Challenges in Switching Psychiatric Medications

By Jeff Boatman, APRN-MHCNS

 

We live in a society where we are accustomed to – and expect – instant gratification and results. However, for many of us, the process of finding the correct psychiatric medication can take time and be extremely frustrating. Oftentimes, we have been misdiagnosed or have tried multiple different psychotropic meds over long periods of time – with minimal positive outcomes. Sometimes, we can become so frustrated that we want to “give up” on finding the right medication, and the problems continue or worsen. It is critical for us to have a clear understanding of the process and potential challenges of switching psychiatric medications so that we can understand and be prepared for the experience.  Switching psychiatric medications can be a crucial step in managing mental health conditions effectively, and this article aims to share valuable information to consider when transitioning between medications, ensuring a smoother and safer experience.
It is vital to have a good working relationship with a psychiatric provider whom you trust when considering a switch. A provider should involve you, the patient, in the decision-making process and be willing to consider your previous experiences with medications, comorbidities, and other factors that may affect the treatment. As a patient, you have a responsibility to share your concerns, symptoms, and goals to ensure the new medication aligns with YOUR specific needs. The provider should spend an appropriate amount of time educating patients and families about all the dynamics involved in making a switch and allow adequate time for questions to be answered and expectations to be discussed. Here are some important considerations that the provider should address with you.
  • Understanding Reasons for Switching Psychotropic – Changes to medication may occur due to various reasons. It could be due to inadequate symptom relief, intolerable side effects, lack of response to the current medication, interactions with other medications, cost, or the emergence of new symptoms. Understanding the specific reasons behind the switch can help you and your healthcare provider make informed decisions regarding alternative medications or treatment strategies.
  • Importance of Gradual Tapering and Titration – Switching psychiatric medications often requires a gradual tapering from the current medication while simultaneously introducing the new one. Abrupt discontinuation can lead to withdrawal symptoms or a sudden worsening of symptoms. Follow your healthcare provider’s instructions carefully regarding the tapering and titration schedule. It may take several weeks or longer to transition fully, as this allows your body to adjust to the new medication while minimizing potential adverse effects. In addition, patients need to be educated about possible withdrawal symptoms that may occur. Some people may experience withdrawal symptoms when switching from one psychotropic drug to another. These symptoms can include anxiety, depression, insomnia, and irritability.
  • Potential Interactions: The provider should explain to the patient and family any potential interactions between the new medication and other medications that the patient is taking. You should also be advised on any food or beverages to avoid when taking the new medication.
  • Potential Side Effects and Monitoring. Different psychiatric medications can have varying side effects. Your healthcare provider should inform you about potential side effects associated with the new medication. Common side effects may include gastrointestinal discomfort, dizziness, drowsiness, changes in appetite, weight gain, lethargy, changes in sleep patterns, or sexual dysfunction. Be aware of these possibilities but remember that not everyone experiences them. Regular check-ins and follow-up appointments with your psychiatric provider are crucial during the transition phase to monitor your response to the new medication and address any concerns or side effects that may arise.
  • A clear understanding of the new medication: The provider should explain the new medication, including its name (generic and name brand), action, dosage, scheduling if it should be taken with or without food, possible side effects to look for, and what the realistic expectations should be.
  • Plan for monitoring: The provider should explain how you will be monitored during the transition to the new medication. This may include a phone call, a text to a provider with an update, more frequent follow-up appointments, and possible blood tests. It is important that there is a plan for the patient to reach out if experiencing issues.
Switching psychiatric medications can be challenging, and it is essential to remain patient throughout the process. It may take time to find the right medication and dosage that works best for you. Changing medications requires careful consideration, open communication with healthcare providers, and patience. By understanding the reasons behind the switch, following gradual tapering and titration protocols, being aware of potential side effects, and maintaining regular communication with your healthcare provider, you can navigate the transition process more effectively and improve your mental health outcomes. Remember, you are not alone—seek the support you need to ensure a successful switch.

