Cyndi Turner's Blog, page 16

Life of a Quarantined Teen

If you asked just about anybody, they would probably tell you that a teenager would love being at home, away from school and other responsibilities. That has proved itself not to be the case. Not even a quarter way through this and I am dying to go back to school and have life unpaused. Being home without having to go anywhere might have sounded appealing at first but it definitely hasn’t turned out that way. Everything I was looking forward to has been canceled including a funeral, ceremonies, field trips, swim meets and practices, hockey season, and vacations. I can’t hang out with my friends or even see my extended family. Many of the places that my friends and I like to hang out at have been closed as well. So far the days without school and my normal interactions have been slow but can turn out to be little adventures. With every bad thing there is an upside. I try to make this time count so I spend more time doing things I claimed “I never had the time for” when we weren’t quarantined. I have developed my love for certain hobbies: things like playing the piano, cooking, going on long walks, sewing, and reading. I have spent a lot of time with my family and together we have deep cleaned most of the house. Now that we have more time together, we have also started family game nights which turn out to be loads of fun. We play our favorite games Sequence, Five Crowns, and mahjong. Well, it helps the days feel more meaningful when we are together.

Then again there are so many that we are missing out on. Now that the governor issued a Stay at Home Order, we aren’t allowed to interact with any of our friends. Even before that, most families had started practicing social distancing so it has been awhile since I’ve seen anyone but my mother, father, or sister. The only form of communication with friends and the outside world is online. Oftentimes communication is through face timing, snap chatting, and texting each other to keep ourselves sane. Nowadays, most teenagers are feeling very lonely and we resort to the media to cure our loneliness. Social media apps like TikTok are full of teenagers voicing their thoughts and feelings about this pandemic and it is nice to hear how others are handling it. Sometimes it can be really funny too. Another thing that is difficult about being stuck at home is the whole birthday situation. My sister just had her 18th birthday and we tried our best to give her a fun and safe party but it wasn’t as grand as we had hoped. Every year on our birthdays my sister and I are lucky to get a “friend party” as we call it, so we can celebrate our birthdays with our closest friends. That didn’t happen for my sister this year. It sucks that she missed out on that on such a special birthday. Because this will be going on for months, many others aren’t getting to celebrate their birthdays as well. My birthday is all the way in June, which seems so far away, but this quarantine is supposedly ending two days after my birthday. That means my sister, my mom, and I will be celebrating our birthdays at home. It’s different but we make the best out of it. So far it is kind of a fun change of pace with the birthdays. We can order our favorite foods, create gifts, and order great presents online for each other. Nobody likes missing out on things that they have waited a long time for. Something I am really sad about is the fact that I’m 13 years old and I have already had my last day of middle school. It ended unexpectedly. I was excited to graduate from middle school as the first class to go through all three years but school ended so suddenly and we won’t be able to go back. It’s a scary thought that the next time I physically go back to school, it will be at my new high school.As much as I dislike this, things are definitely worse for my sister. She is a senior in high school and doesn’t get all of the special events she earned. She returned her dress and shoes for prom and it’s unlikely that she gets a normal graduation. She got into college but we aren’t even sure if move in day will get postponed. I feel terribly for all of the seniors who worked so hard to get to their senior year and then they can’t even finish it off the right way. I just hope that they will end up getting the farewell they deserve. Unfortunately, the future’s uncertain and that is one of the worst parts about this whole thing. Not knowing when this will be over and things can go back to normal is terrible. Even if the deadline for staying at home is pushed back, things will take awhile to go completely back to normal. I sometimes wonder if when this is all over, will handshakes stop being a thing? But the cancelation for all of these major things is for a good reason. Which is to keep us all safe. And that is what we all need to remember. There are many things that parents can do to help their teens during this time. Parents should make an effort to spend more time with their kids since they are the only people they can talk to face to face. Little things like playing games and going on walks together are really good ways to make this pandemic easier on families. This is a chance to enjoy family time and learn more about each other. Sure things can get tense when you’re cooped up at home with your families, but when it gets that way just try to give each other space and revisit family time. I can’t think of anyone who likes missing out on all of these important milestones, but at least we know that we are all going through it together. It’s awful but we’ve got to do our part to keep this virus from spreading and keeping ourselves and others safe. This time spent at home is what you make of it so my recommendation during this dreadful time is to not to think of it as a monthly thing but rather take things one day at a time.  

