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Question:

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p>I was wondering how Dr’s come to decide what medication to try first and how they diagnose possible mental illnesses. I’m afraid to just trust their judgment with my mental health. However, my anxiety really is getting in the way of me complying with a treatment medication. I was prescribed lamotrigine for my mood issues. I do have mood swings that go way down and very mildly up. I like the energy I get in that up week but it always does not last and I again find myself depressed. Normally it seems to be every 3 or 4 weeks. I worry about side effects so much that I wonder if I am just better off letting myself just be as I am but I know that I affect others with my mood and behaviors so it is confusing. How do I just trust them?

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
  • Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
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Answer:

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p>I frankly don’t think that it is a good idea for you (or anyone) to just blindly trust in a given doctor’s advice when you are not in an emergency situation (where your life may be endangered by failing to act quickly) and when you don’t have a history of trust built up with the doctor in question. Medical doctors are highly trained professionals and really the only professionals you might reasonably trust to prescribe medication. Pharmacists know a great deal about medication too, as do nurses, but these professionals typically are not in prescribing roles. Even so, the reason that medicines are designated prescription-only is because they can be dangerous when misused or mis-prescribed. Despite their advanced training, Drs. are quite capable of making mistakes. For this reason, it is a good idea to talk to several Drs. If you have the resources to do so when worried about any given doctor’s opinion. When more than one Dr. recommends a similar medication for treatment of your condition, you can be at least sure that the recommendation is a valid reflection of how the local medical community tends to treat that condition.

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p>Although medicine is largely a standardized affair, there are regional and cultural variations in how conditions are diagnosed, and how medications are prescribed to address given conditions. In addition to their basic medical “best practices” training, Drs. are influenced by these regional and cultural trends (e.g., by how influential doctors they are affiliated with prescribe). They are also influenced to some degree by medication sales representatives from the big pharmaceutical companies who visit their offices periodically to push them to prescribe the latest (not necessarily the best) medications. Drs. are also influenced by what their patients want too, which is why the pharmaceutic companies are spending so much money aimed at direct-to-consumer advertisements these days.

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p>Bipolar conditions such as you likely have some variation of can become life threatening in some cases. Some number of individuals with Bipolar I conditions end up committing suicide. Even people who have milder cases end up with disabling or difficult depressions that can cause social and occupational difficulty. Medications are available to treat this particular sort of condition, and few other interventions are likely to be of use in helping to reduce symptoms. For these reasons, it is reasonable to consider taking medication to reduce the symptoms.

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p>Most every medication available has some level of side effects associated with it. The decision to use a medication to treat a given condition is always a decision that the benefits of using the medication will outweigh the side effects that may be experienced. Ideally, both you and your physician are aware of what those benefits and side effects are likely to be and are making an informed decision that on the whole will benefit you more than hurt you. Your physician can help you to be informed about side effects of various medications that might help your condition. Websites like rxlist.com are also good sources for this sort of information.

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p>Most of the mood stabilizing medications are fairly well understood, and are safe if used as prescribed by a competent psychiatrist. I would suggest talking to your doctor about your fears, and working with him or her to come up with a treatment plan that will err on the safe side of the equasion. You can then experience what side effects will happen and, of course, what benefits will happen too (for that is the whole reason for using the medicines in the first place). In conjunction with your doctor’s approval, you can always later adjust your dosages up or down as needed, or add additional medications so as to provide the best treatment bang for the least side effects. This is, in fact, how many patients end up doing it.

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p>In sum, research your condition and the medications used to treat it, and then develop an initial treatment plan in conjunction with your doctor. Then communicate with your doctor regularly (and whenever you experience an odd or unwanted side effect) so as to interactively adjust your prescriptions to best treat your unique condition.

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