I’ve identified 3 factors influencing whether a client will submit to a trial of psychotropic medication – or any medication for that matter. The first factor is rather obvious – the client perceives that there is something wrong with them medically or psychiatrically; the second factor is medication has been deemed an acceptable treatment option; and the third is that the medication meets all requisite safety standards. Some are satisfied with the results they obtain, while for others, the search for relief turns into a long, slow slog through a labyrinth of options requiring the patience of Job.
Some people, however, won’t even begin the quest. I once thought this was just resistance or defiance, but instead, these patients genuinely believe that certain medications aren’t suitable for them. And some are right about this.
Take bipolar disorder for example: It’s not unusual for the first bout of mania to be greeted by a lack of concern. So, why would someone decide to begin taking medication if they didn’t first believe something was wrong? The issue here is not an unwillingness to accept what may be a potentially troublesome condition; the issue is that the patient believes something that we don’t. Maybe it’s something else? Maybe it won’t be recurrent? So, try to understand the client’s beliefs first, and then just wait the situation out; none of us makes a key decision until we’ve adequately weighed alternatives.
For those who have decided to pursue medication, investigate their beliefs also. Inquire as to how they’re doing on their current medication. You may not have to get very far before their body language, particularly facial expressions, tells you much of what you need to know. If it’s apparent they’re pleased with their regimen, I find it best to just leave it alone – even if they’re not getting the best relief.
Approaching Medication Side Effects
I’ll ask, “When you say you’re feeling less energetic, how is that impacting your everyday life?” “What is low energy keeping you from doing?” “Might your low energy be stemming from something else?” I’m interested in how they feel, but I’m also interested in the thoughts and fears undesirable feelings can generate, because these can influence a decision to abort medication, not simply side effects. If it were just about side effects, who would ever embark upon a regimen of chemotherapy? Side effects are often temporary, and many of them pass when the body and brain adjust to a new substance.
Do I Still Need These Drugs?
For some patients reaping the benefits of medications, as time marches on, they begin questioning their long-term viability. If they’re considering discontinuation at some point, and they ask me my thoughts on this, I reply, “I’ll be very honest with you, I believe this is something we should work on together. So, if your goal is to stop, I’m happy to pursue that, but we should begin tapering off slowly. Let’s also agree that you won’t stop this medication cold turkey, okay?” I want them to know that I’m an ally, but I add my concerns about symptom reemergence, so I ask that they call me at the first hint of any worsening. On occasion, and particularly in situations where medication use is considered a mainstay for keeping symptoms at bay, I’ll say, “My fear is that your bipolar will come back, because unfortunately it tends to be a lifetime condition, so I’d strongly recommend you consider staying on your lithium.” I want them to know for some conditions, medication is vital.
Medication “Sensitivity”
This is the most common concern I hear. Usually when someone tells me they’re “sensitive” to medication, what they really mean is that they’ve previously experienced some benign side effects like mild nausea or stomach upset from medication use. This is when I’ll recommend starting out at half the customary initial dosing recommendation. (Example: For depression, beginning with 5mg of Prozac). “I believe this is a smart and safe way to start, given your history of sensitivity to other drugs. Okay if we start out at this very low dose?”
Clients appreciate being able to air their concerns when it comes to medication, so active listening, along with some clinically sound and compassionate recommendations, can aid them in how to proceed.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.