The post Life of a Quarantined Teen appeared first on Insight Into Action Therapy.

Covid-19: A Middle Schooler’s Experience

Sitting at home with nothing to do would seem like the ideal thing that any student or kid, for that matter, would want. But that’s not necessarily true.  The Coronavirus has spread across the globe with its contagious wrath causing chaos and mass panic.

News reports tell us it has a very significant chance of killing the elderly and causing harm to young adults and teens.  While we all take the necessary precautions to wash our hands and keep safe.  This virus is not just affecting the body, but as well the mind.

I was just 3-days into the quarantine and it built up and came out. I was on my porch with my dogs while talking with my mom. I told her I wanted to go back to school and said “I never thought I’d ever say that” then shed a few tears. I even told her “I don’t even know why I’m crying” she held me and told me I’d be ok. It does take a toll on your brain.

As states have imposed social distancing and quarantine guidelines, students are stuck at home not able to visit and hang out with friends or play the sports we love.  So, what do we have X-Box, PS4, Nintendo which you think wouldn’t be an issue.  But it eventually gets boring.  How much gaming can you do?  I miss and need human interaction, it fuels us.  It helps build character, it allows us to get thoughts and ideas off our shoulders.  Even with your parents and siblings it gets repetitive and everyone needs variety to stay sane – nobody wants to eat chicken every day for a month.  In short, I miss school, my friends, and my teachers.  I understand that quarantine is for safety and like everything in life the virus will eventually pass. It will be a story that I can tell my children and grandchildren.

Find some way to speak to a friend. Maybe just set aside an afternoon to talk over the phone…

Insight Into Action Therapy is here to assist you, a family member, or a friend struggling with mood and emotional challenges. We also specialize in the treatment of Substance Use Disorders. Give us a call at (703) 646-7664 to learn about our services.

 

 

Covid-19: A middle schooler’s experience

Sitting at home with nothing to do would seem like the ideal thing that any student or kid, for that matter, would want. But that’s not necessarily true? The Coronavirus has spread across the globe with its contagious wrath causing chaos and mass panic.

News reports tell us it has a very insignificant chance of killing the elderly and causing harming to young adults and teens.  While we all take the necessary precautions to wash our hands and keep safe.  This virus is not just affecting the body, but as well the mind.

I was just 3-days into the quarantine and it built in and came out at once. I was on my porch with my dogs while talking with mom. I told her I wanted to go back to school and said I never thought I’d ever say that” then shed a few tears. I even told her “I don’t even know why I’m crying” she held me and told me I’d be ok. It does take a toll on your brain.

As states have imposed social distancing and quarantine guidelines, students are stuck at home not able to visit and hang out with friends, play the sports we love.  So, what do we have X-Box, PS4, Nintendo which you think wouldn’t be an issue.  But it eventually gets boring, how much gaming can you do.  I miss and need human interaction, it fuels us.  It helps build character, it allows us to get thoughts and ideas off our shoulders.  Even with your parents and siblings it gets repetitive and everyone needs variety to stay sane – nobody wants to eat chicken every day for a month.  In short, I miss school, my friends, and my teachers.  I understand that quarantine is for safety and like everything in life the virus will eventually pass. It will be a story that I can tell my children and grandchildren.

Find some way to speak to a friend. Maybe just set aside an afternoon to talk over the phone…

Insight Into Action Therapy is here to assist you, a family member, or a friend struggling with mood and emotional challenges. We also specializes in the treatment of Substance Use Disorders. Give us a call at (703) 646-7664 to learn about our services.

