Medication Management
Medications in General
Medications influence brain chemicals called neurotransmitters. Most of us have heard or read about serotonin, dopamine, GABBA, and norepinephrine to name a few. These neurochemicals are important determinants of mental health and cognitive functioning as they influence our general mood, ability to relax, focus and concentration, and feelings of well-being. Medications attempt to balance neurotransmitters in ways that support emotional health.
When symptoms are clinically significant and medication treatment is indicated, my clients are well informed on the indications, expected benefits as well as management of possible side effects. My clients receive extensive medication education as I consider treatment an informed partnership and the process follows a shared decision making approach.
Anxiety
Anxiety
We are living in a time of serious collective stressors. Repetitive exposures to stress can lead to excessive anxiousness hindering our daily functionality. When we are losing sleep, feel constantly on edge, consistently irritable around others, and heavily relying on substances just to relax, then it may be time to consider treatment.
Anxiety is part of our natural stress response and an increased anxiety level does not always indicate a clinical anxiety disorder. A thorough assessment will help establish an appropriate diagnosis and associated treatment goals. Treatment for anxiety can involve varied approaches with or without medication augmentation. Working together, the best approach can be explored.
Medications can be part of a treatment plan either for short or extended periods. For many, psychotropics are the tools needed to help lower the intensity of anxiousness. This in turn allows improved engagement in a therapy process offering skill development, enhanced insights and strategy development leading to enhanced control.
Attention Deficit Disorder
ADHD, Cognitive Performance and Motivation
Medications and non-medication treatments are available including the use of cognitive behavioral therapy and mindfulness practice approach to help build skill in managing emotions, increasing focus and concentration, and improving motivation. An integrated approach offering alternative methods may reduce overreliance on medications while still leading to improved academic and professional performance.
Federal agencies regulating controlled medication treatment require periodic in-person follow up although Telepsychiatry can be used intermittently. When stimulants are indicated in the treatment of ADHD, a client will consent and agree to a treatment plan that reinforces good medical practice while following guidelines from state and federal agencies that monitor the prescribing of controlled substances.
Clients appropriate and who desire medication treatment agree to additional controlled substance agreements and may be asked to obtain urinalysis to start and maintain treatment with controlled substances.
Depression and Mood
Depression
Depression shades perspective. It can significantly reduce the quality of life with negativity, low self-esteem, fatigue and low energy, sleep disruption, difficulty interacting with others and irritability, suicidality, changes in appetite and weight and actually cause psychomotor retardation or a slowing down of speech, movement and engagement. Some of us experience depression as episodic with periods of reduced symptoms alternating with intermittent episodes of lower mood. Others have a sense of depressed mood persistently for extended periods of time.
Either originating through genetic predisposition, environmental influences, or a complex combination of both, depressive symptoms can be targeted by varied treatment approaches including medication treatment.
Depression is often co-occurring with anxiety and influenced by similar neurotransmitters. Many medications target both and are approved for use for these dual conditions by the Food and Drug Administration (FDA). This is difficult to imagine, but there are medications that can simultaneously reduce symptoms of both anxious and depressive conditions.
More about Substance Use
Substance Use Issues
Problematic substance use may be the source of anxiety and depression or may have originated from these emotional experiences. Some may experience improved results when these co-occurring conditions can be treated together.
There are limitations to outpatient care and substance use treatment. Detox and moderate to severe withdrawal treatment cannot be safely provided in an outpatient setting. Some active substance use conditions require stabilization before outpatient treatment. For example, Detox and monitoring during withdrawal require skills rendered in a higher level of care environment. Assessing for an appropriate level of care is a matter of placing the welfare of the client first. I will work with you and provide information on linking to higher levels of care if necessary.
Protracted withdrawal is a phase of recovery following acute withdrawal stabilization. It is a syndrome of experiences and symptoms that may continue for weeks even during a period of abstinence from substance use. These symptoms are typically less intense than experiences during acute withdrawal but may create risks for relapse. Outpatient treatment can reduce the symptoms and struggles associated with protracted withdrawal including mood shifts, anxiety, sleep disruptions, and cravings. Outpatient support utilizing therapy and medication treatment may reduce the risks of excessive use and or relapse associated with the symptoms of protracted withdrawal.
Conditions Appropriate for Outpatient Treatment:
- Alcohol, uncomplicated without risk of serious withdrawal with the goals of either use reduction or abstinence.
- Cannabinoid use disorder when use causes health or social problems
- Opiate Use Disorder, Stabilized: Suboxone/Buprenorphine Maintenance is available as transfer of care following induction and stabilization in specialized care. environment such as a MAT clinic, ER, or specialized substance use center.
Conditions Requiring a Higher Level Care Above White Hart PMH Outpatient Treatment:
- Opiate Use Disorder needing induction and initiation of treatment.
- Severe to Moderate Methamphetamine and other Stimulant Use Disorder.
- Severe Alcohol Use Disorder with risk of severe withdrawal requiring detox and withdrawal services.
- Benzodiazepine Detox and Withdrawal.
Other Resources:
https://www.harmreductionactioncenter.org/
https://www.samhsa.gov/find-help/national-helpline
https://www.samhsa.gov/medication-assisted-treatment
https://store.samhsa.gov/sites/default/files/d7/priv/sma10-4554.pdf
Benzodiazepines
Benzodiazepines and Dependence
Benzodiazepine dependence is not always associated with abuse but may occur when tolerance develops within the course of extended daily use during authorized treatment. Dependence with the risk of withdrawal syndrome may develop as early as within two weeks of daily use. Tolerance and dependence may increase the anxiety state as well as lead to emotional dysregulation. When these adverse effects occur, many assume increased dosing or augmenting with other medication is the answer. This may lead to overprescribing.
There are other concerns. Research indicates long-term use may lead to cognitive deficits including memory and thinking problems. The elderly are especially vulnerable to disorientation and falls even after a long period of tolerating a certain dosing level. Accidental overdose associated with benzodiazepines with alcohol and opiates is also a serious potential outcome.
Certain mental health conditions warrant the use of benzodiazepines which can be very effective in controlling severe symptoms when used on a short-term basis. Risks can be reduced when care is provided in partnership with a provider who utilizes a sensible and appropriate prescribing approach including prescribing within recommended guidelines on limits in supply and period of use.
Guided by current research and practice guidelines, daily scheduled benzodiazepine scripts are not prescribed at White Hart PMH. Short temporary scripts with a small supply to be used sparingly, may be indicated in some conditions. Benzo scripts are not provided during active substance use due to risks of accidental overdose.
Other Resources: https://www.benzoinfo.com/