54. Medications for Anxiety and OCD with Jennifer McGlothin, psyNP
Jennifer McGlothin, a psychiatric nurse practitioner and I have an informative conversation on medications for anxiety and OCD
- What is the role of a psychiatric nurse practitioner? Can they prescribe medication for mental health? Are they allowed to diagnose?
- What patients should know when they are starting a new medication or switching medication.
- How long does it take for psychiatric medication to work?
- Managing mental health medications
- The Importance of communication between patient and health professional
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Transcript
Welcome to Hope for Anxiety and OCD Episode 54. I have been wanting for a little while to talk about medication as an option for anxiety and OCD. So that is what we are going to do today. I know that a lot of people have questions about whether or not they should get on medication. Whether they should look at that as an option or whether they should stay away from it.
So hopefully this episode will give you a little bit more information to help you make an informed decision about whether or not you want to pursue that as an option and maybe dispel some myths that people have about medication for mental health conditions. So today on the show I have with me Jennifer McGlothin, who is a Psychiatric Nurse Practitioner at Safe Harbor in Murfreesboro, Tennessee.
Carrie: Welcome to the show.
Jennifer: Thank you so much for inviting me.
Carrie: Tell us a little bit about your background and what you do on a day-to-day basis.
Jennifer: So I have been doing psychiatry since around 2009. I graduated from Vanderbilt with my Masters in Psychiatric Nursing, and I’ve always been in a clinic setting, primarily community mental health until August of 2020, which is when my friend and I opened our own private practice. As far as psychiatric nurse practitioners in the medical world, we’re primary utilize is as medication management, we have the ability to do therapy. But that’s not really where we sort of fall on a day-to-day basis. When I was in a clinic that was my all day, every day was just seeing people back to back doing medication management.
And so August 2020, sort of out of necessity and God’s guidance, my friend and I opened our own private practice with the idea of being able to start to treat patients the way that we knew it needed to happen and to be able to provide a safe setting that they could come in and tell their stories and be heard and get the treatment that they needed.
Now day-to-day is a little bit different because we’re an owner of that, but we still see patients every day, but then that’s just sort of peppered in with administrative stuff of running the business. It sort of depends on the day whether we have new patients or just return patients, some days are telehealth some days are in the office, just kind of, depending on what the patient’s preference is at this point, especially since COVID has kind of changed the face of psychiatry telehealth is utilized a lot more. But our primary role and expertise, I would say probably, is medication management.
Carrie: Okay and I think some people get very confused as well by the terms psychologist, psychiatrist, licensed counselor. And so it’s important for people, sometimes people will contact me and ask me about medication. I’m like, hey, I’m not a medical doctor, that’s not what I do. I don’t have that training. So typically the psychologist is someone with a Ph.D., but they don’t prescribe medication, and psychiatrists or psychiatric nurse practitioners are medication providers. So this is for people who are kind of wondering about some of those titles or maybe confused. I know some of the terms sound similar and so it’s easy to get that confusion there. So I know that even though I’m a therapist, clients will certainly talk with me about medication. Should I get on medication? Should I not? Maybe they’ve had experiences with medication in the past. Maybe it was helpful, not helpful, so forth. And I think it’s understandable. Sometimes people look at anxiety as a physical condition. Some people look at it as a mental health condition and from what you’re seeing, sometimes people may pursue that medication route first.
Whereas others for anxiety, whereas other people may pursue a therapeutic route. First, I would imagine that you have some people that come in there that are being seen for anxiety, but then you start to ask more questions and identify that what they’re really dealing with is OCD. Can you tell us about that?
Jennifer: It depends. It really runs the gamut, whether they, when they come in to see us. Sometimes, they’re treatment-naive, which means that they’ve never seen a mental health professional before, or sometimes they’ve been doing mental health for 20 years. And once you start asking questions, we are asking questions about all disorders really. So we’re asking about depression. We’re asking about bipolar disorder. We’re asking about anger. We’re talking about sleep and appetite. We’re really looking for, what could the potential diagnoses be? Sometimes OCD will come out as a potential diagnosis because there are a lot of aspects of OCD that people don’t necessarily associate with it because it’s not as well known.
