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Talking To Your Patients About Medication Side Effects-Practical Advice From A Prescriber

Angela Couch, RN, MSN, PMHNP-BC
Psychiatric Nurse Practitioner
Lindner Center of HOPE
University of Cincinnati College of Medicine

 

Suspected side effects are one of the most frequent barriers to medication compliance.Therapists are likely meeting with
the patient more frequently than the prescriber, and in some cases, may have better rapport with that patient. Sometimes the patient is more likely to open up to their therapist about problems with their meds, rather than the prescriber, particularly if they are afraid of disappointing the prescriber. Therefore, this puts therapists in an important position to be able to intervene in a constructive way.Symptoms that occur after the start of a medication may or may not relate to the medication. Several possibilities should be considered before attribution of symptoms is determined (Goldberg and Ernst, 2012). The natural course of illness may be responsible for symptoms; often symptoms of mental disorders may overlap with potential side effects of medications. Discontinuation symptoms may present upon stopping the previous drug, and may complicate the picture. Discontinuation symptoms may also occur when a patient’s compliance is spotty. Interactions between multiple drugs may be responsible
for an effect, versus an independent effect of a single medication. Medical comorbidities, substance use and compliance issues may also be implicated. Timing of onset of symptoms in relation to when the medication trial started is also important to evaluate. It requires careful assessment on the part of the prescribing clinician to determine whether an adverse effect is occurring, and what, if any, change to make.Many side effects may be adequately managed by simple changes to the regimen. A dose decrease may result in reduced negative effects but still maintain efficacy of treatment.Interested in touring Changing the schedule of administration can have significant impacts on side effects.

For instance, moving the dose from morning to evening or vice versa, or moving the dose in relation to meals could both
be helpful. Changing the schedule in relation to when another medication is given might be helpful.

Other medication side effects may require more complicated changes. These may include stopping the medication, changing to another medication, or adding a medication that may counteract the negative effects while allowing the patient to make use of the positive benefits. Much discussion may need to occur in cases in which many previous medication trials have been unsuccessful, or resulted in other more bothersome side effects. In those cases, the benefits of the drug may outweigh the level of discomfort from the side effects.

How can you as the therapist help?

Do:
Ask your patient about compliance with each medication at each appointment. Poor compliance can often cause, or
be caused by, side effects.

Encourage your patient to talk to his/her prescriber if they have questions or concerns about their medications.

Remind your patient that most medications take several weeks of regular administration before they start exerting positive effects, and that dose changes MAY be required, so it is important to continue taking the medication even
if he/she is not seeing results, and communicate with his/her prescriber before making changes.

Contact your patient’s prescriber directly at any time if you have specific concerns or questions about the patient’s medication regimen, or you have a specific suggestion regarding the medication regimen.

Do Not:
Suggest to your patient that you believe they are on the wrong medication or make specific suggestions regarding medication changes directly to the patient. This can cast doubt on the prescriber’s ability and possibly impede their therapeutic relationship. Suggest to your patient that other patients have had bad experiences with a particular
medication. Instruct your patient to change the dosing of the medication.

In summary, patients benefit from good collaboration between prescribers and therapists, and the therapist can have a positive impact on a patient’s chance of success on medication. Reference: Goldberg, J.F., & Ernst, C.L. (2012) Managing the side effects of psychotropic medications. Arlington, VA: American Psychiatric Publishing.

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