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Use of Psychiatric Medications for Mental Health Concerns

Medications used to treat depression, anxiety, and other mental health concerns are considered additional and more intensive treatments than counseling and/or behavior change alone. Medications used to treat mental health symptoms effect neurotransmitters in the synapses of the nervous system. These neurotransmitters are also affected by stress; poor daily habits such as irregular sleep, lack of exercise and unbalanced diet; and emotional losses such as ending relationships, the death of a loved one, or difficulties in making academic progress. When the distress has been present long enough, medications may be helpful as an adjunct to the counseling which is focusing on the learning and growing from the distressful experience and the re-establishment of healthy daily activities. In order to make best use of counseling, it is important to have stability in biologic functioning. Medication may help improve mood, motivation, anxiety symptoms, concentration, appetite, and sleep so that it is possible to more fully participate in the psychotherapy process. Psychotherapy focuses on learning effective ways of responding to stressful life events and on re-establishing healthy behavioral patterns.

Medications, when indicated for specific symptoms and monitored by a physician, are safe and may be quite beneficial in regulating mood, anxiety, concentration and attention to increase the likelihood of academic success. The first step in accessing services is to call CAPS (706-542-2273) for a telephone screening. If you are appropriate for services, you will be scheduled for an initial consultation appointment at the time of the phone screening. After the initial consultation, you will be scheduled for the medication evaluation with the psychiatrist or prescribing clinician. Previous treatment records will also be requested at the time of the initial consultation. Prescribing medications requires an evaluation (usually 60-90 minutes, by appointment) by one of our trained and experienced medical/psychiatric staff to assure the correct medication is provided for the concerns of the student. In the process of this evaluation, the clinician and the student both work to establish a healthy treatment relationship. Information is provided at that first meeting on side effects that may occur with a specific medication, instruction on how to use the medication, the usual course of treatment, and how to reach the clinician with questions in between appointments. A follow up appointment for medication monitoring is almost always scheduled when medication treatment is initiated and usually within 2-4 weeks of the initial appointment. It takes this amount of time for medications to stabilize and then make decisions about the medication effects and if a dosage adjustment is needed.

Follow-up appointments for medication monitoring are usually for 15-20 minutes and focus on review of medication response ( i.e. effectiveness and any side effects that may be present or causing problems). At this appointment, medication dosage may be adjusted, the medication switched, or a new medication added if there has been poor response or problems with side effects. There is little time for counseling during these brief appointments but if counseling is needed another appointment may be scheduled at that time.

If medications have been used in the past or are currently being prescribed by another medical care provider, we will need to obtain the previous treatment records. Please see Psychiatric Services: Transferring Medication to CAPS for more information.

In summary, use of medication is often an individual decision to assist the counseling by helping with regulating moods, anxiety, and physical symptoms that affect daily performance. Medications are relatively safe and require professional monitoring to be effective and to minimize side effects. For medications to be beneficial, students must trust and be candid with their medical clinician in reporting their experiences, both positive and negative, when using medication. The best treatment is in coordination with the CAPS counselor. Shared treatment with counselors in the community is not available at this time. This is due to the time it takes to coordinate treatment and the sharing of records. We are happy to help with a referral to the community if that is the best option for treatment.

General Information About Medications Commonly Used in a College Health Setting:

Antidepressants (i.e. SSRI's, and tricyclics)
These are the most commonly prescribed class of medication because they are well tolerated, effective and also the treatment of choice for anxiety disorders. These medications are non-addictive but may cause discomfort when discontinued suddenly without proper monitoring. (See Possible Discontinuation Reaction from Serotonin Reuptake Inhibitors)

Some examples of these medications are Prozac, Zoloft, Paxil, Celexa, Lexapro (AKA SSRIs). They are used to treat depression, anxiety, panic and obsessive compulsive symptoms. They are also the treatment of choice for social anxiety and some eating disorders. Other related medications are the older tricyclic medications, and newer antidepressants such as Effexor, Cymbalta and Wellbutrin. Wellbutrin has been less effective for anxiety but quite effective for depression, attention and concentration, and some physical symptoms of stress. Wellbutrin also frequently is used to minimize some side effects common with SSRIs. Generally these medications are started at a low dose and the dose increased until effectiveness is reached or problems with side effects decrease.

It is helpful to know if biological family members have responded to any of these medications in the past as this helps in the choice of medications for the student. The medications should be tapered slowly to avoid discontinuation symptoms (see link above for details) but withdrawal is not considered dangerous. Tapering slowly also allows for faster response by increasing the dose if symptoms return. Tapering is done in concert with regular appointments with the prescribing clinician.

Benzodiazepines
This class of medication ( i.e. Valium, Xanax, Ativan, Klonopin etc.) is effective for short-term use but may be addictive if used regularly over time. The most common side effect is sedation and they also may be helpful as a sleep aid for brief periods. For these reasons, the SSRI's are the treatment of choice for anxiety unless the symptoms are very short term.

Hypnotics or sleep meds (i.e. Ambien, Lunesta, Sonata, Restoril etc.)
These are either benzodiazepines or similar to the benzodiazepines. They may be helpful to replace normal sleep patterns which are often disrupted during times of stress, loss or with depression and anxiety. These medications may be very helpful as an adjunct to counseling and to assist in the return to exercise and healthy eating habits. When sleep deprived, it is common to feel more emotional and have difficulty with control of emotions in stressful times. Sleep deprivation also interferes with concentration and attention, and therefore performance when going to class, studying or taking tests. These medications are used along with suggestions for establishing a healthy work schedule to improve the chances of academic success.

Stimulant medications (Adderall, Ritalin etc)
These are used to treat ADHD and in CAPS we insist on a formal ADHD testing evaluation before prescribing and monitoring these medications in CAPS. These medications are abused when used to stay awake or in combination with alcohol or other drugs, and may be dangerous. It is a crime for students to share stimulant medications with other people as they may be dangerous if used improperly and without supervision. When used properly at prescribed doses and appropriate times to avoid sleep disruption, they can help maximize studying, attention in class and academic performance for students with ADHD. They are quite safe when used as prescribed with close supervision. It is important to maintain healthy sleep and eating patterns when taking these medications.

Mood stabilizers
These are mainly anti-convulsant medications, lithium, and some of the newer atypical antipsychotic medications. These medications require close monitoring until the effective dose is determined and there are no significant problems with side effects. They should not be discontinued suddenly as return of symptoms may occur quickly and some of them require blood level monitoring.

Herbal supplements (i.e, St John's Wart, Kava Kava, dietary aids etc.)
These are not monitored by governmental agencies as to potency and may have potent adverse effects. They may interfere with the metabolism of prescribed medications. Thus, they should not be used in concert with prescribed medications unless there has been a check for potential interactions. The research is still incomplete on what conditions they may help, but as many of our medications have been developed from plants, combining them with prescribed medications is not recommended at this time.