 

 

Covid-19: A Middle Schooler’s Experience

Sitting at home with nothing to do would seem like the ideal thing that any student or kid, for that matter, would want. But that’s not necessarily true.  The Coronavirus has spread across the globe with its contagious wrath causing chaos and mass panic. News reports tell us it has a very significant chance of killing the elderly and causing harm to young adults and teens.  While we all take the necessary precautions to wash our hands and keep safe.  This virus is not just affecting the body, but as well the mind.

I was just 3-days into the quarantine and it built up and came out. I was on my porch with my dogs while talking with my mom. I told her I wanted to go back to school and said “I never thought I’d ever say that” then shed a few tears. I even told her “I don’t even know why I’m crying” she held me and told me I’d be ok. It does take a toll on your brain. As states have imposed social distancing and quarantine guidelines, students are stuck at home not able to visit and hang out with friends or play the sports we love.  So, what do we have X-Box, PS4, Nintendo which you think wouldn’t be an issue.  But it eventually gets boring.  How much gaming can you do?  I miss and need human interaction, it fuels us.  It helps build character, it allows us to get thoughts and ideas off our shoulders.  Even with your parents and siblings it gets repetitive and everyone needs variety to stay sane – nobody wants to eat chicken every day for a month.  In short, I miss school, my friends, and my teachers.  I understand that quarantine is for safety and like everything in life the virus will eventually pass. It will be a story that I can tell my children and grandchildren. Find some way to speak to a friend. Maybe just set aside an afternoon to talk over the phone…

Insight Into Action Therapy is here to assist you, a family member, or a friend struggling with mood and emotional challenges. We also specialize in the treatment of Substance Use Disorders. Give us a call at (703) 646-7664 to learn about our services.

   

The post Covid-19: A Middle Schooler’s Experience appeared first on Insight Into Action Therapy.

LCPS Mental Health and Wellness Conference

Saturday January 11, 2020 at Independence High School, Loudoun County Public Schools had its Mental Health and Wellness Conference.  The conference agenda had 3 breakout sessions one of which included showing of the IndieFlix original documentary, LIKE.

With one in three adolescents suffering from an anxiety disorder, Craig James presented Anxiety: Overcoming the Pressures of Prosperity during the first breakout session.  The presentation reviewed that adolescence is a vulnerable time for the brain and for teenagers in general.  While most teens go on to become healthy adults, as adolescents their brains are more susceptible.  Craig discussed some of these contributing factors, ways to cope, and discussed tools to navigate the stresses of living in the Northern Virginia area. A few highlights from his presentation:

The brain is resilient. Anxiety is treatable however 80% of those diagnosed are not getting treatment.
Preference of other conditions such as bipolar, depression, eating disorders are just as high during adolescence.
While teens look to alleviate symptomology with marijuana and vaping, this short-term relief will likely worsen the condition in time.
Parents remain mindful of your child personality and needs and succumb to the NOVA traps and pressures of:

Grade, or outcomes over effort & AP Course loads,
Permissiveness over accountability
College admissions as an indicator of success


Impairment in daily function and/or inability to manage thoughts and feelings are reasons to seeking clinical interventions. Clinical support is not a one size fits all and may include medication.
Consider other coping strategies

Alpha Stim
Exercise, Yoga, etc.
Diet – reduced sugar & caffeine
Sleep & Monitor artificial light – effects
Unplug & Engage

LCPS Mental Health and Wellness Conference

Saturday January 11, 2020 at Independence High School, Loudoun County Public Schools had its Mental Health and Wellness Conference.  The conference agenda had 3 breakout sessions one of which included showing of the IndieFlix original documentary, LIKE. With one in three adolescents suffering from an anxiety disorder, Craig James presented Anxiety: Overcoming the Pressures of Prosperity during the first breakout session.  The presentation reviewed that adolescence is a vulnerable time for the brain and for teenagers in general.  While most teens go on to become healthy adults, as adolescents their brains are more susceptible.  Craig discussed some of these contributing factors, ways to cope, and discussed tools to navigate the stresses of living in the Northern Virginia area. A few highlights from his presentation:

