Way too frequently, when I ask a client if their psych meds are helpful, these are the types of answers I get:
“I’m not sure what I’m supposed to be feeling.”
“I don’t know. I just take what they give me.”
“I don’t think they’re doing anything, but I’m not the doctor.”
Sometimes, someone will have been taking these meds for years without knowing if they are helping or not.
You may not be a doctor, but you know yourself better than any doctor does.
Medical expertise is relatively worthless if they don’t know what symptoms you are experiencing. I encourage you to speak up; to share your symptoms and concerns; to advocate for your needs. You deserve to have the most effective treatment available.
Generalists vs Specialists
When you bring up a mental health concern with your Primary Care Provider, they will likely ask you some questions to assess for depressed mood, anxiety, and suicidality. Based on your answers, you might leave with a diagnosis and prescription for an antidepressant. (Despite their name, antidepressants can be useful for both depressed mood and anxiety.)
It is helpful that PCPs make psych meds more accessible in that way. For many people, that’s the only way they will ever seek treatment for mental health. And, if you have already determined the medication(s) that work for you, PCPs are an easy way to stay consistent in getting your prescriptions.
In the beginning, though, I strongly recommend that you begin with a specialist, instead of a general practitioner. If you can see a psychiatrist or a psychiatric nurse practitioner, you’ll have a better chance of getting an accurate diagnosis and eventually finding the right medication(s). Mental health is tricky. There isn’t a blood test that can determine your correct diagnosis. Some diagnoses might be straightforward, while others require more detective work – and a specialist will be better equipped to do that.
Even with an accurate diagnosis, the meds are still a bit of a guessing game. People with the same diagnosis can respond very differently to the same medication. There’s a lot of trial and error to determine the right medication, then the right dosage, and possibly a combination of medications.
Keep in mind that meds are not the only answer, and they are not always the best answer. That being said, some of our brains seem to need these medications, and when we figure out what works for us, it is life-changing. Life-saving.
What to Ask the Doctor
When you are going through the process, ask your provider about any diagnosis they give you. Have them explain what the symptoms are, so you can make sure that you’re on the same page. When they give you a prescription, ask them what to expect:
How long should this take to be effective?
What symptoms might this help with?
(Make a list of your symptoms and rate their severity, so you can compare before and after.)
What side effects might I experience? How long should they last?
Is there anything that I should notify you about right away?
(For instance, you should notify them right away if you have increased suicidal thoughts. Other things, like headaches or gastrointestinal issues might be a temporary side effect while your body gets used to the meds.)
They should also schedule a follow-up appointment with you, according to how long it should take to be effective and/or how severe your current symptoms are.
Finding the right medication(s) can be an ongoing process. You may need different things at different times and/or it can take a while to find the most effective “cocktail” for you. Refer to your chart of symptoms. Notice how they have changed, if new ones have appeared, and continue to inform your provider.
Speaking up about your Symptoms
There’s a tendency to think that “this is as good as it gets,” especially if you’ve experienced any improvement in your symptoms. It can be so difficult to figure out what you “should” expect from meds. And we tend to feel shame and self-blame about symptoms we are still experiencing:
“I have a good life. I shouldn’t have thoughts about suicide.”
“I must be doing something wrong. This must be my fault that I’m not better.”
So, we end up keeping those things to ourselves.
I know how intimidating it is to share your symptoms with your provider. But that is the only way that they will know what’s going on. You both need to bring your expertise to the table. Theirs is (hopefully) psychiatry. Yours is YOU. Share your symptoms with your providers and ask what reasonable expectations are for how much better they should get. Don’t assume that this is as good as it gets.
