Q & A on Supplementing Therapy with Medication

Clients sometime ask me questions about psychiatric medications. In this blog, I ask some of the most common questions I receive to Andrea D. Skrocki, PMHNP-BC, a Psychiatric Nurse Practitioner licensed in Colorado who I collaborate with.

When do you think it is appropriate for patients in talk therapy to consider a medication assessment?

While talk therapy is highly effective for many people, there are certain situations where supplementing therapy with psychiatric medication can significantly improve outcomes. Medication is not a "quick fix," but in the right circumstances, it can help reduce symptoms enough to allow therapy to be more effective. If a patient has been engaged in consistent, quality therapy but continues to experience significant symptoms (e.g., severe anxiety, persistent depression, intrusive thoughts), medication may help alleviate biological barriers to progress. When a person is struggling to maintain basic functioning — such as getting out of bed, going to work, sleeping, eating, or maintaining relationships — medications can provide stabilization so they can engage more fully in therapy. In cases where there is suicidal ideation, self-harm, or a risk of harm to others, medication may be needed to manage acute symptoms, in conjunction with a safety plan and close monitoring.

What markers do you look for to indicate someone may not be a good candidate for medication?

Medication can be incredibly helpful for many people, but it’s not always the right fit for everyone. Sometimes, emotional distress is tied to a recent life event — like a breakup, loss, or major change — and therapy alone might be the best first step. If symptoms are mild or unclear, or if someone doesn’t meet the criteria for a mental health diagnosis, medication may not be necessary. It’s also important to consider things like medical conditions, substance use, or past side effects, which might make certain medications less safe. And if someone isn’t comfortable with the idea of medication or isn’t ready to take it consistently, that’s okay — those are important conversations to have. The best approach is always a thoughtful, personalized one based on the patient’s goals, values, and overall health.

Why does a medication that helps one person with depression without many side effects cause so many side effects for another person?

Medications for depression can affect people very differently, and that’s because each person’s body and brain chemistry is unique. Things like genetics, metabolism, other medications, medical conditions, substance use, and even gut health can all influence how someone responds to a particular antidepressant. One person might break down the medication quickly and feel better with few side effects, while another might process it more slowly or be more sensitive to its effects. Brain chemistry also plays a big role — different types of depression may respond better to different medications. That’s why finding the right medication can sometimes take trial and error, and is often best explored with by a psychiatric provider and not primary care provider.

What is pharmacogenomics genetic testing?

Pharmacogenetic testing is a type of genetic test that looks at how your body may respond to certain medications based on your DNA. Everyone processes medications a little differently — some people break them down quickly, some more slowly, and some may be more prone to side effects. This test can give your provider helpful information about which psychiatric medications (like antidepressants or antipsychotics) might be a better fit for you, and which ones you might want to avoid. It’s not perfect science or a guaranteed matchmaker, but it can be a useful tool — especially if you’ve had trouble finding a medication that works well.

Some commonly used brands of pharmacogenetic tests include GeneSight, Genomind, and Tempus. These tests are typically done with a cheek swab and may be covered by insurance, depending on your plan and medical history.

If a medication is started to treat a mental health issue, will the patient have to stay on it for the rest of their life?

Starting a medication for a mental health condition doesn’t automatically mean the patient will need to take it for the rest of their life. The length of time someone stays on psychiatric medication depends on many factors, including the condition being treated, how severe the symptoms are, how well the medication works, and personal preferences.

For some people, medication is short-term support — helping them through a tough season or allowing therapy to be more effective. For others, especially those with chronic or recurrent conditions like major depression, bipolar disorder, or anxiety disorders, staying on medication longer-term may be the best way to maintain stability and prevent relapses.

The key is that this decision should be made collaboratively, with regular check-ins between the patient and their psychiatric provider. If things improve and the patient is interested in tapering off medication, that can often be explored slowly and safely — with close guidance by their provider to make sure the patient continues to feel well and is mentally stable.

Are there medications treating mental health issues that should not be stopped abruptly if the patient doesn’t like how it makes them feel or doesn’t find them effective?

Yes, there are several mental health medications that should not be stopped abruptly, even if you don’t like how they’re making you feel or you feel like they aren’t working. Suddenly stopping certain medications can lead to withdrawal symptoms — sometimes called “discontinuation syndrome” — which can include things like dizziness, nausea, headaches, anxiety, mood swings, or flu-like symptoms. In some cases, symptoms can be severe, especially with medications that affect brain chemistry more strongly.

This is especially true for medications like:

·        Antidepressants (especially SSRIs, SNRIs like venlafaxine/Effexor)

·        Benzodiazepines (like Xanax, Ativan, or Klonopin)

·        Antipsychotics (like Abilify, Seroquel, or Risperdal)

·        Mood stabilizers (like lithium or lamotrigine)

If a medication isn’t working for you, it’s completely valid to speak up — but it’s important to work with your psychiatric prescriber to taper off the medication slowly and safely. Your provider can guide you through a plan to stop the medication in a way that minimizes risks and helps you feel as comfortable as possible.

