Medication Management

Sally K. Miller
Ph.D, APRN, PMHNP-BC

Dr. Miller is a nurse practitioner of 30 years’ experience with four national board specialty certifications, including both psychiatry and family practice. Her experience and practice areas include diagnosis and management of mood and anxiety disorders, psychotic disorders, substance use disorder and attention deficit disorders across the lifespan and behavioral disorders in children. While her primary area of expertise is pharmacologic management, her holistic approach to mental health care includes an active collaborative approach to include non-pharmacologic therapies.

In addition to her clinical practice, Dr. Miller is a clinical professor with Drexel University College of Nursing and Health Professions in Philadelphia, PA, and a frequent presenter at a variety of national conferences and continuing education events. She has served as a consultant for a number of academic and professional entities and often serves as an expert witness in malpractice litigation. She is the lead nurse planner and senior lecturer with Fitzgerald Health Education Associates where she presents a number of continuing education programs on psychopharmacology and psychiatric diagnoses. She has authored over 30 peer-reviewed articles, edited professional texts, and has a chapter on the pathophysiology of psychiatric disorders for an upcoming pathophysiology text is in press.

Initial Assessment: $150.00
Tier I Visit: $110
Tier II Visit: $150

Insurances Accepted: Cigna, UHC/Optum, Tricare, HPN, SHL, Anthem/BCBS, HPN & FFS Medicaid

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What is Medication Management?

Medication Management, or Psychopharmacology, refers to the use of medication in treating mental health conditions. Research has demonstrated that medications can play a role in improving many mental health conditions. While some patients are treated with medication alone, others are treated with a combination of psychotherapy or other mental health related treatment such as brain stimulation therapies.

Medications can affect people in different ways, and it may take several tries to find the medication that is most effective with the fewest side effects. It’s important for people to work with their health care provider or mental health professional to develop a treatment plan that meets their needs and medical situation.

Medication management at Theravada Mental Health means consulting with our medical staff to identify the right medication(s) to properly manage mental health conditions like these, and several others, as well:

• Bipolar disorder
• Depression
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Anxiety
• Attention-deficit disorder (ADD)
• Attention-deficit/hyperactivity disorder (ADHD)

What should I expect during medication management?

During medication management, it’s important to take your medicines exactly as directed by your medical provider(s). They will routinely follow up with you to effectively manage your condition and ensure your treatment is effective.

They might also recommend you make healthy lifestyle changes and attend therapy to help you cope with mental health challenges.

Types of medications you may receive with medication management, aka pharmacological medications:

Antidepressants

Antidepressants are medications used to treat depression. In some cases, a health care provider may prescribe antidepressants to treat other health conditions such as anxiety, pain, and insomnia.

Commonly prescribed types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs).

These medications are commonly prescribed because they improve symptoms related to a broad group of depressive and anxiety disorders and are associated with fewer side effects than older types of antidepressants. Although older antidepressant medications, such as tricyclics and monoamine oxidase inhibitors (MAOIs), are associated with more side effects, they may be the best option for some people.

Antidepressant medications take time to work—usually 4 to 8 weeks—and symptoms such as problems with sleep, appetite, energy, or concentration sometimes improve before mood lifts. It is important for people to follow their health care provider’s directions and take the medication for the recommended amount of time before deciding whether it works.

Common side effects of SSRIs and other antidepressants may include upset stomach, headache, or sexual dysfunction. The side effects are generally mild and tend to improve over time. People who are sensitive to the side effects of these medications sometimes benefit from starting with a low dose, increasing the daily dose very slowly, and adjusting when they take the medication (for example, at bedtime or with food).

Combining antidepressants with medications or supplements that also act on the serotonin system, such as “triptan” medications (often used to treat migraine headaches) and St. John’s Wort (a dietary supplement), can cause a rare but life-threatening illness called serotonin syndrome. Symptoms of serotonin syndrome include agitation, muscle twitches, hallucinations (seeing or hearing things others do not see or hear), high temperature, and unusual blood pressure changes. For most people, the risk of such extreme reactions is low. It is important for health care providers to consider all possible interactions and use extra care in prescribing and monitoring medication combinations that carry above-average risk.

Anti-Anxiety Medication

Anti-anxiety medications help reduce symptoms of anxiety, such as panic attacks and extreme fear and worry.

Many medications commonly used to treat depression—including SSRIs and SNRIs—may also be used to treat anxiety. In the case of panic disorder or social anxiety disorder, health care providers typically start with SSRIs or other antidepressants as the first treatment because they have fewer side effects than other medications.

Another common type of anti-anxiety medication is benzodiazepines. These medications are sometimes used to treat generalized anxiety disorder.

Short half-life (or short-acting) benzodiazepines are used to treat the short-term symptoms of anxiety. Health care providers may also prescribe beta-blockers off-label to treat short-term symptoms. People with phobias—an overwhelming and unreasonable fear of an object or situation, such as public speaking—often experience intense physical symptoms. Beta-blockers can help manage these symptoms, such as rapid heart rate, sweating, and tremors.

As short-term treatments, benzodiazepines and beta-blockers can be used as needed to reduce severe anxiety. Taking benzodiazepines over long periods may lead to drug tolerance or even dependence. To avoid these problems, health care providers usually prescribe benzodiazepines for short periods and taper them slowly to reduce the likelihood that a person will experience withdrawal symptoms or renewed anxiety symptoms. Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both conditions.