So typically when people think about OCD, they may think about the money who washes their hands a lot, or they may think about somebody who puts things in a certain order. Do things by color. One of probably the lesser-known forms would be really common, intrusive thought that they’re going to do something that’s completely outside of their personality and fear that they’re going to do it. So the fear that I’m going to drive my car off the road, even though there’s no desire to do that, they would never do that because they don’t want to hurt themselves. They don’t want to hurt anyone else. But the idea pops into their head that like I’m might do that. Or an idea of maybe I did something that I don’t know about is something I’ll hear a lot. I think that I turned off the stove, but maybe I didn’t actually do it. What if I thought that I said this to my child actually didn’t it, it will be this sort of questioning of themselves. The more that we’ll talk about that it will really kind of move more into the OCD realm.
What that does is it will sort of just change your treatment perspective a little bit, as far as what you’re going to do in medicine and therapy, then it becomes talking about really what OCD can look like. And it makes sense that people who are in a high state of whether it’s anxiety or OCD, they’re dealing with some distress and may have hesitancy about it taking medication.
Carrie: What do you tell your patients who are concerned about starting a new medication or switching medication? Because the last one wasn’t helpful for them.
Jennifer: The very first thing that’s most important for any patient is that, and it’s not always conveyed this way, but I think this is super important for anyone to know is that it’s always their choice. So no matter what the provider says, it’s ultimately their choice at the end of the day. Because when you leave that room, the patient is the one who’s taking the medicine and the patient’s the one who’s going home with it. When you’re coming to see me, for instance, I’m giving you my opinion about what I think is best, but ultimately it’s your choice.
I think a lot of times in medical situations, people can feel kind of powerless and they feel like they have to listen to exactly what the provider says. And sometimes it is good to do that, but if you don’t feel comfortable with the situation, then you don’t have to go along with that. So I think the first important thing is to know it’s always in your court and then also be really educated on what is the purpose of the medicine and that the idea is to make things better. If the medicine you’re taking now is not making things better then we probably need to make a change, really talking about what’s the goal. What do you want? What would make things feel more manageable to you? What would that look like? Then figuring out how do we get there? When they’re anxious about that, you have to really break it down into, we’re just wanting to improve things. This is why this is how, and sometimes I think that education and knowing that ultimately they have the final say is really helpful for people.
Carrie: This is really huge. I think that we don’t emphasize enough, like empowering people to make the health choices that are best for them. Yes. There are experts who can say, hey, these are the medications that are commonly prescribed. Here are the side effects. We believe that in prescribing this medication, the benefits for you are going to outweigh the side effects, but ultimately you have to weigh that option and everything is a potential risk. Empowering people is so key in that. And I liked what you said about it, just ultimately it being your choice.
Sometimes I’ll have people in therapy who want to try therapy first before they try medication. I always tell people I’ll work with, whether you’re on medication or not, it’s not really a big deal for me, but it’s interesting because sometimes we’ll circle back around to that medication conversation after they’ve been in therapy for six months or so. And they’re not seeing the progress that they’d like to see, then I’d say, okay, can we circle back around to this wagon? And can we evaluate this as an option? Will you go talk with someone and just see what your options are? What they think might be helpful for you. And I know that oftentimes people are started on a lower dose of medication, just to make sure that their system is going to handle it well.
Jennifer: One of the things that I’ll talk about when somebody comes in and they’ve never been medicated before, or they’re just coming in because they’re not really sure what needs to happen. And it’s not a very clear-cut case of like, we absolutely need to do something today. Sometimes when I ask the person, okay, do you think you need medicine? Do you feel like this is really impairing your function? And sometimes they’ll say, yeah, I think so. When it’s like, okay, well, I’m willing to give that a try, and sometimes they’ll say, I mean, I think I could do therapy for a little while first and like, I’m okay with that too. So let’s go that route and that kind of, once again goes back to making the decision, but I want to know what’s their opinion. How do they feel like their functioning is affected by the symptoms that they’re experiencing, being able to hear that is really helpful sometimes. And then, when you’re in school, one of the slogans that you’re taught about medicine to start is to start low and go slow. So that is basically just trying to minimize the amount of side effects that someone experiences. Sometimes that, unfortunately, means that they’re not gonna see the efficacy as early as you would hope.
In other words, they’re not going to stay, their symptoms decrease as fast as you would like to stay, because symptoms are too high to match the low dose that they’ve been started on. But then you get into a situation where if you start them on a higher dose, they’re going to have a lot of stomachs upset or they’re going to be too sleepy and they’re not going to be able to get up the next day and then that side effect is not going to be tolerable. So then they’re going to stop the medicine anyway. So once again, it goes back to that balance of trying to, I use a seesaw a lot as like a, not a visual, but to kind of explain that we’re trying to balance the seesaw. It goes back to that idea of trying to balance that risk-benefit, balance that out.
