A majority of emotional and relationship problems can be successfully resolved with counseling. Therapy improves your understanding of the problem, validates your feelings, and provides you with tools to cope in healthy ways. In some cases, this may not be enough and people drop out of therapy. They lose faith in mental health treatment because despite their best efforts, things just don’t get better. There are some mental health conditions for which medication treatment is necessary and it can be immensely helpful, as well as life changing. Psychiatric medication should be used as one part of a comprehensive treatment plan. If so, ongoing evaluation and monitoring by a physician is essential in addition to ongoing therapy. In order to decide whether one needs medication treatment, a good diagnostic evaluation is necessary. In most cases, this involves getting a detailed history of symptoms from the patient; sometimes, additional input from family members or others is needed. Getting a family history of mental health conditions is very important. Psychological testing is needed only for very complex, diagnostically challenging cases; it is generally not required to determine the need for psychiatric medication. CT scans, blood tests, MRI or other forms of diagnostic work up are sometimes necessary only to make sure that there is no medical problem. These tests are done only if there are specific symptoms that may indicate a medical or neurological problem. They are not necessary to determine or confirm the need for psychiatric medication and if not necessary, do not add any value to a good diagnostic work up (detailed history). Psychiatric medications are generally prescribed by psychiatrists who have special training in this area. Psychiatrists are medical doctors who go through the same training in medical school, as any other medical doctor. In addition to psychiatric conditions, they are knowledgeable about general medical conditions, and they have additional training in Neurology. All psychiatrists are trained to provide therapy and counseling during their specialty training. A psychiatrist may provide therapy as well as medication management or they may be available as medical consultants to therapists who provide counseling but cannot prescribe. Certain psychiatric medications are prescribed by general medical doctors or pediatricians, based on their training, experience and comfort level. Contrary to popular belief, most psychiatric medications are not addicting nor do they lead to addiction problems. Medication may be needed over a period of several months, but it is not necessarily a lifelong requirement. It may take several days or weeks before the benefit of medication is evident, so it is advisable to ask questions up front regarding expectations such as how long will it take to work, what level of improvement is expected, will there be need for increasing the dose, etc. If a mental health professional recommends medication evaluation, it will be helpful to understand the reason as well as have a discussion of risks versus benefits. It behooves the person who is suffering emotionally or their loved ones to consider an option that may turn things around for the better. It is possible to agree to a short-term trial, as most medications do not have irreversible or permanent side effects in the short run. Long-term concerns should be discussedup front. – Written by Dr. Ujwala Agharkar, Child Psychiatrist at Kaiser Hospital in Fremont, California
