It is important to know the benefits of prescribed medications, as well as their potential side effects, and to talk to your doctor about any concerns that you may have. As you consider your options, it may help to know some basic facts about medication.
- Medications are not cures. Medications only treat symptoms, so if you stop taking them, your symptoms can return. Ask your health care provider how long you might expect to take medication.
- Every medicine has its benefits and its risks. Deciding to take medication is all about balancing possible benefits against possible side effects. Sometimes, it's hard to know how a medicine will affect you until you try it.
- Medications often help the most when they're part of an overall treatment program. Your plan may include psychotherapy, peer programs and rehabilitative services to help with problems that medication alone can't treat.
- It can take time to feel better. Some medications take a few weeks to work. And sometimes a medication's side effects may start before its benefits. You also may have to try more than one medication before you get the right fit, but many people find it's worth the wait.
Brand vs. Generic vs. Authorized Generic Medications
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Getting the Most Out of Medication
Types of Medications
Learning about your medication options can help you have a more meaningful conversation with your doctor. You also can be more fully involved in taking care of your health. Medications for mental health conditions fall into the following types:
Antipsychotic medications can help reduce or, in some cases, eliminate hearing unwanted voices or having very fearful thoughts. They can promote thinking clearly, staying focused on reality, and feeling organized and calm. They also can help you sleep better and communicate more effectively. These medications can come in pill form, which are taken daily, or in an injectable form that lasts between 3 and 6 weeks depending on the specific drug.
Possible side effects include: drowsiness, upset stomach, increased appetite and weight gain, blurred vision, constipation, dry mouth, dizziness, low blood pressure, restlessness, weakness, shakes and twitches, and muscle stiffness. Rare side effects include seizures and problems controlling internal body temperature.
Antidepressants help reduce such feelings as sadness or depressed mood and anxiety as well as suicidal thoughts. They do not, however, make people "happy" or change their personalities. The oldest form of antidepressants are called tricyclic antidepressants, but they are not prescribed as often as newer antidepressants like SSRIs or SNRIs because they have more side effects.
Possible side effects include: drowsiness or insomnia, constipation, weight gain, sexual problems, tremors and dry mouth.
For people whose depression is resistant to treatment and do not experience relief from antidepressants alone, esketamine may be taken in addition to antidepressants. Esketamine is derived from the drug ketamine and works on different chemical receptors in the brain than antidepressant pills. It is administered by a doctor as a nasal spray.
Mood stabilizers help reduce or eliminate extremes of high and low moods and related symptoms. They shouldn't keep you from experiencing the normal ups and downs of life, though. These medications are also used to treat depression that lasts for a long time, that goes away but comes back or that isn't treated well enough with an antidepressant alone.
Possible side effects include: stomach problems, drowsiness, weight gain, dizziness, shaking, blurred vision, lack of coordination or confusion.
Tranquilizers and sleeping pills can reduce anxiety and insomnia and help you feel more relaxed. Although some of them are used mostly to help with sleep, they all might cause drowsiness. Usually, these medications are used only briefly because longer use can cause dependency.
These medicines are generally safe when used as prescribed and have relatively few serious side effects. As with any medicine, though, some people may have difficulties. You should call your doctor right away if you experience headaches, slurred speech, confusion, dizziness, nausea or increased nervousness or excitability.
Stimulants and related medicines can have a calming effect and help improve concentration and attention span in both children and adults. They also can improve a person's ability to follow directions and reduce hyperactivity and impulsiveness.
Possible side effects include: trouble falling asleep, decreased appetite and weight loss. Less common side effects can include headaches, stomachaches, irritability, rapid pulse or increased blood pressure. These often go away within a few weeks after ending use or if your health care provider lowers your dose.
When you're feeling overwhelmed or confused, it's understandable that you might want to let others make medication decisions for you. But it's becoming clearer to researchers, providers and mental health consumers themselves that being actively involved in your treatment can make a real difference in your recovery. Talking honestly with your doctor is a big part of that process. If you discuss your concerns and learn about your options, you are much more likely to come up with a plan that works well for you and for the life you want to create.
