Psychiatric Med Evals

Psychiatric medicines, such as antidepressants, can be very helpful, especially when combined with talk therapy. But, getting a competent medication evaluation can be complicated. While Primary Care Providers often manage psychiatric symptoms well, it may be useful to get a more expert consultation from a Psychiatrist or Psychiatric Nurse Practitioner.

Disclaimer: This post is written from my perspective having had a twenty-year career as a mental health and addictions therapist and having taught a senior seminar in addictions for the Indiana University School of Public health for six years. I do not prescribe medications. You should be an informed consumer and discuss your medications carefully with your practitioner.

Depression, anxiety, and sleep disturbance are the most common presenting issues treated by psychiatric medications. People often discuss these issues with their regular doctor who then may offer one or more medications. There are a variety of medications used to treat these, and other, mental health issues. You’ll be best served by describing your issues well, asking good questions, and being an informed consumer. It may help to meet with a psychiatric expert for a more competent evaluation.

Ask good questions

In addition to asking if a medication will help alleviate troublesome symptoms, ask about whether the medication can be taken long-term. Many people are prescribed these medications for chronic, rather than acute, issues. In particular, you should ask whether taking the medication can result in tolerance. That is, will your body adjust to the medication so that the therapeutic effect will become lower as you continue to take it. Some medications are good for short-term, acute, issues (ones which would be expected to resolve in days to a couple of weeks), but become problematic if used too long.

In my opinion, the worst use of psychiatric drugs is related to the use of benzodiazepines (such as Xanax and Ativan) for chronic anxiety. Using such a drug scheduled (daily at the same times rather than infrequent and only as-needed) makes it even more likely that you will develop tolerance. The unfortunate irony of this effect is that the central feature of benzodiazepine withdrawal (which can happen after only one month of their use) is anxiety! This issue of tolerance is the reason self-medicating a chronic issue with daily alcohol consumption won’t work, either.

In addition to asking good questions of your provider, you can benefit from the expertise of your pharmacist. Keeping all your scripts at one pharmacy can avoid combining medications that shouldn’t be taken together. Know that some pharmacies and medical offices make available a consultation from a clinical pharmacist to help you sort out medication issues. This is especially helpful for people taking several medications or for people who have metabolic issues such as those encountered by older people. By the way, many people save a lot of out-of-pocket medication expense by utilizing IndianaDrugCard or GoodRx. Sometimes one of those programs can save you money even if you have a prescription benefit with your health insurance. If you have a drug which costs you a lot now, I recommend looking it up on those sites. You can print the discount coupon from the front page of either of those sites.

Should you see a psychiatrist?

Primary care providers can write prescriptions for psychiatric medications. However, seeing a psychiatrist or psychiatric nurse practitioner can often be a better choice for multiple reasons. First, while terms like depression or anxiety to refer to certain constellations of symptoms, there is considerable variation in the presentation of these issues. A competent evaluation will determine which features you are experiencing and lead to the selection of the correct medication. Expert evaluation is even more important if you have tried one or more medications with unsatisfying results.

I worked for two years as a program manager for a state training grant which funded educational programs for primary providers on mood and anxiety disorders. We provided live workshops with panels of psychiatrists to help primary care providers increase their capacity to manage these issues. We found that most primary care doctors had a sufficient competency to prescribe relevant medications. However, the use of the wide range of such drugs is complex and always evolving. For the most competent evaluations and prescriptions, see a psychiatric provider from the beginning of the process.

Unfortunately, there is a nation-wide shortage of psychiatrists. Sometimes, a psychiatrist is tied to an agency and unless you are receiving therapy services from the same agency, you can’t get a medication evaluation. This is a barrier to someone who already has a therapist or who doesn’t want to participate in therapy. Even when a psychiatrist is available to see you without that barrier, the wait for the initial evaluation appointment is sometimes two to three months. This can constitute an unacceptable wait period for an urgent mental health issue.

One option to get a competent psychiatric medication evaluation is to use an online platform for telehealth such as MeMD or MDLive. The wait time for an initial evaluation is usually less than 48 hours on these two platforms. While in my local community, the initial evaluation appointment will cost out-of-pocket $300-400, initial telehealth evaluations with a psychiatrist will be only $200. Follow-up appointments will cost $95 for online practitioners. See the links below to get to those platforms.



Posted by Jon Peters