Knowledge is Power
FREQUENTLY ASKED QUESTIONS
CONTROLLED SUBSTANCES
MEDICATION SIDE
EFFECTS
I do not provide controlled substances/medications. This includes medications such as stimulants (adderall, vyvanse), sleepers/hypnotics (ambient, lunesta), opiates (tramadol, oxy/hydrocodone) or benzos/benzodiazepines (ativan, xanax, klonipin).
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PLEASE speak with me if you have ANY concerns about side effects from medications.
Usually medication side effects will present within the first couple days of taking a new medication or increasing the dosage.
Often medication side effects are “self limiting” which means they will improve or subside within a few days so we often tell people to KEEP TAKING the medication, unless the side effects are severe or unbearable, as they will often improve as the body adjusts.
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If you are having bothersome side effects do NOT just stop your medications. Please schedule an appointment to discuss your concerns so we can work to find a solution. Sometimes a change in dosage or switch to different medication can help and I want to work with you.
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Headache can occasionally occur but if
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IF drowsiness from medication: switch to bedtime dosing
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IF alertness or slight restlessness from medication: switch to AM dosing
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IF upset stomach after taking: take AFTER eating something. Most medications do not need to be taken with food unless specifically stated but if they cause upset stomach after taking without food, take them after eating. If this still doesn’t help, sometimes taking them at bedtime helps so that you sleep through the initial nausea.
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IF constipation issues drink lots of water, decrease caffeine intake, consider prunes or prune juice, move more and if needed often you can use a gentle over the counter laxative such as polyethylene glycol (Brand: Miralax) as directed.
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IF diarrhea, increase fiber intake and you can consider over the counter bulking agents such as psyllium (Brands: Fibercon, Metamucil).
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ODD side effects: occasionally some medications have odd side effects. some of these can including increased urinary frequency or urgency, blurred vision, dizziness, and other.
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Sexual side effects: these can include decreased libido (sex drive), problems with orgasm or, rarely problems with erections. Though some people feel embarrassed talking about these things I hope you will feel comfortable enough to bring them to my attention so I can help. People talk to me about a variety of things including the above issues related to relationships and masturbation. I’m a medical provider, and used to talking about these types of things.
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Again speak with me if you have ANY concern.
CONCERNING REACTIONS
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SEVERE side effects when you should stop taking a medication include: severe swelling, severe intolerable headache, rash, any difficulty breathing, severe muscle aches/stiffness. These are concerning and may need medical attention so go to an urgent care or ER for assessment.
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PRIAPISM (prolonged erection). This is a VERY RARE side effect to some medications including trazodone. IF this occurs you MUST go to the ER immediately and stop the medication.​​​
EFFECTIVENESS OF MEDICATIONS
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Often for mental health medications to be effective it takes 4-6 weeks so BE PATIENT. Even if you do not notice significant improvement in the first few weeks, if you are tolerating the medication well the dosage can sometimes be increased to be further effective.
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Medication does NOT work alone or by itself. You MUST engage in other wellness activities in order for the medications to have maximum effect. This including healthy diet, exercise, sleep hygiene, work, social activities, therapy, and others.
GENE TESTING
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Discuss with me to find out if right for you and possible costs
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​Available through GeneSight
LABS AND VITAL SIGNS
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Labs and vital signs (weight, blood pressure, pulse) are important parts of the assessment for your well being.
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Please get them checked when recommended and provide me with this information. Some medications cannot be provided or continued without this information.
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Labs are ordered and received electronically through questdiagnostic.com you can schedule an appointment and find their locations on-line. Usually labs do not need to be ‘fasting.’
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If a drug/medication level (such as lithium, depakote, or other) is ordered this usually needs to be a ‘trough’ usually meaning just before the next dose is due to be taken or about 12 hours after your last dosage.
VITAMIN B12
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VITAMIN D
​​B12 is important for many things including energy and memory.
Some conditions can contribute to low B12 levels including but not limited to things like celiac disease, use of metformin and some other medications, pernicious anemia, excessive alcohol intake, and older age.
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B12 is a water-soluble vitamin that usually can't build up too much in your body. Therefore it is unlikely to be harmful at very low doses and could possibly be helpful.
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You can consider supplementing with 50mcg weekly or possibly daily. Speak with your provider and levels can be checked if you have concerns.
There continues to be conflicting research on checking vitamin D levels due to questionable accuracy and if levels mean anything. However, there has been various research with evidence to suggest that adequate vitamin D levels can be helpful and important for mental health.
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Most people I check levels on are usually very low or deficient.
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Some insurances refuse to cover vitamin D labs
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2,000 IU (international units) daily is very unlike to cause harm and could be helpful.​
HORMONES
Hormones can dramatically affect mental health and wellness
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However, routinely checking ‘hormone levels’ is NOT usually recommended for most patients. Many hormone clinics are not basing their care on research or practice guidelines and are often just trying to make money.
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Regarding perimenopause most medical providers consider stages of menopause based on physical symptoms.
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​Premenstrual dysphoric disorder is very real. If you have concerns about this please start tracking your periods and your mood symptoms to review with me to discuss options. ​
THERAPY
This is a MUST!! Medications do not work alone! An example once provided to me was medications are like the engine in a plane but therapy is like the wings – you need both for the plane to fly. Please see my page on trusted resources for a list of therapists I have personally and professionally worked with and highly recommend.
EMOTIONAL SUPPORT ANIMALS (ESAs)
An emotional support animal (ESA) is not the same as a Service Animal. Service animals are highly trained animals requiring specific paperwork. Although I agree that animals can be very supportive to emotional and mental health I do not routinely provide letters for ESAs due to the legal repercussions that can result when such letters are provided, especially if the animal were to injure someone or damage property.
MARIJUANA
Research shows that tetrahydrocannabinol (THC) one of the many active chemicals in marijuana can worsen almost all mental health symptoms with chronic, routine use. Although it is legal it is not helpful for mental health symptoms and worsens symptoms over time including anxiety, depression, motivation, energy, sleep, concentration, focus, and others. I am not apposed to occasional low dose use but please try to avoid routine use in order to prevent worsening problems.
MED-9s DISABILITY FORMS
I do not routinely complete Med-9 or disability forms of any nature. If these are required a fee of $200/hour will be charged to complete forms.
LEGAL ISSUES