The brain is resilient. Anxiety is treatable however 80% of those diagnosed are not getting treatment.
Preference of other conditions such as bipolar, depression, eating disorders are just as high during adolescence.
While teens look to alleviate symptomology with marijuana and vaping, this short-term relief will likely worsen the condition in time.
Parents remain mindful of your child personality and needs and succumb to the NOVA traps and pressures of:

Grade, or outcomes over effort & AP Course loads,
Permissiveness over accountability
College admissions as an indicator of success


Impairment in daily function and/or inability to manage thoughts and feelings are reasons to seeking clinical interventions. Clinical support is not a one size fits all and may include medication.
Consider other coping strategies

Alpha Stim
Exercise, Yoga, etc.
Diet – reduced sugar & caffeine
Sleep & Monitor artificial light – effects
Unplug & Engage

The post LCPS Mental Health and Wellness Conference appeared first on Insight Into Action Therapy.

Alternative Solutions for Anxiety

Brian looks like he has the perfect life. He has a well-paying job, nice house, great wife, and two amazing kids. But his anxiety was like a dark cloud that threatened to ruin everything. He struggled with anxiety and debilitating panic attacks for years. He often isolated at home and work, spending a lot of time worrying about the future. He went through periods of time when he was irritable and lashed out at his wife and kids when he was feeling overwhelmed with stress. He stopped exercising and made unhealthy food choices resulting in low energy and poor self-esteem. He would have panic attacks that were so bad that he thought he was dying. Once he ended up in the emergency department.

When Brian was at the end of his rope, his wife  encouraged him to do something different. He’d been to therapist where he just talked and did not get any solutions. He also tried medication, but it made him groggy.

Brian’s wife found Insight Into Action Therapy for a fresh approach to treat his anxiety and panic attacks. Brian reluctantly came to Insight to explore some new options. He was able to be open and honest about the things he was experiencing and the impact it had on his life. He worked with his therapist at Insight to determine a treatment plan to address his anxiety that included CBT, Mindfulness and Alpha-Stim technology.

Brian started attending weekly therapy sessions which consisted of talking about the triggers for his anxious symptoms, incorporating mindfulness practice following disclosure of anxious feelings to help re-connect with the present. He also started integrating the Alpha-stim device for 40 minutes during his 50-minute weekly therapy sessions with the therapist. He was initially reluctant to start with the Alpha-Stim, but after his therapist talked with him about the research-backed evidence for its effectiveness to increase alpha waves in the brain, he felt more comfortable trying the device. He immediately began noticing changes in his anxiety. He was able to recognize the build-up of his symptoms earlier on and began to work through his fears and worries before they became consuming. His overall stress level went down and he had more patience when interacting with his family and colleagues at work.

Brian purchased his own device in order to increase the frequency that he was able to use it from weekly in sessions to daily use at home. He put a plan in place to use the device every morning prior to starting his workday. He continued to practice mindfulness outside of his therapy sessions every evening.

In the last two months, Brian reported experiencing no panic attacks since he started working with his therapist. This was something he had been unable to achieve in the past. Brian reported better sleep since he was not laying awake at night with excessive worry about his future and over-thinking the events of his day. He has told others about how the device, in addition to therapy, has shown him results he had not seen in the past.

Alpha-Stim technology is a safe, fast and effective option for the relief of Depression, Anxiety, Insomnia and pain. Sessions usually last 20, 40 or 60 minutes depending on the frequency of use. The current can be increased to the most appropriate individual level. Results may be experienced for a few hours following the use of the device, with a cumulative effect with more frequent use. Those with anxiety and insomnia typically feel results in 3-4 weeks, those with depression typically see results in three weeks of use.

