Before we start talking about medication, I would like to take a moment to look at who is allowed to prescribe medication. Each state determines the scope of work for the professions that practice within its border.  In New York State the only professions allowed to prescribe medication are medical doctors (MDs), physician assistants (PAs), and nurse practitioners (NPs).  This means that your regular doctor or PA of NP who you see for your physical health is also able to prescribe medication for you mental health while the professionals you see for psychotherapy--PhD psychologists  or PsyD psychologists, LCSWs (licensed clinical social worker), LMSWs (licensed master of social work), LMHC (licensed mental health counselor)-- are not.

I encourage my clients to meet with prescribers who specialize in prescribing medications specific to treating psychiatric diagnoses.  In New York State those are psychiatrists (medical doctors who specialize in psychiatric disorders), psychiatric PAs, and Psychiatric Nurse Practitioners (NPPs)  who also use the title PMHNP-BCs or Psychiatric Mental Health Nurse Practitioner -- Board Certified. Studies show that the majority of psychotropic medications are prescribed by general practitioners not by these specialized professions. Why is that? I can think of a few reasons.  One might be stigma.  People may be reluctant to pathologies their feeling of being slightly more anxious or down than normal or to feel they are at a level requiring psychiatric help.  Just the word alone can make people uncomfortable.  It could also be a matter of convenience.  Rather than go through the trouble of having to find a new provider for this one issue and then wait for the appointment it is easier to just ask their regular doctor (or NP or PA).

So why do I recommend going to a psychiatric specialist for medication. It has been my experience going through this process with clients that prescribing for mental health conditions is different than prescribing for a medical condition.   Often when a person starts medication to treat a mental health condition it can take weeks until the medication takes effect and for some people it can take months to find the right medication and the right titration (finding the most effective level with the least side effects),  Sometimes people do not respond to certain medications or experience side effects that are too uncomfortable to manage even if the medication is working well.  A psychiatric provider will be highly trained in mental health diagnoses and some will even specialize in treating particular diagnoses.  This gives them the added advantage of seeing many clients with similar symptoms respond and react to specific medications.  It makes sense to me these specialists would also be on the front line of learning about new medications to treat mental health conditions as well as new protocols for treatment.  Another consideration is that if you see a psychiatric specialist they will likely have you fill out an intake form and either they or a social worker in their practice will conduct an initial assessment.  If you have been seeing your general practitioner for a while you may not be as thorough in your description of your symptoms or as transparent about the developments in your life or her on developments in your life that are important signposts for making the correct diagnosis and prescribing the correct medication.  

It is my belief and training that taking medication goes hand in hand with attending therapy.  Unless you are in crisis and at risk of hurting yourself or so compromised by your symptoms that you cannot participate in your life at a reasonable level, I think that therapy alone is the first best step for treating psychiatric symptoms.  Many client I work with are opposed to taking medications of any type and are not open therefore to taking psychotropic medications.  For many clients therapy alone is sufficient.  As a therapist I try to be a resource to my clients regarding the decision to take medication.  Generally, my preference is to try to use the tools of my profession to help clients make sense of their symptoms in ways they may not have known to look at them--trauma history, neuroscience, family of origin dynamics-- and then work to reduce the symptoms through those lenses.  Understanding the "why" of symptoms usually offers some relief to clients, but is rarely enough to break the patterns of actions and reactions and behaviors that have developed and solidified over the course of a lifetime.  That is why therapy takes some time to be effective.  Cognitive restructuring and behavior activation and exposure all require practice and application again and again in a multitude of situations before the new patterns of action and reaction and behavior replace the old.  When clients have gained a clear understanding of their patterns and have repeatedly practiced and applied the tools learned in therapy but are still suffering greatly with the symptoms that brought them into treatment, then we have a serious discussion about adding on medication.  In such instances medication can offer clients that last missing piece of the puzzle that allows them to successfully use the strategies and interventions they have earned and practiced in therapy with more confidence and to greater effect.

The decision whether to take medication will always be your own.  If you are thinking about making an appointment with a prescriber here are some ideas to take with you to the appointment: 

++ You are not required to accept a prescription just because you made an appointment. You can ask to meet with the prescriber a few times until you are comfortable with your decision to take medication. The sessions can be used to have a thorough discussion of your experience of symptoms not just as they are presenting now but over the course of your life so that the prescriber has a full understanding of your diagnosis and your needs. 

++ Ask about the side effects.  Antidepressants are widely prescribed for both depression and anxiety.  For anxiety they are usually prescribed at a lower level than for depression.  Many of these medications are SSRIs (selective serotonin reuptake inhibitors) and they are known to have different side effects.  Some medications, for instance, could cause you to gain weight or lower your sex drive.  Don't be afraid to ask about the side effects or to tell the doctor which side effects you want to avoid.  Even though this information is on the internet, your prescriber should be the one to explain this to you.  

++ You may want to know how easy or hard it is to stop taking the medication being recommended/prescribed.  I know this is a concern I have heard from many of my clients. It is a question you certainly can ask.

++ Another area of concern might be dependence.  Benzodiazepines are short term medications prescribed for anxiety.  You have likely heard of Xanax and Ativan which are in this class of medications. They are know for dependence and building tolerance, so I always ask my clients to be cautious with these types of medications.

++ Be sure to let your prescriber know any medications you are already taking and any supplements or over-the-counter medications you take.  There may be interactions between the medications you are prescribed and something you are taking that you don't even think of as serious enough to mention.  It is the prescribers job to know about the interactions of the medications they prescribe with all other ingested materials including foods.  But they can't know what you don't tell them. 

++ Be honest about recreational drug use and alcohol use.  Understanding the interaction between those substances and the medication you are prescribed is essential.

++ Don't work with a prescriber you feel the slightest bit uncomfortable with. This is a long relationship you are establishing, and it requires trust the same as any other medical professional you see. With the advent of Telehealth there are so many more avenues to find psychiatric providers.  In the past people felt lucky to find any provider close enough to them who was taking new patients.

I hope this has been helpful to you.  Please remember that everything written here is my own opinion based on my personal knowledge and experience working with my clients.  Other people in the field may have differing and equally valid opinions.