Meet the family The good, the bad and the quirky members of the psych meds clan
By Jane Mountain, MD
Psych meds are a lot like a large extended family that you are marrying into. You will want to get to know them one or two at a time rather than attending the family reunion and meeting hundreds of cousins at once. You may warm up to part of the family right away, but there may be cousins whom you consider to be black sheep.
You may find it impossible to keep in your head who's who. Doctors, nurse practitioners and physician's assistants keep track of medicines by thinking about classes of medications-just as you might keep track of the cousins by remembering which uncle or aunt they belong to.
Patience With The Cousins
One major way in which most medications differ from psychiatric medications is that non-psychiatric medication in a class or family will work pretty much the same for anyone with the condition being treated. If your doctor decides that an ACE inhibitor is the class of medication to treat your high blood pressure, it doesn't matter which member of the ACE inhibitor family is chosen. They normally work about the same for each patient. These cousins are agreeable with everyone.
Tips for managing medications
Perhaps with psych meds our brains are a bit pickier. A medication can be chosen from a class or family, but it might not work as well for one person as for the next. So there are many cousins, children of the same aunt and uncle, but they don't perform the same at all. These cousins don't agree with everyone.
So do doctors still think of classes of medications when prescribing psych meds? Yes, they do! Does it matter which medication within a class is chosen for an individual? Yes, it does! The challenge is that, at this time in our medical knowledge, it is impossible to tell right off the bat which medication will work for whom.
Have you tried one medicine to find that it doesn't work well for you, requiring a switch to a different medicine in the same class or family? The medicines are cousins but they don't look alike.
It takes patience and some trial and error in finding the medication or combination of medications that will work for you. Some of us give up too soon and experience more pain, more depression, more mania or hypomania, and more parts of our lives to put back together. We've been through this Humpty-Dumpty thing too many times to give up.
But, persistence can pay off with an excellent chance of achieving mental wellness. Psychiatric disorders are more successfully treated than heart and lung diseases and most forms of cancer.
Longer To Work
It's important to remember that most psych meds take longer to work than do other classes of medications. You take something for high blood pressure or a common infection and the goal is usually accomplished in a few days to a couple of weeks.
The cousins in the psych med branch of the family don't work that way. Not understanding the delay between starting a medication and its taking effect can lead you to stop the medication before it has had a chance to work. It may take four to six weeks and sometimes even up to three months for a medication to kick in at its best! But don't give up before you see your medication doing its best work. If only patience could be dolled out generously at the family reunion!
Even More Patience!
Side effects often precede the benefits of many psych meds. Many side effects are uncomfortable and a very few need to be reported right away; your doctor can tell you what to watch for. Nearly all side effects will require patience rather than action. Many-if not most-will go away after you have been on the medication for a while, sometimes within a week or two.
Our nervous system has two parts called the sympathetic and the parasympathetic nervous systems. The sympathetic nervous system kicks in for the so-called flight, fight or freeze response. The parasympathetic system kicks in for everyday things like digestion, normal bodily functions and even sex.
Many of the side effects of psych medications affect the parasympathetic system. This means that symptoms such as dry mouth, nausea, constipation and diarrhea can be common. Sexual performance can also be affected.
Side effects can be temporary, so give your parasympathetic system a chance to bounce back. But if side effects continue to bother you, talk to your doctor about ways to manage. In some cases the medication will need to be changed. But these cousins in the family of medications may be ones you can live with after all.
Don't keep family secrets about the psychiatric medications you are taking. Instead, write down your concerns and take them with you to your next appointment. Your doctor or prescriber should be willing to work with you in a supportive way while you try medications. Your overall goal is to feel better and stay well for as long as possible.
Family members and friends, you be patient, too. Taking psych medications is not like popping an aspirin for a headache. Don't expect instant results. Be supportive of your loved one during the process of figuring out the best mix of medications, psychotherapy and recovery skills.
Have appropriate expectations of the process of finding mental wellness in the context of bipolar disorder. There is every reason to have hope, but you may need a good dose of patience before you see your hopes fulfilled. When you marry into a family it takes time to meet the cousins and size them up. The same is true with medications.