10 Tips When Beginning Medication

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I've lived with depression since 1980 and have worked professionally over 25 years treating children and adults who have depression.

As someone who knows what it's like to take medication personally, and recommend it professionally, here are the top 10 tips for getting the most out of your antidepressants.

1. Get a genetic test: Nowadays, medication for depression doesn’t need to be a hit or miss experience. Personalized medicine offers a unique way of tailoring medications for you and your genetic profile. Specific testing of Cytochrome p450 enzymes can help determine what dosages and the types of medication best suit your genetic makeup. Perhaps even more important is that genetic testing panels for antidepressant medications can detect gene variations that are linked to poor responses to SSRI medications - heightening the risk of treatment resistant depression. Personalized genetic testing can be done by a simple cheek swab in your doctor’s office – and is frequently covered by insurance companies. Labs like GeneSight, YouScript, AssureRX and others can detail more about how this genetic testing works.
2. Fill your prescription right away: Going straight to your local pharmacy once you’ve been handed a prescription or if it’s been called in by your doctor, assures that you can have your medication in-hand, ready to begin the next day. The faster you fill your prescription, the faster you recover from depression.
3. Use a medication side effect checklist. Prior to beginning your medication, it’s a good idea to take an inventory of the behavioral and emotional ways you’re feeling. Medication side effect checklists can be found online, or you can just go old-school and jot down a note to monitor if you've experienced anything like headaches, stomachaches, dry mouth, constipation, or diarrhea before taking your new medication. Being mindful about how you feel physically and emotionally beforehand holds important data for two reasons. First, it helps isolate side effects and second, it helps measure improvements in your mood.
4. Read the medicine packet: Take a few minutes to read the medication information when you pick up your prescription. Sometimes doctors and nurse practitioners don’t have enough time to go into every detail, so reading about the do’s and don’ts of taking this particular medication can help you achieve optimal results. For example, you may need to avoid certain foods with your medication. Or you may need to lessen the dosages of over the counter cold treatments, and other such things. Empowering yourself with such knowledge improves the power of your recovery.
5. Pick and time and stick to it: Treatment consistency is the ability to stay on track with your treatment plan – and it is a big, big issue. Research says that upwards of 70% of people with depression don’t take their medication as prescribed. This is called non-compliance - and not taking medication consistently will significantly delay your recovery. I encourage you to pick a time when you're always awake, like noon, dinner time or in the evening - so you can take your medication at the same time each day. When you take your medication predictably every day, you give your body the necessary ingredients at a timely rate.
6. Keep extra doses handy: Keep at least one day’s worth of your dosage at your place of work and in your wallet/purse in case you forget to take your medication. Having extra dosages helps if you can’t get home for your next dosage. I like having pill boxes that snap tightly closed, or a key chain that holds pills. Resist taking your entire bottle of medication with you wherever you go. The constant shaking of the bottle can flake or chip certain kinds of medications. Worse, if you lose it, you’ll have to pay full price for another refill. And sometimes doctors and nurse practitioners won’t feel comfortable ordering another prescription, especially if the medication is a controlled substance.
7. If you have side effects, call your doctor or nurse practitioner: Side effects come in many forms. They can be dosage related – meaning once your body gets used to the medication, the symptoms fade. Other side effects won’t go away but are not life threatening. Lastly, sometimes you can have allergic or dose related side effects called adverse reactions -- which are very serious. The point here is whenever you're feeling something out of the ordinary, contact your prescribing mental health professional. Explore questions of side effects to see if adjustments can be made, like changing the timing of medication (from afternoon to night, where you may sleep through some of the side effects), taking the same dosage, but cutting it in half and taking it twice a day – or changing medication entirely. Sometimes you’ll have to find acceptance with certain side effects – for example, which is worse…having the depressive symptoms or experiencing weight gain.
8. Never stop taking medication on your own: Make sure you never abruptly stop taking your medication. Why? You can set into motion a serious condition called Discontinuation Syndrome. The take away here is there’s a specific way to come off antidepressant medications. Generally, your dosage is lowered a little bit at a time over the course of a week or two. This is done to help your body readjust. Antidepressants are not addictive, but stopping them without working with a prepared discontinuation plan can cause great discomfort.
9. Be ready for a long run: When starting your medication therapy, it’s important to remember that it can take some time before you begin feeling better. It may be a few weeks or even months before a medication reaches its optimal level – and for you to experience its full benefits. Keep in contact with your doctor or nurse practitioner - and learn how to evaluate your feeling and thinking states to discover how your recovery is progressing.
10. Consider pairing talk therapy with medication: Research says that the best approach to treating depression is the combination of talk therapy and medication. So, consider adding session work to your treatment plan. In addition to helping you monitor how your medication is doing, psychotherapy can teach you new ways of thinking, problem solving and learning how to live well in spite of having depression.

References

Haddad, P.M. & Anderson, I.M. (2007). Recognising and managing antidepressant discontinuation symptoms. Advances in Psychiatric Treatment,13(6):447-457

Keller, M.B. (2005). Issues in treatment resistant depression. Journal of Clinical Psychiatry, 66: 5-12.

Richards, C. & Michael G. Perri, M.G. (2010). Relapse Prevention for Depression. Washington: American Psychological Association.