Mental Health Treatment

Both medication and psychotherapy are effective in treating most mental health conditions, and treatment is often most effective when these strategies are used in combination.

“Don’t be afraid to ask for help. As a student, you have access to amazing mental health resources that can help you learn skills and coping mechanisms for anxiety, depression, eating disorders, etc. At first, I was nervous about telling anyone that I was seeing a therapist, but the more open I became about it, the more I was able to heal and confront my recovery process. Talk about your mental health, ask for help, ask for support, share your story. Mental health illnesses are more common than you may realize – you are not alone!”


PSYCHIATRIC MEDICATIONS

If you are currently taking medications, you want to make sure you’re able to refill your prescriptions in the Ann Arbor area and when you are on break, as needed.

If you move back-and-forth between the Ann Arbor area during the school year and your home town during breaks, it is important that you have care providers in both locations and to ask your current care provider for a release of information form so that they can share your medical records with your new provider in the Ann Arbor area. A release of information form gives your care providers the legal right to communicate with each other and share information. Allowing your care providers to share information can help them provide you with the best and most efficient care.


STARTING PSYCHIATRIC MEDICATION TREATMENT: 3 KEYS TO SUCCESS

  1. Commitment: It is best to think of treatment as a long-term investment that requires ongoing commitment rather than a quick fix.
    • Medications are effective, but they are not “cures.” You will usually have to continue taking medications so that symptoms remain in check.
    • You may be tempted to stop taking your medication if your symptoms get better, but it is likely that you will find your symptoms return once you stop taking your medication. Talk to your care provider or pharmacist before making any adjustments to your medication, even if you are feeling better.
    • You should find a care provider or providers with whom you feel comfortable. Good care providers don’t just prescribe medication; they listen to your concerns, help you overcome difficulties, and make treatment a collaborative process.
    • Keep regular appointments with your care provider, especially when you first begin treatment. Regular appointments help you and your care provider monitor treatment progress and make adjustments as necessary.
  2. Patience: When starting treatment you may feel frustrated if you do not begin to feel better right away. It may take time before you start experiencing the full benefits of treatment. Here are some possible reasons why:
    • Most psychiatric medications take weeks or even months before they achieve their full impact. Your care provider or pharmacist can help you set realistic expectations about how long it might take for you to start experiencing benefits from your medication.
    • Some physical symptoms, such as sleep and appetite, you may see an improvement before your mood. For example, with SSRIs, it takes a month or more to have a noticeable effect on symptoms. So it is important to keep taking an SSRI as prescribed even if you do not experience immediate relief of symptoms.
    • Prescribing and managing psychiatric medication is a complicated process. No two people respond to medication in exactly the same way, and some medications that are very effective in some people are not as effective in others. It may take time for you and your care provider to find the medication (or combination of medications) and dosage that works best for you.
  3. Flexibility: For people with mental illnesses that require ongoing care, it is often necessary to make adjustments to treatment over time.
    • Medications that were effective at the start of treatment sometimes become less effective over time. When this happens your care provider may recommend that you try a different dose, try a new medication altogether, or that you supplement treatment with psychotherapy or other non-medical interventions.
    • If you experience a side effect from your medication, your care provider may suggest dosage or medication changes to reduce the likelihood of this side effect. Do not adjust your dose on your own. Always evaluate your medications and dosages in consultation with your care provider.

STAYING CONSISTENT WITH YOUR MEDICATION

 

Living in a college environment can pose challenges to managing your medication. This section will help you anticipate these challenges and find strategies to overcome them.

Remembering to Take Your Medication

  • Pick a specific day and time each week to put your pills for the entire week in a medication organizer. This will also help ensure that you do not accidentally take a double dose of medication.
  • Keep your pill box or organizer in a place where you will see it every day (e.g., on your dresser or next to your toothbrush).
  • Try to take your pills at the same time each day and pick a time when you are almost always home (for example, when you wake up in the morning or when you go to sleep at night).
  • Set automated reminders. You can set a daily alarm on your cell phone or computer. Many free online calendars allow you to set daily email or text message alerts (e.g., Google Calendar).
  • Keep a diary, checklist, or use an app to keep track of your medication. You can also use our Medication Wallet Reminder Card to make sure there’s a record of your medication always with you.
  • Keep regular appointments with your care provider.
  • Consider psychotherapy to help you overcome the challenges of sticking to your medication schedule.