Angie Harris, LCSW, LSATP, MAC, MA, Craig James, LCSW, LSATP, MAC, and Cyndi Turner, LCSW, LSATP, MAC are all trained at integrating the Alpha-Stim device into your treatment plan for Depression, Anxiety, Insomnia and pain. Give them a call at (703) 646-7664 or email admin@insightactiontherapy.com to learn more about how the device can help you if you are struggling with these issues.

Alternative Solutions for Anxiety

Brian looks like he has the perfect life. He has a well-paying job, nice house, great wife, and two amazing kids. But his anxiety was like a dark cloud that threatened to ruin everything. He struggled with anxiety and debilitating panic attacks for years. He often isolated at home and work, spending a lot of time worrying about the future. He went through periods of time when he was irritable and lashed out at his wife and kids when he was feeling overwhelmed with stress. He stopped exercising and made unhealthy food choices resulting in low energy and poor self-esteem. He would have panic attacks that were so bad that he thought he was dying. Once he ended up in the emergency department.

When Brian was at the end of his rope, his wife  encouraged him to do something different. He’d been to therapist where he just talked and did not get any solutions. He also tried medication, but it made him groggy. Brian’s wife found Insight Into Action Therapy for a fresh approach to treat his anxiety and panic attacks. Brian reluctantly came to Insight to explore some new options. He was able to be open and honest about the things he was experiencing and the impact it had on his life. He worked with his therapist at Insight to determine a treatment plan to address his anxiety that included CBT, Mindfulness and Alpha-Stim technology. Brian started attending weekly therapy sessions which consisted of talking about the triggers for his anxious symptoms, incorporating mindfulness practice following disclosure of anxious feelings to help re-connect with the present. He also started integrating the Alpha-stim device for 40 minutes during his 50-minute weekly therapy sessions with the therapist. He was initially reluctant to start with the Alpha-Stim, but after his therapist talked with him about the research-backed evidence for its effectiveness to increase alpha waves in the brain, he felt more comfortable trying the device. He immediately began noticing changes in his anxiety. He was able to recognize the build-up of his symptoms earlier on and began to work through his fears and worries before they became consuming. His overall stress level went down and he had more patience when interacting with his family and colleagues at work. Brian purchased his own device in order to increase the frequency that he was able to use it from weekly in sessions to daily use at home. He put a plan in place to use the device every morning prior to starting his workday. He continued to practice mindfulness outside of his therapy sessions every evening. In the last two months, Brian reported experiencing no panic attacks since he started working with his therapist. This was something he had been unable to achieve in the past. Brian reported better sleep since he was not laying awake at night with excessive worry about his future and over-thinking the events of his day. He has told others about how the device, in addition to therapy, has shown him results he had not seen in the past.

Alpha-Stim technology is a safe, fast and effective option for the relief of Depression, Anxiety, Insomnia and pain. Sessions usually last 20, 40 or 60 minutes depending on the frequency of use. The current can be increased to the most appropriate individual level. Results may be experienced for a few hours following the use of the device, with a cumulative effect with more frequent use. Those with anxiety and insomnia typically feel results in 3-4 weeks, those with depression typically see results in three weeks of use.

Angie Harris, LCSW, LSATP, MAC, MA, Craig James, LCSW, LSATP, MAC, and Cyndi Turner, LCSW, LSATP, MAC are all trained at integrating the Alpha-Stim device into your treatment plan for Depression, Anxiety, Insomnia and pain. Give them a call at (703) 646-7664 or email admin@insightactiontherapy.com to learn more about how the device can help you if you are struggling with these issues.

The post Alternative Solutions for Anxiety appeared first on Insight Into Action Therapy.

Do Psychiatric Medications Work?

As a practicing psychiatrist, I am often asked this question both by patients as well as family members. The answer is: it depends. It depends on several important factors that patients need to be aware of, especially when they agree to trying a medication for the first time. So, what are these factors?

It depends on what the medication is used for and what the evidence-base suggests

Both the patient and the physician need to be clear on whya medication is being added. It could be to treat a psychiatric disorder such as ADHD, Depressive Disorder, Bipolar Disorder or an Anxiety Disorder.