Can a patient become dependent on benzodiazepines?

Yes, it is possible to become dependent on benzodiazepines — medications often prescribed for anxiety, panic, PTSD, or sleep problems (examples include Xanax, Ativan, and Klonopin). Dependence means that over time, your body gets used to the medication and may need it to function normally. If you stop taking benzodiazepines suddenly after using them regularly, you might experience withdrawal symptoms such as anxiety, irritability, shaking, trouble sleeping, or in some situations, seizures.

Because of this, benzodiazepines are usually recommended for short-term use only, and if longer use is necessary, your provider will carefully monitor and create a plan to reduce the dose gradually when it’s time to stop. It’s important to never stop benzodiazepines abruptly without medical guidance to avoid uncomfortable or even dangerous withdrawal effects.

If a patient has concerns about dependence or are thinking about stopping their medication, they should talk openly with their psychiatric provider — they can help the patient make a safe plan.  Dependence on these types of medications should also be discussed prior to starting the medication, as well as at every follow-up.

What is your biggest challenge as a prescriber?

One of the biggest challenges as a prescriber is finding the right balance between effectiveness and side effects, since each patient’s response can vary widely and side effects may affect whether they stick with the treatment. Managing patient expectations is also key, as some people hope for quick fixes or worry about taking medication, so education and trust-building are essential. Many patients have complex medical histories, co-occurring conditions, or are on multiple medications, which require careful consideration to avoid interactions and ensure safety. Time constraints in busy clinical settings can make thorough assessments and follow-up difficult.  Therefore, ensuring that the visit duration is sufficient to address all the patient’s questions is important. Additionally, stigma and misinformation about mental health medications can lead to resistance, requiring sensitive communication and personalized approach.  Finally, staying up to date with rapid advances in psychopharmacology is an ongoing effort to provide the best care possible.

What are the most important things people need to consider before seeking a medication assessment or taking medication to treat a mental health issue?

Before seeking a medication assessment or starting psychiatric medication, a patient should consider the nature and impact of their symptoms, how those symptoms affect daily functioning, and what they hope to achieve through treatment. While psychiatric medications can be highly beneficial, they are not a one-size-fits-all solution and tend to work best when combined with therapy and healthy lifestyle changes. It’s essential for the patient to share a full and honest medical history, including any substance use and current medications, as these factors can influence safety and effectiveness. Finding a provider the patient feels comfortable with — someone who explains options clearly and involves them in shared decision-making — is also key. Lastly, patients should understand that results often take time, as many psychiatric medications take several weeks to show full benefit and may require adjustments to find the right fit.

Why should patients work with someone who specializes in mental health medication when a general practitioner can prescribe these medications?

While general practitioners (GPs) can and do prescribe psychiatric medications — and often play a vital role in early treatment — working with someone who specializes in mental health, like a psychiatric nurse practitioner or psychiatrist, can offer a deeper level of expertise. Mental health specialists have advanced training in psychiatric conditions and psychotropic medications, which allows them to navigate more complex symptoms, medication interactions, and treatment-resistant cases. They’re also more familiar with a wider range of medication options, including newer or less commonly used drugs, and can monitor for side effects that might be missed in a general setting.

In addition, mental health providers are trained to take a more nuanced view of diagnosis, often recognizing subtle patterns or co-occurring conditions like trauma, ADHD, or bipolar disorder that can be mistaken for anxiety or depression. This leads to more accurate treatment — and better outcomes. While a GP may be a great first step, working with a specialist is often beneficial for patients who have ongoing, severe, or complicated symptoms, or who haven’t responded well to initial treatment.  I prefer to work and collaborate alongside the GP so they know what I’m prescribing, and my treatment plan is, as well as I can be informed about the patient’s ongoing medical/physical health and lab results. 

What do you like about your work?

One of the greatest things about being a psychiatric nurse practitioner is the opportunity to build meaningful, long-term relationships with my patients and witness their growth over time. It’s a privilege to be trusted during some of the most vulnerable moments in someone’s life and to walk alongside them as they move toward healing, stability, and a renewed sense of hope.

I love that this role allows me to blend medical knowledge with a holistic, person-centered approach. I don’t just treat symptoms — I get to treat the whole person. Whether it’s through carefully managing medications, listening deeply, or collaborating with therapists and other providers, I’m able to support patients in a way that feels both clinical and compassionate.

There’s also something incredibly fulfilling about reducing stigma and making mental health care more accessible, especially in communities where resources are limited. Every day, I have the chance to educate, empower, and remind people that they are not alone — and that living your best life is possible.

Many thanks to Andrea for sharing her expertise on the subject of psychiatric medications. If you are in Colorado and want to contact Andrea to schedule an online medication assessment, you can call (720) 853-0030 or click the link below:

https://www.psychologytoday.com/us/psychiatrists/andrea-skrocki-denver-co/971824