Traveling

  • Leave a reminder note on your luggage to pack your medication.
  • At least one week before you leave town, make sure that you will have enough medication to last through your trip. If not, be sure to have your prescription refilled before leaving.
  • Be sure to take your insurance information and a phone number to reach your care provider.
  • If you are taking a medication that requires you to have blood drawn frequently, ask your care provider if you should have your blood work done before you leave.
  • If you are flying to your destination, always pack your medication in your carry-on luggage so it will be easily accessible, and to avoid being without your medication should the airline lose your luggage.

Long Breaks

  • If you are leaving campus for one month or longer (e.g., during Summer break), be sure that you will be able to fill your prescription while you are away.
  • Find a clinician in the area where you are traveling in case you need to go in for a visit while you are away.
  • Be sure to take your insurance information and a phone number to reach your care provider.
  • If you are studying abroad, locate a care provider with whom you can communicate easily in case you need a medication refill or for any emergencies.

REACTIONS & SIDE EFFECTS

Psychiatric medications sometimes come with unwanted side effects. In most cases, side effects from psychiatric medications are mild and go away after a short time. But for some people, side effects can be more problematic and ongoing.

Side effects are most likely to occur within about two weeks of either starting a new medication or increasing the dosage. The potential for side effects depends on many factors, including the kinds of medication you are taking, your metabolism and your lifestyle (such as the kinds of food you eat, the amount of sleep you get, etc.).

Sometimes it is difficult to know if what is being experienced is a side effect of medication or a symptom of your mental illness. For example, some experience a loss of interest in sex when taking medications, but this change is also a symptom of many mental illnesses such as depression. You can work with your prescribing care provider to help distinguish between psychiatric symptoms and side effects.

It is extremely important to tell your care provider and pharmacist about all of the medications (prescription and non-prescription) you are taking so that they can look to see if there are any drug interactions that may result in unwanted side effects. It is also important to tell your care provider and pharmacist if you begin taking any new medications so they can check for interactions with your psychiatric medications.

What to do if you develop side effects:

  • Talk to your care provider. Don’t stop or adjust your medication on your own. Often your care provider can adjust your medication regimen in a way that reduces or eliminates your side effects.
  • If you are having trouble tolerating your medication, your care provider may be able to try different medications to find the one that’s right for you.
  • Keep in mind that side effects are often a temporary reaction to the medication, and go away once your body adjusts.
  • It can be helpful for both you and your care provider to keep a diary of your experiences, both good and bad, while taking your medication. You can use the following forms to help:

When you begin to feel better:

  • People sometimes stop taking their medication once their symptoms improve without first consulting their care provider. But many psychiatric disorders are chronic problems that require ongoing treatment. Stopping your medication prematurely puts you at increased risk for having a relapse of symptoms. Always check with your prescribing doctor before stopping or adjusting your medication. Remember, the goal of treatment is not just to make you feel better, but to keep you feeling better.

PAYING FOR PRESCRIPTIONS
  • Sometimes students don’t fill their prescriptions because they are concerned about the cost of psychiatric medications.
  • You may be able to save money by buying generic drugs rather than brand names. Generic prescriptions have the same active ingredients as brand name drugs but are often considerably less expensive. Some pharmacies have low-cost generic drug programs. If you are concerned about paying for medications, talk to your care provider about generic drugs.
  • Your pharmacist may also be able to help to find ways to pay for your medication.
  • It is also important to remember that treatment could save money in the long run. Untreated mental health conditions could lead to expensive medical visits, poor academic and job performance, and a prolonged academic career.