Many antidepressants such as Zoloft® aka Sertraline are also used to treat anxiety disorders. Newer antipsychotics are also excellent mood stabilizers because they target the same brain neurotransmitters in the brain (serotonin). In fact, at low doses, many antipsychotic/mood stabilizing medications have proven anti-anxiety properties (e.g. Gabapentin, or Seroquel® aka Quetiapine), even if the package insert doesn’t say so. This is called off label prescribing.

In addition, not all antidepressants work in the same way. Some are more activating, such as Wellbutrin XL® aka Bupropion while some are more sedating such as Remeron® aka Mirtazapine).

Depending on the accuracy of the evaluation completed by the medical professional, symptoms may prove to be even more important than the diagnosis. In turn, these symptoms can then be targeted. For example, if a patient tells me he/she is having a hard time falling asleep or staying asleep as part of their depression, I would not want to add an activating medication, especially at the end of the day. I would, instead, choose a sedating medication at the appropriate dose. When chosen properly, the right medication can either provide complete relief of symptoms or have a significant impact on what were previously unbearable or chronic symptoms.

Studies vary as to how effective whole classes of medication, like SSRI antidepressants, are. Oftentimes, various internet threads will trash a particular medication or class of medications. I would ask individuals turning to Dr. Google for advice to be wary of applying any such studies/websites to their own situation, and instead to discuss their individual concerns with their treating provider. It is also a good idea to ask what evidence-based studies there are that support the use of a medication for a particular symptom or a particular disorder.

As a practicing psychiatrist, I can say I have regularly seen improvements in patients’ depressed moods, mood swings, anxiety, distractibility, sleep, energy and even zest for life, as a result of choosing the medication that targeted the relevant brain neurotransmitter(s)that was/were actually at the root of such a symptom.

Hence, discussion with your physician as to the likely effectiveness as well as possible side effects can/should be expected, so that you know what symptoms are going to be treated, as well as realistic expectations as to what the medication is designed to actually do.

It depends on the dosage

One of the most common questions I ask a patient who tells me a medication I mention didn’t work is: Do you remember what dose you were on? This is because underdosing of psychiatric medications is far more common than is realized. Frequently people stay stuck at what is known as a subtherapeutic dose.

By the time I inherit such a patient, I typically increase the medication, sometimes doubling the dose, in order to see more rapid or effective recovery from their disabling symptoms. I also then educate the patient on how an effective and proper dosage is key to being able to ascertain whether or not a medication works.

There is also established evidence that indicates the more rapidly psychiatric disorders are treated, the better the overall outcome, including quality of life and day to day functionality. Conversely, the longer a psychiatric disorder remains untreated/undertreated, the harder it can be to treat. Because psychiatrists are trained as physicians to know how brain receptors and medications work, they can therefore gauge how fast to increase the medication dose.

It depends on the duration of treatment

Most psychiatric medications do not work on mood or anxiety symptoms immediately. While there are some medications that can rapidly relieve ADHD symptoms or anxiety, they also come with the risk of physical dependence including stimulants like Adderall® or benzodiazepines such as Xanax®, Valium® and Klonopin®.

As long as realistic time frames are discussed from the outset, people can know when the medication will kick in. Essentially, the longer the duration of treatment, the more effective and lasting the recovery is likely. The brain’s biology is such that it tends to respond to consistent medications that act on those receptors. In fact, it is the brain’s adapting to chronic medication treatment, that is known to be the keybehind the effectiveness of antidepressants.

It depends on whether the medication is actually taken

Yes, that may sound obvious, but you would be surprised how many patients either fail to fill the prescription, take less than recommended dose, skip doses, or stop their medication altogether, all without the prescribing physician being even aware of what happened. Medication nonadherence is the number one reason for worsening or persistence of symptoms and even hospitalization. I emphasize the importance of being absolutely consistent with taking medication, in order to better gauge how effective it actually is.

