Medication

Overview

Today there is an ever expanding selection of medications available. While medications do not necessarily cure most mental illnesses, they markedly reduce symptoms for most people, and are generally considered the first line of treatment for more severe mental illnesses.  It is common for individuals to use medication in combination with other treatments such as lifestyle choices, psychotherapy (also called “talk therapy” or “cognitive behavioral therapy”), or community rehabilitation programs.  Choosing the right treatment plan should be based on a person’s individual needs and medical situation, and should always be conducted under a mental health professional’s care. 

Overall, medication can help a person to better function and cope. It may be a short-term aid that only needs to be taken for a few months, or may be a long-term, even life-long, treatment approach. With well-developed programs and the right medications, some patients recover substantially and achieve a satisfactory life, while others may require additional support for most of their lives. The goal is to help each achieve the highest degree of independence and productivity possible.

 

Understanding Medications

When prescribed a medication, the person should:

  • Tell the doctor about all medications and vitamin supplements they are currently taking.
  • Remind the doctor about any allergies and any problems they have had with medicines.
  • Not take medicines prescribed for another person or give theirs to someone else.
  • Call the doctor right away if they have any problems with their medicine, or are worried that it might be doing more harm than good. The doctor may be able to adjust the dose or change the prescription to a different one that may work better for the individual.

 

Effective Treatment is a Matter of Trial and Error

When starting treatment it is common for patients to try several prescriptions before finding the right drug and dosage that alleviates their symptoms.   Certain drugs will affect each individual differently with varying degrees of success and severity of side-effects.

Things might be picture-perfect if psychotropic drugs were “Silver Bullets” and only affected those areas that control specific symptoms of mental illness. However, psychotropic medications are more like buckshot -- they hit the target and everything else around it. Medications impact many parts of the brain and may include unpleasant side-effects.  These effects vary from person to person, and depend on the type of drug and dosage being given. Sometimes side-effects disappear after a few days or weeks, while others are more troublesome and long lasting.

Therefore, it is very important to let your prescribing doctor know of any unwanted effects the medication may be having.  This is because unpleasant effects can often be eliminated, reduced in severity, or made more tolerable by making some simple adjustments.

Attentive, informed, and well-managed treatment succeeds in these illnesses most of the time.  Today’s psychotropic drugs provide one of the most powerful tools in controlling symptoms of mental illness and preventing relapse. In the last sixty years, the story of the advances in tolerability and effectiveness is one of steady advances to make it easier for people who must take these drugs. There are setbacks and successes, but overall, problems with psychotropic drugs are outweighed by their benefits.

 

Trouble with Adherence to Medication

1.   Discouraging Side-Effects

At some point during their lives any person taking medication may ask, “Are the unpleasant side effects of a drug worth tolerating to gain the symptom relief the drug provides?” 

Often times the aforementioned struggles with side-effects discourage people to consistently adhere to their regiment. However, this dilemma doesn’t just apply to those with mental illness who are prescribed psychotropic medications; it applies to how people approach taking medication in general. Various studies indicate that only approximately half, 50% of patients, “adhere” to their prescription as directed. In other words, many of us “fool around” with prescribed medications.[1]

There are common experiences people have when taking any prescribed medications, whether it may be for diabetes, cardiovascular disease, or hypertension etc.  The following are very normal reactions and may sound familiar:

  • The person will say they feel ‘drugged’, lethargic or foggy.
  • They will feel they do not need the medication once they start to feel better.
  • The medication may make the person feel sick
  • The person may experience weight gain.
  • The medication may dampen the person’s sexual responses
  • They may feel inconvenienced and not take the medication every day, or at regular intervals

These are the tough cost/benefit choices every patient must make when given a prescription, not just those with mental illnesses.  However, for all of these negative responses, it is also common for people to have positive ones.  By “taking charge” of their medications people gain a sense of control over their illness and no longer see it as a looming obstacle in their lives. 

For those struggling to regularly adhere to their drugs, relapse is a strong possibility.  During relapse, symptoms come back or get worse. Therefore, it is very important for the patient to talk to their doctor when choosing to stop taking a medication.  Prescriptions should only be gradually tapered off— never stopped suddenly.

[1] Brown, M. T., & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), 304–314. http://doi.org/10.4065/mcp.2010.0575

2.      Anosognosia or “Lack of insight”

Over half of the individuals who are admitted to the hospital do not acknowledge that they are ill; this common lack of insight is referred to as Anosognosia. The person continues to deny their need for treatment even though their symptoms improve on medication. A “Lack of Insight” is so common during psychotic and/or manic episodes that Anosognosia is now considered a reliable clinical sign of both these illnesses. Depressed people commonly fail to recognize that they are becoming dangerously ill, believing that their episode “isn’t really serious” or that “it will pass.” Lack of insight seems to be a part of the mental illness process, and may persist for the duration of the illness.

3.      Protective Denial by Peers

It is important to know that relatives go through many of the same emotional responses as the ill individual.  At some point, loved ones may realize that something is terribly wrong, but are not ready to deal with this painful recognition. 

During this denial period, “accepting” drugs is an admission of illness and refusing them maintains the protective illusion that “nothing is wrong.” Even if the relative agrees temporarily to medication, typical side effects may be disturbing at the denial stage of “not needing medication.” From this point of view, quitting makes sense.

Overall, when the family fails to acknowledge the severity or existence of the illness, or does not possess a fundamental understanding of mental health, it’s highly likely the ill individual will be discouraged from seeking help or lack the will to continue treatment.  It is important to note that, when faced with a serious condition such as Schizophrenia or Bipolar disorder, friends and family are indispensable in the person’s recovery.

 4.      Perceived Loss of Self

One of the great advantages of the anti-depressants is their ability to lift mood and enhance wellbeing. But many other psychiatric drugs have the opposite effect. If someone’s mania or psychosis is grandiose and exciting, medications bring a painful return to the colorless world of “having a mental illness.” Even when medications block a terrifying psychotic experience, there is this “dull” after-effect.  People are also afraid that taking a medication will change their personality or they complain it interferes with the immediacy of their perceptions and feelings.  They relate that these drugs make them feel distant and inhibited.

However, despite what some see as a loss of self, others find that treatment allows them to take charge of their lives, and express their personality more profoundly than before.  No longer at the mercy of crippling moods and the disorientation of psychosis, they are able to make better decisions and improve their quality of life. 

 

What to Do if You Have a Problem With Your Mental Health Coverage


When You Have a Problem with Your Managed Care Plan

If talking with your mental health provider or your plan does not help, you have the right to file a complaint (also called a grievance or appeal). Your mental health provider may assist you with your complaint. You can file a complaint if you have any problem related to your care or service such as:

  • Inability to find anyone on your plan’s provider list who is taking new patients.
  • Inability to get an appointment as soon as you need one.
  • Inability to get authorization for services when you need them.
  • Your medication is denied or changed without your approval.
  • Your plan has limited your number of therapy sessions.

First contact your health plan to file a complaint over the phone, in writing or through your plan's website.  Health plans are required by law to have a grievance process in place to resolve enrollee complaints within 30 days. 

If your health problem is urgent, if you already filed a complaint with your health plan and are not satisfied with the decision, or it has been more than 30 days since you filed a complaint with your health plan you may submit an Independent Medical Review Application/Complaint Form with the State of California Department of Managed Health care (DMHC).

 

Department of Managed Health Care (DMHC) Resources

Department of Managed Health Care
California Help Center
980 9th Street, Suite 500
Sacramento, CA 95814-2724