Meeting challenges in medication compliance
When I prescribe a psychiatric medication for a patient, I remind him or her to read the label and to follow those instructions to the letter. Taking medications as prescribed, however, can be a challenge. The elderly can become confused and not remember to take their medications. Some need help organizing medications so that they adhere to the prescription.
Today’s elderly generation also has a self-reliant outlook that can make them reluctant to take psychiatric medications. When facing depression, however, this attitude can lead to unnecessary suffering. The loss of a loved one and other problems can cause depression in a person who has never experienced it before. Also, if an elderly person has a depressive episode without having a root cause, the problem has a chemical cause and requires medication. Even patients with robust mental health can encounter psychiatric symptoms caused by medications that they take for other conditions. For example, even Benadryl taken over the counter (OTC) has hallucinations as a possible side effect.
I recommend that a patient suffering a first episode of depression stay on an antidepressant for nine months to a year and then taper off if the depression has passed. Once someone has experienced an initial episode of depression, they are at higher risk of having depression again in the future. They have a 50 percent greater likelihood of having a second episode and the odds are increased again after each episode they experience.
Some patients resist taking an antidepressant because the drug can take two or three weeks to reach full effect. Patients feel the side effects before the benefits of the medication. I urge my patients to stick with a medication until it works unless the side effects are intolerable. Many side effects go away after a week.
Outpatient therapy also an option
Besides medication, cognitive therapy helps improve mood. Senior Bridges at Northern Nevada Medical Center treats the mental and the physical health of adults 50 and older. It is designed for short-term care to stabilize and resolve immediate psychological problems.
Sometimes therapy is adequate for people suffering chronic pain or the loss of a loved one, when they just have too many emotional burdens to face alone. If a Senior Bridges patient needs medication though, he or she will have been diagnosed and can feel confident knowing that the need for medication is truly warranted. Senior Bridges also provides a thorough education on medication compliance for its patients.
Learn about drug interactions
I also prescribe medications with an eye to their interaction with other medications and substances. The elderly are more prone to interaction problems because their kidneys and liver sometimes cannot function properly when processing a variety of medications.
Seniors who take several prescription drugs have an online resource for learning about drug interactions, www.northernnvmed.com. The Health Library includes a Drug Interaction Checker. A patient can search for a drug by its brand or generic name and learn about the drug’s interaction with other drugs and with alcohol, caffeine, foods and other substances.
To learn more about prescriptions, click on “Drug Search” in the Health Encyclopedia Drug Reference. This online service will search by the drug’s generic name or by key words. The Drug Search then gives:
• A description of the treatment for which the drug is intended.
• Conditions to discuss with a physician before taking the drug.
• Instructions for taking the medication, including action to take in case of an overdose or a missed dose.
• Detailed information on medications that a patient should not take while taking the drug and its interaction with other medications.
• Side effects that require medical attention and those that are less serious.
• Instructions for storing the medication.
With these online services and with help from Senior Bridges, northern Nevada seniors no longer need to face worry and confusion over psychiatric medications.
Senior Bridges at NNMC offers a separate outpatient facility. The intensive outpatient program provides more thorough treatment than traditional outpatient care. For a free, confidential assessment call 356-1279.
Ellen McBride, MD, is the medical director for Senior Bridges Intensive Outpatient Program. Dr. McBride graduated from UNR School of Medicine and completed her residency at UNR.