Starting a New Med?

Dr. David Baldes here, board-certified psychiatrist practicing in Duluth, Minnesota and telehealth across the state of Minnesota with a new video today about starting a new psychiatric medication. Six questions you have to ask your doctor if you'd like to have a good outcome. Six questions you should ask me if we work together.

So starting a new medication can feel scary and well for the doctor who might have prescribed this medication hundreds or thousands of times. This is the first time in your life perhaps that you've taken this medication or any medication. So if you're nervous that's normal and if you ask some questions it can feel a lot less scary. So here are six that I would want you to ask me or recommend that you ask anyone who's prescribing you medication.

First question, what is this for? And what will better even look like? And so, given the fact that psychiatric conditions have variable presentations, a patient's idea of what better might look like could be different than a psychiatrist. And so having a mutual understanding of A, the patient's priorities and B, what the target symptoms that we're trying to treat is really critical for evaluating whether the medication is working like we hope.

The next question, how long until I would notice anything? And so depending upon the medication, those time frames can really significantly vary. Conventional wisdom with antidepressants suggests that we ought not make judgments for four to six weeks after starting medication, although a nuanced read of the treatment study shows that people who do end up being long-term responders typically show early response within the first week or two and then later fully differentiate. And those people who are non-responders have some short-term placebo response that wears off after a few days and then never really catch up terms of treatment response.

Other medications, however, like a psychostimulant medicine for ADHD works very quickly. It works well, it's in your system, and when it's not in your system, it's not doing anything. And so we expect meaningful first dose effects. Medicines to help sleeping or medications that have sedating side effects but are also antidepressant or anxiety reducing might give you that sedating sleep improvement effect immediately but the antidepressant and anxiety reducing effects might lag behind because they have different mechanisms of action within the same drug. So understanding what and when to expect is critically important.

So, understanding what side effects are common, which ones are dangerous, how long should annoying side effects last, what side effects should never be tolerated because they're dangerous, and when should I call, when should I reach out, what should I do if this is intolerable to me, can I just stop it.

How do I take this medication? What time of day do I take it? Does it matter? There are some medications where you absolutely must take it with food. There are other medications where you mustn't take it with food. There are medications that can be taken in the morning or at night like certain antidepressants, although some people with antidepressants find that they have more vivid dreams when they take their antidepressant at night. So ask these questions of me or of your doctor.

Also ask what you should do if you miss a dose. Do I double up my dose the following day? Usually we don't recommend that but there could be contexts in which that could be appropriate for you and your doctor to figure out and so we always ask.

You should ask about alcohol, other medications or supplements that you take and how these drugs might interact with one another. And remembering the supplements is really important and if you have to bring the bottles, that's just fine. There are a variety of really valuable nutraceutical type of supplements out there. And particularly if they are plant-based as opposed to being a mineral or a vitamin, they oftentimes have psychoactive properties and sometimes have overlapping or synergistic effects with, say, an antidepressant medicine.

And then if a person wants to stop, how should they do that? So we talked about this in a previous video. Some medications can't or shouldn't be stopped abruptly. And so plan that out together with your doctor.

So bring the questions. Write your answers down. Bring notes to your visit. Again, all the action happens within the patient. The doctor is a facilitator of the path of recovery, but you're the expert on how you feel. And oftentimes, treatment relationship, particularly starting a new medication, goes best when we have detailed notes on how things are going within the first few weeks.

So please do remember this is general education. This is not advice for your specific situation. Do not by any means start, stop, or change your medication without talking to your prescriber. And if you're in a crisis, call or text 988. And if you're unsafe, call 911.

As always, if you're interested in learning more about how I work, or interested in working with me, and you're based in the state of Minnesota. You can find me at davidbaldesmd.com. Thanks.