, accidental overdose, and toxicity. If you are experiencing adverse effects to your medication call your doctor and let them know. They can advise you on how to proceed in a way that does not jeopardize your health.
Limit access. Always remember to keep your medication stored in a safe and secure place. Small portable safes are a good option given that they are easily obtained and are not too expensive. This helps limit accidental access by children and pets, and can be invaluable in the event of a disaster like a fire or a flood.
Be in the know. Lastly, knowing what medication you are taking is just as important as knowing why you are taking it. If you find the names hard to remember, write them down on a piece of paper with the doses and keep it in your wallet. It is better to be prepared by knowing what you are taking or have easy access to the information. This will help providers update your medical record so it accurately reflects what you are currently taking, minimizes risk for being prescribed a medication that may negatively interact with your current medication, and if you are in an accident and can not communicate the list of medication can be very helpful to the medical providers taking care of you.