And I think that piece is another thing that’s super important for people to understand is what’s the timeframe that I’m going to start to see a difference, because if they’re expecting that they’re going to see a difference in a week, but the reality is four to six weeks. And they’re not told that it’s going to be hard for them to maybe stick with the medicine. And so it’s really important for people to know what we are looking at? What’s the timeframe? When should we start to see a difference? Are we going to see a difference in this dose? If symptoms are really high right now, and obviously not all of that, a hundred percent predictable, but you can give them an idea of what you would maybe hope to see, kind of give them a little bit of a window in.
Carrie: Those are some great points that you made in terms of having to increase dosages at times because people aren’t at a therapeutic dose. Sometimes people end up dropping out and stop taking the medication without talking to their provider. That’s one thing that just drives me a little bit bad. I’m like, no, if you’re not happy or you don’t feel like you’re getting what you need, you go back to that person and you explain, hey, I’m not seeing the results I’m wanting, or I’m having these side effects or there are always different things that can be done or like you just said, they may tell you, okay, well, we’re going to increase your dosage because it doesn’t look like you’re at the therapeutic level or you need to stay on it for sometimes four to six weeks to see the full results from it. I think sometimes people go into the doctor’s office and they’re not always hearing or receiving all the information that they need because they’re distressed. Right.
And so it’s hard to remember everything that was said and the guidance that was given. So if I could tell, make any recommendations to people it’s please don’t stop your medication. Please stick with it, call your provider, talk with them because some of these medications, it’s really not good for you to stop suddenly.
Jennifer: I also, unfortunately, think that the education piece for patients is not always there. Sometimes they’re not always getting everything they need to get as far as what are the side effects? How long should I wait? Like it’s more just, here’s the prescription first Alexa, 20 milligrams, I’ll see you in two months and that is no information whatsoever. And that is completely on us as a provider. And that drives me nuts because it’s like, it’s so important to me, for my patients to know why they’re taking, why they’re taking it, what it does because I want them to be educated about it because they’re part of the treatment team.
Carrie: It was important for people not to see, I think, any medication really as a miracle cure. And I think sometimes people go into taking psychiatric medication, whether it’s for anxiety, OCD, depression, or something else. And they think, okay, well, I’m just going to take this medicine. It’s going to solve all my problems and similar to, if you put somebody on a blood pressure medication for high blood pressure, you wouldn’t just say, well, just take this medication you want also for them to make some lifestyle changes that would support what that medication is working on.So talk with us a little bit about that too.
Jennifer: I use diabetes as an example. A lot of the time I will say, this is very similar. So like someone with diabetes, they take their insulin, but then they also check their blood sugar and they exercise and they have to watch what they eat. It’s a combination. And so that’s when we talk about that. The best results come from a combination of medicine and therapy and that medicine is just one tool in the toolbox. It is not the end. All be all, and medicine can help you cope, but it doesn’t teach you how to. And super important for people to know that you have to learn the coping skills medicine can help lower your anxiety, but life circumstances, there’s gonna be times that anxiety is going to spike and you need to know what to do when that happens and medicine doesn’t teach you that. So that’s where that other piece of the puzzle comes in. Whether that’s a therapist you’re seeing your past, or you’re seeing you’re doing a workbook at home, whatever it is that you’re doing something to learn what to do in those other moments, because it’s not a matter of if it’s going to happen. It’s a matter of when. And so we have to plan ahead for that.
Carrie: What different types of medication would you say are commonly prescribed for anxiety or OCD?
Jennifer: For both of those really it’s antidepressant and anti-depressants are first-line treatment for anxiety. And so I’ll have a lot of people come in and there may be already on a medicine that came from primary care and they’ll say, well, I have anxiety and they put me on this antidepressant and I’ll say, well, that’s actually appropriate because the antidepressants are first-line treatment for anxiety. The five medicines that are FDA approved for OCD are actually all antidepressants. The most common medicine probably used in OCD specifically is probably Prozac. There are four others after that, that are sort of used in varying order.
There are some medicines for anxiety that can just be used as needed that we like in our practice. We use an antihistamine sometimes that’s as needed. There are actually a couple of blood pressure medicines that we use as needed for anxiety. Providers will use benzodiazepine for anxiety that is not favored where we are, because those are very addictive medicines and they actually make anxiety worse in the long run and they call short and long-term memory loss.