It depends on your tolerance to medication

Patients naturally vary in their tolerance to medication or susceptibility to side effects. This can be related to genetics, age, sex, height and weight, as well as how physically active they are. Having a history of drinking or smoking regularly also plays into the kind of doses they may need because their liver may be faster at metabolizing doses that might seem high for others.

That is why your doctor needs to be made aware of these factors when choosing a particular starting dose, in deciding how rapidly the dose is increased, and even the maximum dose for your particular situation/disorder. Genetic testing can also identify whether you are a fast or slow metabolizer of medication.

It depends on whether side effects were experienced or were hard to tolerate

Side effects matter. In fact, they are the number one reason why people stop medications and say that they didn’t work. There is enormous variation among patients as to which side effects are likely to be experienced, and, if so, whether they are mild, moderate, severe, or just simply intolerable.

There are differences in the genetics of the enzymes in the liver that metabolize medications and other factors that make some patients more susceptible to the effects of medication than others (akin to different people having different tolerance for alcohol).

I educate my patient as to which side effects are common, whether they are likely to wear off, and whether antidote medication, reduction in dosage or a switch to another medication is recommended. In any case, the final decision would be the result of a mutually informed discussion where the patient provides me as much relevant information in order for me to give an appropriate recommendation.

As you can see above, it really does depend on a number of factors as to whether a medication does or does not work. While there are a number of medications that may not work for psychiatric symptoms, it would also be important to consider the above factors before writing off a medication altogether. As the old adage promotes on television, please talk to your doctor, so you can be best informed as to which medication is right for you.

 

Dr. Anand is a psychiatrist with Insight Into Action Therapy. He is available in both the Ashburn and Fairfax locations for one-hour evaluations and half hour medication monitoring appointments.  He will not rush  your diagnosis or treatment. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

Do Psychiatric Medications Work?

As a practicing psychiatrist, I am often asked this question both by patients as well as family members. The answer is: it depends. It depends on several important factors that patients need to be aware of, especially when they agree to trying a medication for the first time. So, what are these factors?

It depends on what the medication is used for and what the evidence-base suggests

Both the patient and the physician need to be clear on whya medication is being added. It could be to treat a psychiatric disorder such as ADHD, Depressive Disorder, Bipolar Disorder or an Anxiety Disorder. Many antidepressants such as Zoloft® aka Sertraline are also used to treat anxiety disorders. Newer antipsychotics are also excellent mood stabilizers because they target the same brain neurotransmitters in the brain (serotonin). In fact, at low doses, many antipsychotic/mood stabilizing medications have proven anti-anxiety properties (e.g. Gabapentin, or Seroquel® aka Quetiapine), even if the package insert doesn’t say so. This is called off label prescribing. In addition, not all antidepressants work in the same way. Some are more activating, such as Wellbutrin XL® aka Bupropion while some are more sedating such as Remeron® aka Mirtazapine). Depending on the accuracy of the evaluation completed by the medical professional, symptoms may prove to be even more important than the diagnosis. In turn, these symptoms can then be targeted. For example, if a patient tells me he/she is having a hard time falling asleep or staying asleep as part of their depression, I would not want to add an activating medication, especially at the end of the day. I would, instead, choose a sedating medication at the appropriate dose. When chosen properly, the right medication can either provide complete relief of symptoms or have a significant impact on what were previously unbearable or chronic symptoms.

Studies vary as to how effective whole classes of medication, like SSRI antidepressants, are. Oftentimes, various internet threads will trash a particular medication or class of medications. I would ask individuals turning to Dr. Google for advice to be wary of applying any such studies/websites to their own situation, and instead to discuss their individual concerns with their treating provider. It is also a good idea to ask what evidence-based studies there are that support the use of a medication for a particular symptom or a particular disorder. As a practicing psychiatrist, I can say I have regularly seen improvements in patients’ depressed moods, mood swings, anxiety, distractibility, sleep, energy and even zest for life, as a result of choosing the medication that targeted the relevant brain neurotransmitter(s)that was/were actually at the root of such a symptom. Hence, discussion with your physician as to the likely effectiveness as well as possible side effects can/should be expected, so that you know what symptoms are going to be treated, as well as realistic expectations as to what the medication is designed to actually do.

