Psychiatric appointments can be intimidating, and things may feel rushed at times. I've worked with a lot of families over the year who think they come prepared with a ton of things to ask..but by the end of it, everyone is kind of blank.
Brain drain can happen after someone asks you about a million questions.
These are the top 5 questions I think everyone should be aware of before walking into an appointment. In a situation in which you are making a decision about medication for your child, it's good to know all the information before making a decision you can be comfortable with.
1. Why did you pick this medication instead of another one?
It kills me when I ask someone why they are on a medication and they literally have no idea. They make a guess like "maybe for anxiety, or maybe depression?" If it's a medication typical for bipolar disorder, I'll ask if there's ever been a history.. and if the say no, then I ask why..and they still don't know.
There's a lot of options for medications. If you're wondering why your prescriber picked an antidepressant when you are coming in with anxiety, ask why. If you're wondering why your prescriber wants you on a nonstimulant medication instead of Adderall, ask why. If you're wondering why your kiddo with ASD is being prescribed an antipsychotic, ask why. If you're wondering why "guanfacine" comes up as a blood pressure medication when you told your prescriber that your kid has ADHD, ask why.
These are things that as prescribers, we know about. They are things that as the patient putting the medication into your body, YOU should also know about.
2. Can you tell me the most common side effects AND the possible rare/dangerous side effects?
Typically when you hear side effects, you'd like to hear "nothing, maybe some dry mouth" rather than "seizures, coma or death" like you hear in the commercials. Most psychiatric medications are really well tolerated. It doesn't mean they don't come without risk. Yeah, sure, nausea, diarrhea, dry mouth.. then why do the commercials list all this terrible stuff? Suicidal ideation comes up as a black box warning on a lot of medications. There's a few reasons for this, and generally I do not prescribe these medications to people who I feel are high risk to have that side effect. But if it is listed, ask if your prescriber is worried about that for your specific case.
If you're being told to watch for a rash when taking a medication, ask more. A rash from taking Lamictal, for example, can be the start of something that is extremely life threatening.
Risperidone can cause lactation in some cases, and other medications like Abilify and Seroquel can cause serious side effects like tardive dyskinesia (also known as your face making involuntary movements).
Again, not to say that these things WILL happen..and yeah, it's anxiety provoking to read about it. But it's important to know about these things so if they do start to pop up, you know what your next steps are.
On that note..
3. What do I do if I have a serious side effect?
Some prescribers will tell you that they want you to take a medication until you come back. I've encountered a lot of patients that have been taking medications that make them ill, or have been causing issues. If you develop a rash, do you stop the medication? If you develop suicidal ideation that you didn't have before, do you stop the medication (hint: answer is YES and go to ER/call 911/crisis if feeling you are unable to keep yourself safe)? If you start hallucinating and running around amped up and stop sleeping, do you stop the medication?
Sometimes if things happen, it might not be during office hours or you may be unable to reach your provider. So you should have a mental plan of what to do if a side effect does occur.
4. Will this medication affect my blood work at all?
At times, you may be asked by your provider to have labs done. Have you ever wondered why? As a provider, we are looking for different things here. I always want to run baseline labs so if anything happens after prescribing a medication, I can compare the before and after values. We usually check how the kidneys, liver and thyroid are working, along with some electrolytes and vitamins. We'll also take a look at your white blood cells (also known as your immune system) and your red blood cells (also known as the stuff you need to live).
Now, why? First off, sometimes medical problems can cause anxiety, depression or hallucinations. By checking labs, we may be able to identify that. Boom, may not even need psych meds.
However..some medications DO affect your lab values. For example, Lithium is known to affect thyroid levels and kidneys. Depakote is known to affect the liver. Medications like Abilify can lead to a higher risk of diabetes. Risperidone can increase a hormone called prolactin that can cause a lot of other problems.
While not all medications affect your labs, these are things you should certainly be aware of. Which brings me to the following question..
5. Have my lab values changed at all from last time, and if so, what exactly does that mean?
If someone is stable on medication, the last thing we want to do is stop that medication. So when labs come back a little abnormal, it can start a process of thinking about possible alternatives. Sometimes I've asked families about if anything ever came back abnormal on labwork, if the thyroid was ever normal, etc. and a lot of the time, the answer is "I don't know." A lot of the time, it hasn't been thoroughly explained. However if you're taking Lithium, and your kidney labs are all normal..it doesn't mean they haven't been elevating over years.
Sometimes I've run into medications causing the white blood cells (also known as: your immune system) to go down. That's medical talk meaning that your immune system is not functioning as well as it should be, and you are at higher risk of getting sick and not being able to fight it off. In the time of COVID, that is something to be super aware of.
The end game here is that you want to know what's going into your (or your child's) body. At the end of the day, if you are going to take a medication, you should understand all the positive things it can do for you along with the not-so-positive things.
Point of the story.. Don't be afraid to advocate for yourself and ask questions.
This is about you and your journey to healing. YOU are the person putting these medications into your body. It is your job to understand them and take power over this process.
