Medication Management is One of Many Treatments for Mental Health
My philosophy is to begin with a thorough evaluation and often a medical examination through one’s own PCP (Primary Care Physician). I usually obtain routine labs either at the first few visits or if they were obtained through one’s PCP recently, I will ask for a copy of them. Getting the proper diagnosis is axiomatic to obtaining the proper treatment. Psychoendocrinology is the study of the interrelationships between endocrine function and mental states, incorporating the idea that variation in physiological hormonal response to stress is related to psychological variables that determine the specific emotional response to that stress. These lab tests of how the hormones, thyroid, and other glands are functioning are critical to a comprehensive evaluation. Often thyroid issues can mimic either depression or ADHD, once the underlying glandular issue is treated; the mental issues resolve.
A Comprehensive Evaluation Will Sometimes Detect an Underlying Medical Condition Causing the Depression or Anxiety
Once a diagnosis is found, a treatment plan will be formulated. This will range from medication management, medication management and, brain-spotting or EMDR, psychotherapy, cognitive behavioral therapy, or sometimes just psychotherapy or counseling. If you need only psychotherapy, I will refer you to a psychologist or counselor. I focus on medication management. The underlying cause of the condition will determine the form of treatment and the outcome of the treatment. Sometimes the cause is Diabetes, Mellitus, or Thyroid Disorders to just name a few of the illnesses or conditions that can present with depressive or anxiety symptoms. If this is the case, I will refer you back to your PCP or endocrinologist for further evaluation and treatment. The success of a treatment program will be predicated on experience in dealing with similar issues, medical knowledge, and a sound logical approach to medicine.
Since there are many different types of psychiatric illnesses, I will just key in on the most prevalent of them. The usual treatment of depression and anxiety disorders is with an antidepressant medication such as an SSRI or SNRI and psychotherapy. As far as we know at the present, there is a chemical imbalance or deficiency in the neurotransmitters serotonin, norepinephrine, and dopamine. This deficiency is corrected while one is taking the antidepressant medication. It can take up to approximately four to six weeks for the antidepressant medication to reveal it’s true efficacy; but within even the first few weeks, many people see improvement in their depressive symptoms also with the amount of worry decreasing along with their physical anxiety symptoms. It is crucial to stay on the medication for the prescribed dose and time. In many cases the medications don’t have any therapeutic benefit until theses these levels have been achieved in the bloodstream.
Sometimes, it is necessary to give an anti-anxiety medication, such as, Klonopin, Ativan, or Xanax for the first four weeks if the anxiety symptoms are very intense. This is prescribed for a short amount of time usually, because these medications, unlike antidepressant medications are addictive. We give them along with the antidepressant for the first four weeks to give the antidepressant time to show it’s full effect. After this time, a taper off is usually tried.
Side effects that may occur with the antidepressants include: upset stomach, headache, diarrhea or constipation, decreased libido, weight gain or weight loss. The side effects are a little different depending on the one you are started on to initiate treatment. Many side effects get better and go away after the first week of treatment.
Some of the side effects of the benzodiazepines (i.e. Klonopin, Ativan, Xanax), are psychomotor slowing and sedation. Therefore, you have to know how you are functioning after you take this especially before you get behind the wheel of a car.
The success rate of being treated with these agents is pretty high. It is 75% effective even with the first antidepressant tried. Sometimes, though people have untoward side effects initially that would be too bothersome to continue on the particular antidepressant. At that time, the medication is switched. For the small population that are treatment resistant there are other therapies that we are using such as Vagal Nerve Stimulation and TMS; these will sometimes also be used to augment medication management. If you are seeking a Phoenix psychiatrist or a psychiatrist in Scottsdale, please call my office to schedule an appointment. I look forward to working with you.
