How to Monitor Your Progress

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The use of psychiatric medications requires careful evaluation to ensure their effectiveness and safety. Always arrange a follow-up appointment with your doctor to go over your response to the medication. There are many issues to consider.

Evaluate Effectiveness Obviously the most important issue is whether the medication improves the target symptoms. Although it is certainly valid to believe that a medication makes you "feel better," it can be enlightening to know exactly how. You may find it only improves one or two symptoms, or you may find them all better. For example, you may feel that lorazepam helps you feel less anxious and that you no longer have panic attacks. However, since the effect of lorazepam wears off after a few hours, you will soon feel anxious and need another pill. If you think you are "better," you are probably only focusing on one aspect of your experience, the time when the medication is working, and neglecting the periods of rising anxiety that lead you to take another pill.

Observe Physical and Psychological Changes It is important to notice all the various effects the medication has on you. If you notice any difficulties when you are taking medication in regards to your thoughts, feelings, behaviors or physical condition, it is important to bring this up with your doctor so that it can be addressed as effectively as possible. For example, antidepressants such as fluoxetine, paroxetine, and sertraline often cause significant sexual dysfunction. Even if your physician doesn't ask about it, bring it up so that you can discuss how you might handle it.

Changes in your condition will affect your relationship with your family, friends and, most especially, your partner. Ideally, these will be positive changes that will enhance your relationships. Sometimes however, these changes can require unforeseen adjustments. For example, if sildenafil (Viagra) improves your sexual functioning, the change may be disconcerting to someone who has grown accustomed to your previous level of sexual interest. If fluoxetine has improved your anxiety and depression to the point that you want to start working, your partner' s role as provider or caregiver may no longer be the same. This may lead to distress if your partner felt satisfaction with your previous level of functioning. Make sure you communicate with your partner and family about the changes you notice and how those changes may affect your relationship with them.

Complete a Full Trial You need to give any drug a full trial before deciding whether it is going to be effective for you. This means that you need to take it at an adequate dose for an adequate period of time to produce a therapeutic response. The dosage size and time period for each drug is different, so there is not a uniform standard as to what constitutes an adequate trial. If you stop before you've finished a complete trial, you gain little information about your response to that drug. I have seen countless people switch drugs prematurely, only to go back to the first drug when subsequent ones were ineffective, resulting in needless distress from symptoms because of the time delay.

Use Blood Levels as Servants, Not Masters Lithium, valproate, and many antidepressants and antipsychotics can be measured in the blood. Although therapeutic ranges for effective doses have been proposed, many people respond to levels that are above or below the supposedly "therapeutic" range. It is important to use blood levels as a guide to treatment, but not to believe them so blindly that you ignore the most important aspect of any drug treatment: how you are doing.

There are times when a blood level is important. First, it can ensure that your dosage is not so high as to be dangerous. For example, imipramine and amitriptyline can cause cardiac arrhythmias when the blood level gets too high in the absence of any physical symptoms that might alert you to any problems. Second, a blood level can provide useful information if a drug appears to be ineffective at the maximum recommended dose. If it turns out that the level is too low, it may make sense to proceed beyond the usual upper limit of dosing size to ensure that you get an adequate trial. Third, blood levels can be essential when you are adding or removing another psychiatric or medical drug that interacts with your psychiatric medication. For example, fluoxetine, paroxetine, and fluvoxamine can raise the level of other antidepressants and antipsy-chotics in the blood to dangerous levels. A blood level check can guide you to the appropriate dose of the other medication after you add one of these medications.

Monitor Side Effects All medications have side effects. Aspirin can cause ulcers. It can even cause severe brain damage in infants when ingested during the course of a viral illness. Acetaminophen can cause liver damage. Amoxicillin, the most common antibiotic given to ward off ear infections, can cause allergic reactions that are potentially fatal. There is no way to introduce a chemical into the body that induces only the alteration that helps you. They all cause other changes that may result in side effects.

You should be aware of the common side effects. It is important to know how the more dangerous ones might manifest themselves so that you can alert your doctor right away. For example, some medications can impair your bone marrow's ability to make blood cells. This can result in an infection, anemia, or problems with clotting, problems that are potentially life-threatening. If you take a medication such as this, you should be on the lookout for easy bruisability or sores on the mouth, so that you and your doctor can be alert to the possibility that you are experiencing an unusual but potentially dangerous side effect as soon as possible. (Side effects are listed in part IV.)

Second, you should know what you can do about any side effects that do occur. Some side effects occur only when you first start a drug, while others are long-lasting. Know which is which. You need to alert your prescribing practitioner if you are experiencing any dangerous side effect. Many of the more common side effects, however, can be anticipated so that you can manage them when they arise. (Methods to minimize different side effects are discussed in part IV.)

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