Frequently Asked Questions About Psychiatric Care
When it comes to psychiatric care, there are a lot of questions clients have but often find answers difficult to come by. This lack of accurate information often prevents them from getting the best treatment available. I care about your mental health and want to arm you with the most accurate information that helps you get the most effective treatment. To do this, I have answered some of the most frequently asked questions about psychiatric care.
1. What is the process for undergoing a psychiatric evaluation?
I meet with a new patient for about seventy-five minutes to gather the history of the presenting complaint and symptoms the patient is experiencing. This will include taking a personal and family psychiatric history, a personal and family medical history, social history, drug and alcohol history, and a complete mental status exam.
After gathering the history the patient and I will discuss the possible treatment options. Sometimes I will recommend a patient try psychotherapy first, sometimes medication along with therapy. If we decide medication treatment is appropriate, I will discuss the different options available, possible side effects, and directions for starting medication.
2. What is the process for getting a psychiatric evaluation for a child or adolescent?
For a child, I will meet with the parents first to gather the history of the presenting problem, and to get a complete history, including past psychiatric and family psychiatric history, medical history, developmental, social, and educational history. In a separate session, I will meet with the child to gather the history from the child's point of view and to perform a complete mental status examination. We will often need a third session to discuss a treatment plan.
For an adolescent, I will meet with the patient first to gather a complete history, as above, from their point of view, including a substance use history. Then I have the parents join us to complete the history taking and to discuss a treatment plan. Often, discussing the treatment plan will require an additional session.
3. Can I become addicted to anti-depressant medication?
No, it is not possible to become addicted to anti-depressant medication. After a successful trial of anti-depressants, when it is time to taper off, some people's symptoms reappear, and they need to resume medications for a while. This is not an addiction; it just means that we tried to taper you off too soon.
4. If I try medication, how often will I need to come in for follow up sessions?
Once we start medication, I will see you back in two to four weeks to see if you are tolerating the medication and to see if a dosage adjustment is needed. I will see you back in another four weeks to monitor progress. If you are not significantly improved, we may need to change medication or add a second medication in order to achieve remission. Once I am no longer making medication changes, I will see you every three to four months.
5. How long does it take for medication to work?
Some patients see benefits within two weeks, but for most people, it takes more like four to six weeks. This is when the first medication we try is effective. If we need to change medication or add a second medication, it will take longer.
6. How long do I need to stay on anti-depressant medication?
The goal of a medication trial is to treat to remission, that is until you have returned to your normal functioning. At that point, it is recommended to stay on the medication for 9-12 months before trying a taper.
7. How do I taper off medication?
Most people can taper off medication easily, reducing the dose weekly over four weeks. Others need to taper more slowly to avoid getting a discontinuation syndrome, which might include flu-like symptoms, nausea or a headache, dizziness, or odd physical sensations. Perhaps twenty to twenty—five percent of people have more difficulty, needing to taper off much more slowly.
8. I've heard of genetic testing to determine what medication might work best for a person? Is this helpful?
It is the consensus of the psychiatric community that these genetic tests are not useful in finding the “best” medication for an individual patient. I do not recommend them. However, if a patient wishes to try such a test, I can perform it. It is simple, requiring a buccal (inside the cheek) swab for analysis.
If you have any more questions about psychiatric care, get in touch with Dr. Trudy Hartman, an experienced psychiatrist in Palo Alto, CA. I treat a wide variety of patients with diagnoses including depression, bipolar disorder, anxiety, ADHD/ADD, panic, OCD, and psychotic disorders. I also provide diagnostic evaluations and medication treatment, while for psychotherapy, I refer my patients to local clinicians. To learn more about how I can help you, please click here or contact me by clicking here.