It depends on the dosage

One of the most common questions I ask a patient who tells me a medication I mention didn’t work is: Do you remember what dose you were on? This is because underdosing of psychiatric medications is far more common than is realized. Frequently people stay stuck at what is known as a subtherapeutic dose. By the time I inherit such a patient, I typically increase the medication, sometimes doubling the dose, in order to see more rapid or effective recovery from their disabling symptoms. I also then educate the patient on how an effective and proper dosage is key to being able to ascertain whether or not a medication works. There is also established evidence that indicates the more rapidly psychiatric disorders are treated, the better the overall outcome, including quality of life and day to day functionality. Conversely, the longer a psychiatric disorder remains untreated/undertreated, the harder it can be to treat. Because psychiatrists are trained as physicians to know how brain receptors and medications work, they can therefore gauge how fast to increase the medication dose.

It depends on the duration of treatment

Most psychiatric medications do not work on mood or anxiety symptoms immediately. While there are some medications that can rapidly relieve ADHD symptoms or anxiety, they also come with the risk of physical dependence including stimulants like Adderall® or benzodiazepines such as Xanax®, Valium® and Klonopin®. As long as realistic time frames are discussed from the outset, people can know when the medication will kick in. Essentially, the longer the duration of treatment, the more effective and lasting the recovery is likely. The brain’s biology is such that it tends to respond to consistent medications that act on those receptors. In fact, it is the brain’s adapting to chronic medication treatment, that is known to be the keybehind the effectiveness of antidepressants.

It depends on whether the medication is actually taken

Yes, that may sound obvious, but you would be surprised how many patients either fail to fill the prescription, take less than recommended dose, skip doses, or stop their medication altogether, all without the prescribing physician being even aware of what happened. Medication nonadherence is the number one reason for worsening or persistence of symptoms and even hospitalization. I emphasize the importance of being absolutely consistent with taking medication, in order to better gauge how effective it actually is.

It depends on your tolerance to medication

Patients naturally vary in their tolerance to medication or susceptibility to side effects. This can be related to genetics, age, sex, height and weight, as well as how physically active they are. Having a history of drinking or smoking regularly also plays into the kind of doses they may need because their liver may be faster at metabolizing doses that might seem high for others. That is why your doctor needs to be made aware of these factors when choosing a particular starting dose, in deciding how rapidly the dose is increased, and even the maximum dose for your particular situation/disorder. Genetic testing can also identify whether you are a fast or slow metabolizer of medication.

It depends on whether side effects were experienced or were hard to tolerate

Side effects matter. In fact, they are the number one reason why people stop medications and say that they didn’t work. There is enormous variation among patients as to which side effects are likely to be experienced, and, if so, whether they are mild, moderate, severe, or just simply intolerable. There are differences in the genetics of the enzymes in the liver that metabolize medications and other factors that make some patients more susceptible to the effects of medication than others (akin to different people having different tolerance for alcohol). I educate my patient as to which side effects are common, whether they are likely to wear off, and whether antidote medication, reduction in dosage or a switch to another medication is recommended. In any case, the final decision would be the result of a mutually informed discussion where the patient provides me as much relevant information in order for me to give an appropriate recommendation. As you can see above, it really does depend on a number of factors as to whether a medication does or does not work. While there are a number of medications that may not work for psychiatric symptoms, it would also be important to consider the above factors before writing off a medication altogether. As the old adage promotes on television, please talk to your doctor, so you can be best informed as to which medication is right for you.  

Dr. Anand is a psychiatrist with Insight Into Action Therapy. He is available in both the Ashburn and Fairfax locations for one-hour evaluations and half hour medication monitoring appointments.  He will not rush  your diagnosis or treatment. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

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