Psychiatry Q&A

Is Narcisa a therapist or counselor?

Narcisa is a psychiatric nurse practitioner who provides medication management with brief psychotherapy. Although she has extensive experience providing psychotherapy, she has limited availability to take on psychotherapy clients at this time. If you’re interested in traditional psychotherapy alone or in addition to medication, our practice has experienced clinicians that provide psychotherapy.

How do you know what sort of approach to take with a particular individual? What is your process of getting to know a new patient and understanding the issues that he/she is having?

We believe that all medication and therapy work, but they don’t all work for one particular patient because one size doesn’t fit all. The approach taken with a particular patient depends on the presenting mental health symptoms, current and past medical health issues, patient’s current psychological insight, their personal experience with psychotropic medication, and of course their treatment goals.

We view patients as the experts in themselves, meaning that there’s no one else who knows themselves better at the time when we first meet. Therefore, we spend the first few sessions getting to know the person by asking them questions and by carefully listening to their personal narratives. We steer away from diagnoses and labels. We want to see the person who’s hidden behind their symptoms and issues. Once we gain an understanding of their presenting problem including what has been contributing to their symptoms and what might be helpful in addressing them, we collaboratively create a treatment plan that covers estimated length of treatment and methods to be used.

What are the consequences of leaving psychological issues untreated? What could happen?
Untreated psychological issues may have people end up in unhappy relationships, estranged from loved ones, on wrong career paths or without jobs, using damaging coping methods like substance abuse, or developing eating disorders. It’s just a matter of time until people lose their life meaning, purpose, and their ability to function and to live healthy lives at full potential.

What kinds of results can a patient expect to see after starting medication? Will they see immediate benefits?

The results depend on the patient’s clinical condition and on their personal response to medication. Treat­ment results and experiences with medication and with therapy as well are as individual and unique as people. Some people get immediate results from medication and only need them for a short time. For example, some patients with an episodic de­pression or anxiety may feel much better after taking a medication for a few months, and may never need it again. Other patients with recurrent episodes of depression and anxiety may need to take medication for a much longer period of time. Also, some medication is being taken as needed with immediate effects (for example the treatment of panic attacks before a flight) while others are being taken regularly for a longer period of time and it takes a few weeks to feel its effects (for instance in the case of depression or generalized anxiety treatment). It is not uncommon during a patient’s treatment plan to try several medications over time in order to achieve optimum results.

What should a new patient know about medication for mental health? Or what do they frequently misunderstand before coming in?

Psychotropic medications treat symptoms of mental health conditions by influencing the brain chemicals that regulate emotions and thought patterns. Its purpose is to restore a person’s health and functioning and to improve their quality of life.

It’s important to know that for a patient to achieve an optimal state of health and wellbeing, in addition to medication, psychotherapy, healthy eating habits, exercise, and overall lifestyle changes are needed. There’s this frequent misunderstanding that taking medication will automatically resolve a patient’s presenting problem. Let’s take for an example someone who’s been suffering of depression and lacks energy which has been affecting their work performance. Medication can increase a person’s energy level to improve work attendance, however helpful strategies and habits need to be added, for example allotting extra time to get to work in case of traffic. Exercise and healthy eating also increase a person’s energy level and state of wellbeing while counteracting certain medication side effects, like let’s say weight gain. Lastly, we couldn’t emphasize enough the importance of psychotherapy in addition to medication. Medication can offer a patient a window of opportunity to work through some issues that have been negatively impacting their life, in this particular example their job performance.

Why might someone be hesitant to seek medication? What do you say to individuals who might have reservations?

Common patient concerns about psychotropic medication include fears that the medication will permanently change their mind, their personality and their behaviors; that it would negatively affect their lifestyle or impose restrictions on it; and that taking medication (or being in therapy) is a sign of personal weakness, wondering what family, friends or coworkers might think of them for taking a psychiatric medication. Other hesitations to seek medication are related to beliefs that medication is for “crazy” people, and that all psychotropic medication is addictive and needs to be taken for life. People also fear side effects.

Psychotropic medication targets specific symptoms of mental health conditions. There is no evidence that it would fundamentally change someone’s personality. For instance, someone’s mood might improve and therefore spend more time with friends, however this person wouldn’t be transformed from an introvert into an extravert. Depression, anxiety, attention deficit and other mental health conditions are illnesses, not a reflection of a person’s character or personal traits. Incorporating medication into someone’s life is meant to improve their life. Anyone who has symptoms of a mental health condition negatively affecting the quality of their life can benefit from medication. Most psychotropic medication do not cause physiological addiction. A few medications, like benzodiazepines or stimulants are known for their addictive potential and are being tightly regulated. However, with proper management, patients can safely benefit from their therapeutic effects. Medications have various side effect profiles that can be counteracted with proper monitoring and a healthy lifestyle, and some side effects could actually work in a patient’s favor.