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8 Ways Non-Prescribers Can Promote Medication Success

Simple Strategies for Any Mental Health Professional

Kenneth Carter, PhD, ABPP

Imagine this client walks into your office鈥

Susan complains that she feels exhausted, but you can鈥檛 help but notice that she鈥檚 also been experiencing anhedonia, difficulty concentrating, lack of appetite, bouts of crying, an overwhelming sense of guilt, and trouble falling asleep.

Based on this constellation of symptoms, the diagnosis is probably clear to you...

Susan is depressed.

But you鈥檙e not the first professional Susan has visited. Before you, she saw her primary care physician, who decided to give her something to help her sleep and prescribed a benzodiazepine.

It鈥檚 a situation you鈥檝e likely encountered before: your client鈥檚 presentation doesn鈥檛 match the prescription they have.

And it鈥檚 not that Susan鈥檚 prescriber was negligent or made a mistake.

The bulk of antidepressant and benzodiazepine medications are written by non-psychiatrists, and the average primary care visit is only 8 minutes long. In that time, the physician needs to take a history, make a diagnosis, prescribe treatment, educate the patient, and answer questions.

In that 8 minutes, your client may not have been able to get all their questions answered. Additionally, they may have been too nervous to bring up all their symptoms or simply thought their mental health concerns weren鈥檛 appropriate for their primary care physician.

It鈥檚 also very common for clients to present in very different ways to different professionals.

As a non-prescriber, you may be wondering what you鈥檙e ethically able to tell your clients. What advice are you able to give within the scope of your practice?

Because of our role in our clients鈥 lives, it鈥檚 important to be proactive in speaking with both clients and prescribers. Here are eight ways that we can help clients succeed on their medication.

1. We can help our clients have realistic expectations of their medications.


Many clients may have unrealistic hopes for what their medication will do and how quickly it鈥檒l begin to work. Early conversations with clients to establish their expectations for their medication can help us align them with reality.

Often, clients with depression will say something to the effect of, 鈥淚 don鈥檛 think my medication鈥檚 working. I don鈥檛 feel happy.鈥 My response to this is that there鈥檚 a big difference between feeling not depressed and happy.

This is the metaphor I often use with my clients. Think about the pool noodles that kids like to play with. If you want to get from one side of the pool to the other, that pool noodle isn鈥檛 going to get you all the way there. It鈥檚 going to assist you, and then you still need to figure out where you want to go and what resources you need to get there.

Medications are the same way. They鈥檒l assist and help relieve some symptoms, but they won鈥檛 do everything.

2. We observe or are told about potential side effects that may interfere with compliance.


One barrier that prevents clients from following through on a treatment program is the side effects of their medication. For example, sexual dysfunction is a common side effect of SSRIs.

When I want to give clients information about side effects, I encourage them to speak to their pharmacist. Think of the pharmacist as your healthcare partner. They have so much information about side effects and may even know OTC treatments to address them.

3. We know information clients may be too embarrassed to tell their prescribers.


Trouble affording medication. A history of substance abuse. Sexual dysfunction. These are all issues a client may tell their therapist before their prescriber.

Reasons to withhold information from a prescriber can be complex and varied. A survey done by USA Today found that many clients were too embarrassed, didn鈥檛 want to be lectured, didn鈥檛 think it was the doctor鈥檚 business, or even forgot to mention things during their appointment.

If you learn something that you believe the prescriber should know, this can be the right time to get a release of information (ROI) from your client. To preserve the therapeutic relationship, make sure your client knows what you want to communicate with their provider and why you find it important.

4. We are aware when clients aren鈥檛 taking their medications as prescribed or have stopped.


Prescribers often assume a client is no longer taking their medication when they stop calling in for refills. Because of this, prescribers can be the last to know a client has stopped taking their information.

If you know or suspect a client has stopped taking their medication and you have a release of information, this is important information to pass along.

5. We are on the front line at witnessing the emergence of late-onset side effects.


Some side effects like nausea, heartburn, and insomnia are typically seen early on, but there are side effects that don鈥檛 emerge until much later. Muscle spasms or tardive dyskinesia are examples of late-onset symptoms that show up months later.

Knowing the late-onset symptoms associated with your client鈥檚 medication can help you know what to continue to watch for.

6. We can recognize breakthrough symptoms.


A common breakthrough symptom that can happen with some antidepressants is the depression coming back. It doesn鈥檛 mean that the medication has stopped working, but it is time for the client to check in with their prescriber.

But the prescriber won鈥檛 know that the client is having a breakthrough depression in the first place unless you help your client identify what鈥檚 going on and encourage them to see their provider.

7. We can encourage clients to discuss substance use with prescribers.


Whether it鈥檚 alcohol or other substances, I encourage clients to disclose to prescribers anything they鈥檙e taking that can affect their mood, energy, or body chemistry.

As a clinician, I want to know if a client is feeling less tired because their antidepressant is working or because they鈥檝e doubled down on energy drinks. Are meditation techniques helping reduce their anxiety, or have they starting using marijuana?

8. We can recognize inadequate medication response which may warrant dosage adjustments or augmentation.


You may be wondering how you can recognize this as a non-prescriber, but you can be very helpful because you鈥檙e seeing your clients on a regular basis. Consider using a rating scale to monitor changes in mood, like the Beck Depression Inventory or even a mobile app. Your client can then share this information with their prescriber at follow-up appointments.

Distinguish Yourself as an Expert in Psychopharmacology
The Mental Health Professional's Guide to Psychopharmacology
Dysregulated nervous systems, comorbidities, and tons of therapeutic and psychopharmacological options can interfere with your clients' desired goals. That鈥檚 why it鈥檚 essential that all mental health professionals understand how medications work, their benefits, side effects, and the dangerous reactions associated with them.

In this online course you鈥檒l expand your knowledge of psychopharmacological treatment, take a close look at the ethical decisions of medication use, and learn the non-prescriber鈥檚 role in medication discussions with clients.

Plus, discover a four-step symptoms-based diagnostic method for anxiety, depressive, trauma-related, substance-related, psychotic, and neurodevelopmental disorders.
Meet the Expert:
Kenneth Carter, PhD, ABPP, is a board-certified clinical psychologist and professor of psychology at Oxford College of Emory University in Atlanta, Georgia. Dr. Carter received his MA and PhD in clinical psychology from the University of Michigan in Ann Arbor and a postdoctoral master's degree in clinical psychopharmacology from Fairleigh Dickerson University. Dr. Carter has taught clinical psychopharmacology classes at Emory University since 2005 and has presented highly rated psychopharmacology workshops to clinicians throughout the United States since 2010. Dr. Carter has served as a senior assistant research scientist in the Epidemic Intelligence Service of the Centers for Disease Control and Prevention. He has been a psychotherapist and researcher for more than 20 years, during which time he has garnered awards from the National Institutes of Health, the National Heart, Lung and Blood Institute, and thea University of Michigan. Dr. Carter has presented at numerous conferences and written several books and articles on introductory psychology, neuropsychology and psychopharmacology.

Learn more about their educational products, including upcoming live seminars, by clicking here.

Topic: Psychopharmacology

Tags: Advice | Ethics | How To | Safe Practice | Stress | Success

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