The following tips can help you decide about taking a medication:
- Get information. Ask your provider how the medication is supposed to help with your specific concerns. Also find out about any possible side effects. You might consider taking notes, since it can be hard to remember a lot of information, especially when you aren't feeling well. You also might ask a friend or relative to go with you for emotional support and to help keep track of important information.
- Talk with others with similar experiences. Self-help groups and peer specialists-people with mental health conditions who are trained to help-can provide great first-hand information. Local Mental Health America affiliate offices, the National Alliance on Mental Illness, Depression and Bipolar Support Alliance and Children and Adults with Attention-Deficit/Hyperactivity Disorder are good sources for this kind of support. Remember that every person is different, but you can learn from the experiences of others.
- Think about your priorities and goals. Is relief from symptoms extremely important? If not, maybe you're willing to live with some symptoms to avoid side effects. What are your main life goals? How might medication help?
- Sometimes the only way to know if a medication is right for you is to try it. You may find that it helps you feel much better. If not, you can decide to stop later.
Brand vs. Generic vs. Authorized Generic Medications
Medications are often prescribed by their brand name. This was the name they were given by the company that first created them. Once these medications are no longer “on patent” other companies may start making them and offering them as generic medications. These go by chemical names. For instance, Zoloft is a brand name antidepressant, and its generic name is sertraline. Brand name drugs and generic drugs must have the same active ingredient, but they may have different inactive ingredients used to make them. Inactive ingredients can be things like coloring agents, preservatives, and fillers. The FDA requires generic drug makers to prove that their products are just as effective as the brand name drug before people are allowed to buy them. Your insurance company will often require that you be given the less expensive, generic version of medication (if one is available) unless your doctor determines that the brand name version is medically necessary.
When a doctor determines that a brand name medication is medically necessary for you or if you are seeking a generic that is identical to the brand but you have trouble affording the higher cost of the brand name medication, a third option may be available. This third option is an authorized generic. An authorized generic medication is a medication made by the original creator of the drug, using the exact same formula (including inactive ingredients) as the original drug. It is manufactured by the maker of the brand name medication and distributed by a special generics division of the drug company. An authorized generic medication will cost the same as a generic medication. But you may have to specially request it from your pharmacy because they may not keep it in stock. Not all medications are available in authorized generic form, but you can check to see if yours is at www.authorizedgenericmedicines.org/product-finder.
Pharmacogenomics is the study of how a person’s genes impact their reaction to drugs. It is a relatively new field that holds promise for developing effective medications and dosages based on a person’s genetic makeup.
When working with a clinician to start medication for a mental health condition, there are a number of factors that play into deciding which medicine is a good fit for you – this includes things like your physical and mental health history, family history, cost, and side effects. Pharmacogenomic testing can be an extra tool in your clinician’s toolbox to help inform medication selection.
Pharmacogenomic testing is conducted by your doctor with a simple cheek swab. By analyzing the genetic variations in your DNA, the test can provide information about genes that may impact how you break down or react to certain medications. This can help your doctor predict which medications will be effective for you.
The cost of testing varies depending on which test is ordered and your health insurance. Not all insurance companies cover it, though some may depending on the reasons for testing – like if you have tried other medications that haven’t worked. If you’re concerned about cost and coverage, contact your insurance provider prior to testing so you can know what to expect.
Learn more about pharmacogenomic testing here.
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Getting the Most Out of Your Medication
Some people get relief from their symptoms immediately, others after a few days or weeks; for others it may take even longer. Medications differ widely in how quickly they take effect. After a short time on the medication, it's important to share with your doctor or therapist how you are doing with the treatment.
Remember to be honest with your provider. Tell him or her about your symptoms. Also make sure to tell the provider about any drugs, alcohol, over-the-counter or prescription medicines and herbal supplements you've been taking. That way you'll get the most appropriate treatment.
