Affiliated Medical Group

Starting Medication

When considering starting a new medication, there are always benefits as well as risks in doing so. Regardless of the type of medication, whether it’s prescribed by your Primary Health Care Provider, Psychiatrist or ER Doctor, there will always be various things to think about. Here are a few tips that our providers at Affiliated Medical Group have compiled when considering starting a new medication: 

  1. Start as low as possible. 
There are two main reasons why we start a new medication as low as possible. 
  1. Watch for any allergic reactions.
  2. Watch for any Side Effects (SE). 

If an allergic reaction and/or SE arise when beginning a new medication, contact your prescribing provider immediately or seek emergency medical attention if needed.  
 
  1. After reviewing all SE and possible allergic reactions, once the medication is tolerated, THEN we assess whether the medication is effective. 
So, in order to use any medication, these are the two elements that must be present: 
  1. Medication has to be tolerated. 
  2. Medication has to be effective. 
 
  1. Once we are sure that the new medication is tolerated, then we may adjust the dose to the best effect.
Once the patient reports that the new medication is tolerable, the patient and doctor can discuss making any dose adjustments or possibly even change the medication, overall. 
 
  1. The whole medication experience is an overall team effort. 
While the doctors or NPs are the ones who prescribe medication, the patient is “The Captain,” in this medication experience. Therefore, the doctor and patient discuss medication options and recommendations are made. Lastly, the patient decides whether they would like to start the medication, per the doctor’s suggested recommendations. 
 
  1. At each medication dosing, we reassess effectiveness and tolerability. 
It is very important for a patient to keep their regular appointments with their provider so that we can continue to track and check if the medication continues to be tolerated and effective for the patient. That is why we reassess those two things at each dosing. Additionally, if any side effects occur, the patient must decide if the benefits outweigh those problems. Sometimes a medication may be beneficial but a problem like a side effect from the medication may occur as well, so it is up to the patient to decide if they will continue taking the medication with benefits as well as possible risks. For example Julia may take Adderall for her ADHD in the morning and see a ton of benefits with great results, however she reported also experiencing symptoms of restlessness in the evening time. These “problems” or side effects are something that we encourage Julia to report to her provider and decide how she would like to move forward. 
 
  1. As time passes, medication may be less effective or may continue to be effective. 
Sometimes medications seem to work in the beginning and then we notice that the effectiveness has decreased over time. Sometimes the medications just stop working overall. If the medication is less effective, we normally try to determine why. There are a few things to watch for if medications become less or not effective. One thing to watch for is any changes in Manufacturer. Each generic medication can have several different manufacturers. For example generic Sertraline has several different manufacturers, therefore not all generic Sertraline pills will look or act the same way. One thing that our providers at AMG suggest is for the patient to write down the manufacturer name of the medication the patient is taking and continue to monitor the bottles at every refill, assuring they’re all the same. Other things to watch for if a medication becomes less effective includes factors such as changes in stress levels, diet, sleep patterns and/or changes in other symptoms. Finally, things such as interactions with other medications or even foods such as grapefruit juice or Grapefruits can cause changes in medication effectiveness. 
 
  1. Please note that everyone's metabolism is different and their response to medications will differ overall. 
Another thing to consider when looking at medication effectiveness is that every single person’s metabolism is different, meaning that all medications will affect people differently. Sometimes people say that the type of medication they are taking works great for them so they recommend it to their neighbor, brother-in-law, boss, friend, spouse, etc… For example, let’s say Mark is taking Zoloft for his depression and anxiety. Mark’s best friend Isabella is also struggling with some depression and anxiety herself. Mark recommended Isabella take Zoloft to treat her symptoms because he finds it works well for him. Everyone is so unique that those kinds of predictions are not always helpful.
 
  1. Some medications are used for the longer term whereas others are very short term. 
Some patients experience moments in their lives that may cause significant distress for a short period of time. Such moments may include a death in the family, loss of a job, starting college, loss of a family member or pet, etc… These events in life can cause symptoms that fall under different diagnoses such as Insomnia, Panic Attacks, Anxiety, Depression, Trauma and more. There are specific medications that providers can use to treat these symptoms that are usually short term. In other cases, some medications are used for the longer term. Certain symptoms can include the ones just mentioned, but other symptoms like those associated with Bipolar or Schizophrenia may require long-term medication. 
 
  1. Always talk to your provider if you are thinking about discontinuing medication.
If medication is to be stopped for whatever reason, a taper down schedule is developed similar to tapering up as we start medicine. We recommend that a patient never stop taking medication on their own account, and instead discuss with their provider what they wish to do. Once stopped abruptly, some medications can cause withdrawal effects and may even require a patient to seek emergency assistance right away. 
 
  1. One category of medicine which often needs less tapering down is stimulants. 
Some stimulant medications may include Adderall, Concerta, Vyvanse, Ritalin and more. Oftentimes some patients will skip taking these types of medications on the weekends or over the summer, in the case of students. Whenever properly discussed with their provider, a patient can choose to skip days on these medications if desired. 
 
  1. There are times when a combination of medications is used. 
Some patients may need to take more than one medication and that is okay. The patient and the provider will discuss any interactions as well as risks, if any. It is always the patient’s duty to let all their providers, not just Mental Health providers, know about all medications they are currently taking or are newly prescribed. 
 
  1. Don’t stress about it. 
We understand that starting a medication may seem like a lot, but with a good relationship between the patient and the provider, then the ship can be sailed smoothly. Just remember, there are a few things to consider before starting and ending a medication. If you ever have any questions or concerns in doing so, then bring it up to your provider at the time of your appointment.

Here at Affiliated Medical Group our providers care tremendously about all of our patients. The safety of our patients is always our number one priority, which is why we always strive for the best and try to communicate with patients as best as we can. We would also like to encourage our patients to visit their Patient Portal at any moment, where they can find additional information about their visits and medications, such as side effects. Feel free to contact our office at any given moment and see how we can further assist you. 

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