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It can take a long-ass time to find the right medication regimen to manage your mental health. Sometimes, that means spending months (or years) looking for the right psychiatrist or other provider, trying different prescriptions, dialing up and down dosages, and managing unexpected side effects. It’s worth it, though, once you hit on the treatment plan that’s right for you and actually get to experience the “feeling better” part of psychiatry.
When you’re in a good medication routine, it can knock you for a loop if you have to find a new provider, whether it’s because you or your psych is moving, your insurance changes, or some other curveball. As you figure out who’s going to manage your care next, you might worry that this new person will want to change your treatment plan and have you start all over again. “Often, what happens is, a new provider picks up this person, and looks at this med regimen, and they’re like, Well, this is interesting. This wouldn't have been my first choice,” Heidi L. Combs, a professor of psychiatry and behavioral sciences at the University of Washington and medical director of Inpatient Psychiatry at Harborview, told VICE. What would help them understand is some context: Maybe your previous provider didn’t expertly nail the combination of medication, dosage, and frequency the first time, either. Even your diagnosis itself may have changed. Combs said the single most important thing to understand—and be able to communicate to a new psychiatrist—is how you ended up where you are on your medications.But how do you clue a new person in about your medical history—and why a particular Rx regimen works for you—in a way that gets through to them? You should be ready to offer some answers about your experiences with medications before you sit down for a consultation. To prepare for your first appointment, Combs said it’s important to get as complete a history of your diagnosis and medications as possible; she calls it your “Rosetta Stone.” Your previous provider should have kept detailed documentation throughout your relationship, including the medications you’ve been on; the length of time you took them, and at which dosages; their benefits and side effects; and your overall experiences with them, including what worked and what didn’t, and why. They can probably email you that detailed treatment history (possibly after you sign a release, said Combs)—and, if you ask, they might be willing to include a letter with an invitation to contact them directly with any questions.
If you want to be even more proactive, ask your current psychiatrist and your potential new one to have a conversation with each other in addition to sending through documentation of your history. “You can’t pre-figure-out what the [new] psychiatrist is going to say,” Alan Schatzberg, a professor of psychiatry and behavioral sciences at Stanford University, told VICE. “You can only try to make sure that the previous treater and the next treater are on the same page.” If both are willing to talk, you can let your former provider know it’s OK for them to share that you’re nervous about changing medications and, if they’re willing, speak up on your behalf accordingly. “My job, as a provider, is to advocate for my patient,” Combs said. She recommends using a script like this to bring up your concerns: “I’m really nervous right now. We worked really hard to get me to this place where I’m very stable—but I’m afraid that things aren’t going to go well because they’re going to want to change everything.” Your doc can then, if they so choose, express this to your new psychiatrist as they give some clinical background for why these medications have been successful for you. Whether or not your potential and former provider discuss this aspect of your feelings about your care, Combs said it’s “beyond helpful” for practitioners—and you as a patient—when the two can talk to each other about the treatment: It lets you hit the ground running.
If for some reason you can’t access documentation of your care, Columbia Medical Center psychiatrist Jennifer Sotsky recommended writing down everything you can remember about your medical history yourself. Working from most recent to oldest, list what working diagnoses you’ve had; when you tried each medication and for how long at each dosage; whether it was helpful/how it felt more generally; whether you had major side effects and what they were; and any other treatments for the underlying condition you’ve tried, even if they were non-medical. You may not remember everything, but the information you are able to remember can guide you when you’re meeting with someone new,” Sotsky said.When you do meet with someone new, the conversation might be stressful, but remember: You’re in charge. Outside of your Rosetta Stone, go in with a written list of questions and concerns—that way, you won’t be derailed by the questions you’ll be asked about your mental health (and any potential triggers or traumas that may affect it). “I love when patients come in with a list, because then I know we’re going to address the things that are important,” Combs said. If you’re worried about adjustments to the treatment you’re on, be forthright about that. Offer the details about how your medication allows you to feel good and stable. Combs said a worthwhile provider probably isn’t going to want to do anything to disrupt care that’s working well for you—but a worthwhile provider also won’t just take things pertaining to a client’s brain chemistry on their face, especially when it comes to controlled substances. They’ll likely have questions about how your medications affect you beyond the information you offer them up front.
“When you’re meeting with a new psychiatrist, I think you can kind of expect to go over your whole history, and that includes your medication history,” said Sotsky. That conversation can be “hard, stressful, and exposing … because they’re going to ask you all these questions about things you wouldn’t normally want to talk about with a stranger.” Be direct and clear, and account for how the medical expert is making you feel as you go: Are they present and supportive throughout the conversation? It might also feel helpful to take notes throughout the meeting—your psychiatrist doesn’t have to be the only one with a notepad!In some cases, a new prescriber might give you pushback about your medications—even if you come prepared, and even with your previous provider’s blessing. Different people have different prescribing practices, and some have specific medications that they just don’t prescribe, regardless of the patient. For instance, there’s a certain benzodiazepine that’s shown to be potentially more habit-forming than others which Combs doesn’t prescribe in her inpatient psychiatry practice, though other providers do. Sotsky pointed out that as new evidence about long-term use emerges, existing medications can fall out of favor within the medical community. And any time providers are prescribing controlled substances that have the potential for abuse—like benzodiazepines (like Xanax) to treat anxiety disorders or stimulants (like Adderall) for ADHD—they might be a touch warier of doing so right away.
To avoid a potential gap in your treatment, Schatzberg said starting your search for a new provider right after you receive your last prescription—and even before, if you know the switch is coming due to a move or other life event—gives you “enough of a runway” for a few consultations as you find someone who’s OK with your current medication schedule—and whom you like and trust. That “liking and trusting thing” is really necessary, too—this person should be able to offer you more support than just writing you a prescription every month (although, yes, that by itself is a huge relief). “I remind patients that the [provider] is actually their employee,” Combs said. “You are in the drivers’ seat; you hired this person to have them help you.” Your new provider should make you feel valued and cared for, including (but not limited to!) by working with you and listening to you about the medications you take.Most psychiatrists and other providers aren’t suggesting alternative ideas when it comes to medication (and other forms of mental health care) just to mess with you. Listen to what they have to say, see how that squares with your own history, and do some research about the recommendations they’re making with an open mind. If you’re not sure about a plan they’re raising specifically because it involves medications or methods you haven’t tried, you can and should go to consultations with other providers and see what they say, too.Don’t be afraid to ask questions, advocate for yourself, and be honest if you’re feeling nervous or unsure about having someone new manage your care. “People should know that their concerns are valid, even if they feel silly or like it’s embarrassing to bring them up,” Sotsky added. “Good doctors, they want to know.”Follow Emily Cassel on Twitter.