Dealing with side effects
If you're having trouble with a medication, or experiencing unpleasant side effects, don't suffer in silence. Your doctor or pharmacist will likely have suggestions that can help. You can use a side-effect checklist to keep track and quickly share information with your provider.
Sometimes side effects can be addressed easily. If you have:
- Dry mouth...Try sugarless gum or mints
- Constipation...Drink plenty of water and eat lots of fruits and vegetables. Ask your doctor or pharmacist about over-the-counter remedies.
- Nausea...Take your medication with a meal.
- Feeling sleepy...Ask about changing when you take the medication.
- Problems with sexual functioning...Talk with your doctor about changing or adding medicines. Talk with your partner about what's happening.
Try to keep track of your progress
- Keep a chart of your medications and how you're feeling. That way you can make sure you're taking your medicines at the right times, and you can see how they affect your progress. You also might want to share your chart with your health care providers. It's very important that your providers have all your recent information so they can figure out how best to support your recovery.
- If you have any questions, consider putting them in your chart. It can be hard to remember everything you want to discuss with your doctor, especially if your appointment is short or you feel somewhat stressed about it.
- Hold on to your records. If a doctor suggests a particular medicine, you can check your records to see if you've taken it in the past and how well it worked.
- Keep track of who can help. Ask your doctor whom to call if you suddenly have troubling side effects. Pharmacists can be of tremendous help in understanding medications, how to use them safely, possible side effects and other treatment options. Give a list of your medications to a friend or family member in case of emergency. Carry one in your wallet too. Include the names of your pharmacy and your health care providers.
If you are thinking about stopping your medication...
There are many reasons people consider stopping their medication. Some people dislike the side effects, feel that there's stigma about medication or worry about the expense. If these or other concerns are bothering you, know that you are not alone. Still, quitting is a big decision and can seriously affect your health, so think it through carefully.
Some possible steps if you're thinking about stopping include:
- Take a look at your situation. Consider whether changes in your life or your body may be affecting how well the medication is working. Ask your doctor if switching or adding medications might help. And ask whether stopping a medication creates a risk that means it won't work as well if you decide you want to go back on it later.
- Talk honestly with your health care provider. Some people feel uncomfortable raising concerns with their providers. Remember that it's your right to ask questions and make decisions. To help the conversation go smoothly, make sure you both have enough time to talk. State your concerns calmly, and try to agree on some reasonable next steps for promoting your recovery.
- Talk to the people who support you. They may be able to help you decide. Even if you don't want help with the decision, people close to you should know that you haven't been feeling well. That way they can provide extra support if you need it.
Following some basic guidelines will protect your health while taking medication:
- Avoid using street drugs or drinking alcohol while taking psychiatric medications. The combination can be dangerous and even deadly.
- Be careful while driving or using machinery, especially if your medicine makes you sleepy.
- Women who may become pregnant, are pregnant, or are breast-feeding should talk with their doctor about possible special concerns related to medications.
- Stopping medications abruptly may cause you to feel ill - and possibly could even cause a seizure. They should be stopped gradually and according to your doctor's instructions.
- If taking a medicine causes you to feel sick, have a fever, skin reaction or anything else that worries you, contact your doctor or pharmacist as soon as possible.
Ask Important Questions
To protect your health, be sure to ask your doctor or pharmacist the following questions:
- What is the name of the medication? Is it known by other names too? Is it a "brand name" or generic?
- When will the medication begin to work?
- What is the recommended dosage? How many times a day will I take it?
- Should I take the medication with food?
- What are the side effects that commonly occur with this medication?
- What are the less common but more serious side effects that can occur?
- Is this medication addictive? Can it be abused?
- Are there any laboratory tests that I need before beginning this medication or while I'm taking it?
- Are there any medications, foods or supplements I should avoid while taking this medication?
- How long will I be taking this medication? If I stop taking it, what are the chances of my symptoms returning?
- Is there any chance my symptoms will be worse once I stop?
- How soon will I see results?