PSYCHOTHERAPY

What is psychotherapy? Psychotherapy is a term used to describe a broad range of non-pharmacological mental health treatments. In nearly all cases, psychotherapy involves meeting with a trained professional to explore and work through problems. It is a common form of mental health treatment that can be used alone or in combination with psychiatric medications.

Why do people choose psychotherapy?

People enter psychotherapy with a variety of different goals:

  • To learn how to cope better with challenges and problems
  • To reflect on experiences and feelings with a supportive listener
  • To get a different perspective on problems from someone who has experience and training in helping others
  • To learn to recognize, develop, and use personal strengths
  • To have a safe and supportive place to talk about problems and experiences
  • For help making difficult decisions or getting through difficult times
  • For help in finding direction and setting future goals
  • To improve relationships with others
  • For help coping with a chronic medical or mental health problem or with the side-effects of medication

Types of Psychotherapies

Psychotherapies can take many different forms and can involve very different activities. Here are some ways that psychotherapies differ from each other:

  1. Format
    • Individual Psychotherapy: In individual psychotherapy, clients have one-on-one sessions with their therapist.
    • Group Psychotherapy: Sometimes mental health problems are better treated in a group setting where several clients with similar issues meet with a therapist (or sometimes more than one therapist). Groups can be non-threatening, supportive places to work on interpersonal difficulties and receive feedback from peers. Groups can also be helpful forums to learn how others have dealt with similar difficulties and have learned to cope with them.
    • Family Psychotherapy: Family therapists help families, couples, and sometimes other groups of individuals who live or work closely together to work through difficult problems and identify both healthy and unhealthy patterns of interaction. All members of the group or family are considered clients and the therapist(s) is bound to act on behalf of all members.
  2. Approach
    • Skill-Focused Psychotherapies.
      • The focus of these approaches is on helping a person learn skills and coping strategies. Examples include how to communicate with others more effectively or how to engage in activities that will help a person’s mood.
      • These approaches tend to be present-focused; that is, they emphasize the importance of analyzing and adapting a person’s current behavior and circumstances.
      • These approaches tend to be directive; that is, the therapist will often recommend specific strategies (often in the form of homework assignments) or changes for the patient to make.
      • Examples: Cognitive-Behavioral Therapies (CBT) and Dialectical Behavior Therapy (DBT)
    • Insight-Focused Psychotherapies.
      • The goal of these approaches is generally to help individuals gain better self-understanding by exploring their experiences, emotions, and relationships.
      • The understanding of past experiences and how they relate to current emotions and behavior is considered crucial.
      • These approaches are often (but not always) less directive than skill-focused psychotherapies; that is, the therapist is less likely to recommend specific changes or strategies to the client.
      • These approaches tend to take longer (i.e., require more sessions) than skill-based therapies.
    • Relationship-Focused Psychotherapies.
      • These approaches also involve relationship skills.
      • These approaches focus on how relationships impact mental health and functioning.
      • Often the goal of these approaches is to help clients better understand how their behavior influences relationships by analyzing positive and negative patterns and developing alternative strategies.
      • These approaches can be directive or nondirective depending on the therapist and his/her training and outlook.
      • Interpersonal Therapy is an example of a relationship-focused psychotherapy.

*Note: Often, therapies don’t fall cleanly into any one of the above three categories. Talk to your therapist about their approach to therapy and see what works for you.

 What do the various types of psychotherapy have in common?

  • A Warm and Trusting Therapist-Client Relationship. All psychotherapeutic approaches consider the relationship between the client and therapist to be an important part of the therapy. Good therapists do their best to understand and show a genuine interest in their clients’ feelings and experiences.
  • Belief in Change. Psychotherapies are based on the idea that a helpful change in the client’s situation is possible. Sometimes the underlying problem won’t change—psychotherapy won’t change the fact that a client has Bipolar Disorder, for instance—but the change is often in the way the client copes with the problem or in the client’s outlook.
  • Support. All therapies, regardless of their format or approach, are supposed to be supportive. Simply having a supporter can be a powerful tool, and clients should expect therapists to support their desire to make positive changes. Therapists differ greatly in how they provide this support, but it should be clear to clients that the therapist is an advocate for their well-being. This does not mean, however, that your therapist will support any and all of your actions or behaviors. For example, you should not expect a therapist to support your decision to cope with problems by excessive drinking or drug use.

