Any tips on how to make the transition from one medication to another? I've been through many changes in 27 years and every time it's a struggle.

Your experience is, unfortunately, very common. Changing medication is difficult, and our ability to predict which medication is right for which person is really not much better than it was 27 years ago. Personalized medicine, or choosing the right medication for any individual, is our hope, but currently there is still a lot of trial and error.

There are some specific things you can do to reduce errors and make more informed decisions. The key is making sure that you and your doctor are on the same page about a few simple things, such as:

Why are you making a change? The most common reason is to reduce or prevent mood symptoms. But you might also change medication to reduce side effects or avoid a health risk like rising blood sugar or cholesterol. And sometimes there may be more than one reason, such as the medication isn’t working that well and is causing side effects. Or you may want to increase the dose to get more benefit or reduce it to see if it will be just as effective. These changes are all reasonable, but they have different goals. Before you can answer the question “are we getting anywhere” you’ll want to make sure you and your doctor are on the same page about what you are trying to accomplish.

When and how will you decide if the change is a good idea? The indicators of success will depend on your answer to the first question. Ideally, you’ll have a clear understanding of what you are looking for and how you will measure it. For instance, if the goal of changing medication is to reduce symptoms of depression, you could use the DBSA Wellness Tracker to see if you are really better off. Also be sure that you and your doctor agree on when you will really know if a change is helpful. Some medications might have a positive effect after only a few days, while others may take four weeks or more.

What problems should you be looking out for? All medications can have side effects or risks. But the official warning label may not help you understand which problems are common and which are important. The specific things you’ll want to know include what the common side effects are and when they are likely to occur; what side affects you should try to ride out and which ones would be a reason for stopping the new medication; and what problems or side effects could be dangerous and what you should do if you notice them.

Someday we may have more accurate tools for predicting which medication will work for which person. Those tools might include genetic tests or scans or online tests of how different areas of your brain are functioning. In the meantime, your own experience is the most accurate tool we have. If you and your doctor decide make a medication change, just make sure you have answers to the questions raised here.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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