Mental health articles

Timing of Medication Consultations
It is important to consider the psychological impact of being on a medicine.
Since many of the problems that students present with at college mental health
centers are brief and self-limiting, a patient who is quickly medicated may feel
better several weeks aft erward. But then patients and clinicians are presented
with a tough decision: Has the improvement resulted from the medicine (in
which case it should probably be continued for several months) or from some
circumstantial change in the student’s life? Complicating the decision, the
student may believe that medication explains the improvement, so stopping
it may cause anxiety about symptoms recurring. A more general problem is
that most people imagine that response to medication implies an illness, and
this in turn implies chronicity. Many college students now present to counseling
services stating, “I have clinical depression” or “I have panic.” In fact,
however, late adolescents’ and young adults’ diagnoses tend not to be stable.
And it is important to bear in mind that any person who experiences an episode
of major depression has a signifi cant chance of never having another episode
(Kessing, Andersen, & Mortensen, 1998). Further, there are suggestions
in the literature that treating people with medicines can lead to a decreased appreciation for psychological factors and a devaluing of psychotherapy as a
component of treatment (Bolton, 1996).
In light of these considerations, except in urgent cases such as psychosis
or severe depression, or if the student is already on medication and is doing
well, it is a good idea to do a careful assessment and try a few sessions of
talk therapy before considering medication. When there are environmental
precipitants for the problems, they will oft en shift or resolve in a few weeks.
Developmental issues (like homesickness) and personal crises will also oft en
begin to improve with a few weeks of support and adjustment. Many people
who have never been in psychotherapy need a few sessions to get the hang of it,
but will oft en begin to show improvement aft er 2 to 6 weeks of therapy. If the
symptoms persist or worsen during this time, a psychiatric consultation can
be obtained. Also, aft er several visits, the therapist is in the position to pass
along useful information to the psychiatrist. By this time there should also be
the beginning of a therapeutic alliance in the treatment, so that the patient
has a greater sense of trust that consultation is being suggested for good and
therapeutic reasons.