How Can Psychotherapy be Helpful?
  1. As a Stand-Alone Treatment
    • Psychotherapy is used by many people with mental illnesses as their primary treatment.
      • Research suggests that psychotherapy is an effective treatment for many people with mental illnesses. The Society of Clinical Psychology website provides detailed information about available research evidence for psychotherapies.
    • There are some mental health problems (like schizophrenia and bipolar disorder) for which medication is almost always necessary or recommended; psychotherapy alone is generally not recommended for these disorders.
  2. In Combination with Medication
    • Psychotherapy and psychiatric medication are commonly used in combination to treat mental health problems, and there is good research evidence showing that a combination treatment is preferable for most people.
    • Psychotherapy as an additional treatment to medications can address certain issues or symptoms that medication alone cannot. Research has shown that the effects of psychotherapy last long after the therapy has ended and can be helpful in preventing a relapse of symptoms.
    • Here are some common reasons that people who use psychiatric medication as their primary treatment choose to also attend psychotherapy:
      • They have a mental health issue for which research has found that a combination of psychotherapy and medication is most useful (e.g., recurrent depression or bipolar disorder).
      • They want to learn skills that they can use in their everyday life that can help relieve mental health symptoms, or that can help them function despite having mental health problems.
      • They want a supportive environment to talk through problems and to cope with the idea of having a mental illness.
      • They need support to stay on a difficult medication regimen.

4 Ways to Make the Most of Psychotherapy
  1. Patience. Patience is a key to reaping the full benefits of therapy. Psychotherapy is not a quick fix for mental health problems. Most people beginning psychotherapy have lived with mental health problems for a long time. Changes will take time.
  2. Commitment. Successful treatment requires a strong commitment on the part of the client to attend scheduled sessions and follow through with the treatment, just as treatment for a medical condition requires that you keep your doctor’s visits and follow prescriptions.
  3. Willingness to Try New Things. Psychotherapy often involves changing behaviors or outlooks that have become second-nature. Making these changes can be very difficult. In fact, psychotherapy can sometimes increase discomfort in the short-term as you work with your therapist to make changes or explore difficult topics.
  4. Rapport. The relationship between you and your therapist is crucial to successful treatment. As a client, you should feel comfortable sharing information with your therapist. Additionally, you should feel comfortable talking to your therapist about how the treatment is going. Here are some questions to consider when evaluating how therapy is progressing:
    • Are the goals of the treatment clear?
    • Do you feel that your therapist understands your experiences and is receptive your ideas and concerns?
    • Is there mutual respect between yourself and your therapist?
    • Are you happy with the progress that you have made? If not, have you and your therapist talked about how to change the direction of treatment?

BRAIN STIMULATION (OR NEUROMODULATION)

In these types of medical procedures, electrical or magnetic currents are used to stimulate the brain and alter (or “modulate”) brain activity, which can help relieve symptoms of depression and other conditions.

  • rTMS (Repetitive Transcranial Magnetic Stimulation). This involves stimulating the brain with a magnetic field. A magnet is applied to the scalp daily for about 40 minutes, over several weeks. The treatment is done in an office setting, and does not require anesthesia. rTMS treatment is extremely safe and has been approved for treating adults with depression that has not improved with antidepressant medication. In fact, rTMS can be an attractive alternative for individuals who do not wish to take medications. Delivering pure energy to specific parts of the brain avoids the widespread side effects that medications can have.
  • ECT (Electroconvulsive therapy) is usually used for people with severe depression, including people who do not respond to medications. ECT applies brief electrical pulses to the brain through electrodes attached to the scalp. This is done over a series of treatments, although it is not considered to be a non-invasive procedure because anesthesia and other medications are given through an IV. This approach has also been proven safe and effective for treating depression and a variety of other mental disorders.

 


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