What Parents Should Know About Children and Psychiatric Medication

While pediatricians are an important part of a child’s healthcare team, seeing a psychiatrist for medication management can be crucial for a child’s mental health treatment. Here are some reasons why:
Expertise: Psychiatrists are medical doctors who specialize in mental health. They have extensive training and experience in diagnosing and treating mental health conditions, including those that require medication management. While pediatricians have some training in mental health, their expertise is primarily focused on physical health and development.
Diagnosis: Psychiatric diagnosis can be complex, and accurate diagnosis is key to effective treatment. Psychiatrists have a deep understanding of the various mental health conditions that can affect children and can provide an accurate diagnosis based on a comprehensive evaluation. They can also differentiate between similar symptoms that may be caused by different conditions.
Medication Management: Medication can be an effective treatment for many mental health conditions in children, but it must be carefully managed to ensure safety and effectiveness. Psychiatrists have a deep understanding of the medications used to treat mental health conditions, including their potential side effects, interactions, and appropriate dosages. They can also monitor a child’s response to medication over time and adjust treatment as needed.
Therapy: Psychiatrists can provide clinical guidance well as medication management. Because they understand and specialize in mental health diagnoses, they can help make sure that all of the mental health pieces are being considered and addressed. As such, they can help connect children to a therapist who would be an appropriate match for the specific issues that they are treating, and can then collaborate with this therapist to provide the utmost quality of care.
Overall, while pediatricians are an important part of a child’s healthcare team, they may not have the specialized training and expertise needed to effectively manage a child’s mental health treatment with medication. A child seeing a psychiatrist can benefit from their specialized knowledge and experience in mental health diagnosis and treatment, leading to more effective and safer medication management. At West County Behavioral Health, we have the complete team – therapists and psychiatrists collaborating together – to make sure that your child gets the BEST care possible!!
West County Behavioral Health offers full service medication management for both children and adults.  Please contact our office at 314-200-5119 to schedule and appointment with one of our providers.
Meet Our Medication Management Team
Shelah Radke, MD, JD
Pursuing mental wellness is a sign of strength. As a Child and Adolescent Psychiatric Physician, I have enjoyed celebrating my client’s strengths for the past 10 years, having dedicated my career to working with children, adolescents, and young adults in the field of psychiatric medicine.
  • Double Board-Certified in Psychiatry and Child and Adolescent Psychiatry
  • Graduated from Case Western Reserve University School of Medicine
  • Residency at University Hospitals of Cleveland and Fellowship through Rainbow Babies and Children’s Hospital in Cleveland, Ohio.
  • Recently served as the Medical Director of Child Crisis Psychiatry Services at Mercy Hospital in St. Louis
  • Provided direct clinical care in two private practice settings in the Washington, D.C, area
  • Worked with clients at Monarch boarding school in Cleveland, Ohio, collaborating with teachers and parents frequently to optimize opportunities for creative learning.
I am committed to using evidence-based practices, including integrative, lifestyle, and pharmacological interventions, to help my patients achieve better mental health outcomes. I also enjoy partnering with clients by using the shared decision-making model of care. I work with clients to understand their unique needs and goals, and together we develop personalized treatment goals that are tailored to their individual needs. This approach empowers patients to take an active role in their own care and can lead to more positive outcomes and greater overall satisfaction with the treatment process.
Jeff Boatman, APRN-MHCNS
I received my Bachelor of Science in Nursing and my Master of Science in Nursing from St. Louis University, specializing in Psychiatric Adult Mental Health Nursing. I have worked for over 25 years as a certified Advanced Practice Clinical Nurse Specialist in Adult Psychiatric and Mental Health Nursing. While in private practice, I have had a collaborative practice arrangement with Dr. Adam Sky.
I function as an Advanced Psychiatric Practice Nurse with prescriptive authority and have seen patients in hospital, office, and nursing home settings. I serve the adult population, age 25 and up. I am affiliated and have privileges at St. Mary’s Health Center in St. Louis. In addition, I am an active member in the American Psychiatric Nurse’s Association and the APNA Missouri Chapter where I have served on the Board.
I look forward to serving your psychiatric and medication needs with compassion and skill – I want to take the time to truly understand your situation and offer you the tools to feel better and stay well.