Buspirone is a different type of medication that is sometimes used to treat anxiety over longer periods. In contrast to benzodiazepines, buspirone must be taken every day for 3 to 4 weeks to reach its full effect and is not effective for treating anxiety on an “as-needed” basis.

Stimulants

Health care providers may prescribe stimulant medications when treating attention-deficit/hyperactivity disorder and narcolepsy. Stimulants increase alertness, attention, and energy. They can also elevate blood pressure, heart rate, and breathing.

Prescription stimulants typically improve alertness and focus for most people, regardless of diagnosis. These medications can markedly improve daily functioning for people with significant focus problems, such as people with ADHD. Although motor hyperactivity associated with ADHD in children usually goes away by the time they reach adolescence, people with ADHD may continue to experience inattention and difficulty with focus into adulthood. As such, stimulant medications can be helpful for adults with ADHD, as well as for children and adolescents with ADHD.

Stimulant medications are safe when taken under a health care provider’s supervision and used as directed. Some children taking them may report feeling slightly different or “funny.” Most side effects of stimulant medications are minor and disappear at lower doses.

Antipsychotics

Antipsychotic medications are typically used to treat psychosis, a condition that involves some loss of contact with reality. People experiencing a psychotic episode often experience delusions (false beliefs) or hallucinations (hearing or seeing things others do not see or hear). Psychosis can be related to drug use or a mental disorder such as schizophrenia spectrum disorder, bipolar disorder, or severe depression.

Health care providers may also prescribe antipsychotic medications in combination with other medications to relieve symptoms associated with delirium, dementia, or other mental health conditions. Antipsychotic treatment for older adults necessitates additional care and consideration. The FDA requires that all antipsychotic medication labels include a black-box warning stating that antipsychotics are associated with increased rates of stroke and death in older adults with dementia.

Older, first-generation antipsychotic medications are sometimes called “typical” antipsychotics or “neuroleptics.” Long-term use of typical antipsychotic medications may lead to a condition involving uncontrollable muscle movements called tardive dyskinesia (TD). TD can range from mild to severe. People who think they might have TD should check with their health care provider before stopping their medication.

Newer, second-generation medications are sometimes called “atypical” antipsychotics. Several atypical antipsychotics may be used to treat a broader range of symptoms compared with older medications. For example, these medications are sometimes used to treat bipolar depression or depression that has not responded to antidepressant medication alone. Health care providers may ask people taking atypical antipsychotic medications to participate in regular monitoring to check weight, glucose levels, and lipid levels.

Some symptoms, such as feeling agitated and hallucinating, typically go away within days of starting antipsychotic medication. Other symptoms, such as delusions, usually go away within a few weeks of starting antipsychotic medication. However, people may not experience the full effects of antipsychotic medication for up to 6 weeks.

If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed an atypical antipsychotic called clozapine. People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1%-2% of people.

Mood Stabilizers

Mood stabilizers are typically used to treat mood disorders such as bipolar disorder as well as mood changes associated with other mental disorders. In some cases, health care providers may prescribe mood stabilizers to augment the effect of other medications used to treat depression.

Mood stabilizers are sometimes used to treat depression (usually with an antidepressant), schizoaffective disorder, disorders of impulse control, and certain mental illnesses in children. For people with bipolar depression, health care providers typically prescribe a mood stabilizer and an antidepressant to reduce the risk of switching into mania or rapid cycling.

Some anticonvulsant medications may also be used as mood stabilizers, including some people with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder. Health care providers generally ask people taking anticonvulsants to participate in regular monitoring to check medication levels and assess side effects and potential interactions with other common medications.

Understanding Your Medications

People respond to medications in different ways, and it may take several tries to find the medication that is most effective with the fewest side effects. In some cases, people find that a medication helps for a while, and then their symptoms come back. It often takes some time for a medication to be effective, so it is important to stick with the treatment plan and take medication as prescribed.

People should not stop taking a prescribed medication, even if they are feeling better, before consulting their health care provider. A health care provider can adjust the treatment plan and slowly and safely decrease the medication dose. It’s important to give the body time to adjust to the change. Stopping a medication too soon may cause unpleasant or harmful side effects.

If you are prescribed a medication:

• Tell the health care provider about all other medications, vitamins, and supplements you are already taking.
• Remind the health care provider about any allergies and any problems you have had with medications in the past.
• Make sure you understand how to take the medication before you start using it and take your medication as instructed.
• Talk to the health care provider about possible side effects and what to expect when taking a medication.
• Don’t take medications prescribed for another person or give your medication to someone else.
• Call a health care provider right away if you have any problems with your medication or are worried that it might be doing more harm than good. The health care provider will work with you to address any problems and determine next steps.

Resources

If you need to report any serious side effects, you can do so at this link: FDA MedWatch Adverse Event Reporting Program.

Information about medications is updated frequently. Check the U.S. Food and Drug Administration (FDA) Medication Guides webpage  for the latest warnings, patient medication guides, and newly approved medications. The MedlinePlus Drugs, Herbs and Supplements  website also provides information on medications, including side effects and FDA warnings.