There’s links to dementia. It will fix it quickly in the moment when you’re having an anxiety bite, but long-term, it’s going to make things worse for you. And so that’s something that we in our practice avoid because it’s not fixing the problem. So when you’re looking at an antidepressant for anxiety, what that’s actually doing is it’s adjusting the brain chemistry. All of the ones. When we look at anxiety and OCD, because of course the OCD is an anxiety disorder that all targets serotonin in some way or another. They’re adjusting the levels of serotonin in the brain. So we’re actually changing the brain chemistry, ideally back to where it needs to be. So kind of a way I sort of describe that to someone as like the thermostat is stuck and we’re trying to race that we’re trying to sort of teach the brain how to relearn the patterns for which chemicals need to be there and what capacity.
Another important thing I think if it’s just anxiety and especially if someone’s in therapy, is that medicine doesn’t necessarily have to be forever. It’s something that until you can build the coping skills to learn how to manage most situations. And we have sort of put unquote, retrain the brain for what chemicals need to be there and what capacity for long enough, then you can try to come off of the medicine potential and do it on your own. OCD is not necessarily doesn’t fall into that category so much. That’s more of something that’s managed, like someone who has diabetes, that’s just managed throughout the year. But for some disorders, our goal was to try to fix it at the beginning. So it’s not a lifelong thing.
And I think that’s a common misconception too sometimes is that you want to put me on medicine and just keep me on it forever. Not necessarily, we could potentially fix this problem now so that it’s not a problem for it. And it’s dependent on different things as far as what episode they’re in and how long they’ve been on meds and there’s varying factors. But I think a lot of people don’t know that that’s a possibility.
Carrie: I think that’s a really great point that you bring up. One of the common concerns that people have is whether I’m going to become addicted to this medication somehow dependent on it and I’m not ever going to be able to come off of it. So from what you were just saying, these first line of defense medications, the anti-depressant. People aren’t going to become addicted or dependent on those, right?
Jennifer: Not at all. No, they do not have any addictive properties whatsoever. I think sometimes what people might get confused about would be to say that if you forget to take your medicine one day, you might feel kind of bad. Like you might have a headache or you might have a stomach ache, but that is just simply your body reacting to not having something that it had every single day, but that’s not a quote unquote withdrawal effect. There’s a difference in that.
You have to be able to, to know that like, if you come off of these medicines and anti-depressant specifically, you’re not going to go into a physical withdrawal. There are some that are more difficult to come off and others, but if your provider knows how to appropriately taper you down, it minimizes what we call discontinuation side effects. Just knowing how to do that is important. And obviously the provider communicating how to get off of it is important.
Carrie: Right? So that people can do that safely and effectively.
Jennifer: If you just stop your medicine suddenly you are probably going to have side effects because you’re going from a hundred percent to zero. All of a sudden your body is probably going to react very negatively to that.
Carrie: What should people look for in terms of choosing a psychiatrist or a psychiatric nurse practitioner?
Jennifer: The ultimate goal is somebody they feel comfortable with is important. I think to have the ability to have an open dialogue, to express concerns about your medicine at our clinic. Like we are a team and it’s a delicate balance to figure out what the correct path is. And if my patient feels like they can’t tell me that their medicine’s not working or that they’re having a side effect, or they feel like I’m going to get upset about that. It’s the relationship that needs a little bit of work because that’s not what we’re there for. Like if someone comes back and they tell me they stopped their medicine, sometimes they’ll say, they’ll come in and they’ll say, you’re going to be so upset with me. I just stopped my medicine over the weekend. And it’s like, I’m not upset with it. That was your choice. I’m sure it wasn’t probably didn’t feel very good.
So let’s just figure out what we’re going to do next and be able to have that open conversation without judgment and figure out what the best path is. I think I hear a lot of times stories where patients feel like they’re unheard and they just keep taking meds when they feel they’re not working for whatever reason, that’s not a good situation either. I think it’s also important for somebody to have humility because I’m not too proud to break out my books and look something up or to call somebody or to figure out. Because you just can’t know everything. You have to know what your limits are and you have to be willing to research something or to know when it’s time for you to call in somebody else. And if you have a provider who doesn’t do that, I think that’s hard for you, maybe to build a relationship sometimes.
Carrie: I think what you’re saying is really true of any medical professional that you work with. You want to feel heard, you want to feel understood. You want to feel like, okay, this person has a plan. They’re offering me some guidance and not just guidance, but really some education on, instead of just here, take this medicine. Really providing some good education on the medication, why they think that would be a good medication for you and with the symptoms that you’re dealing with, what the potential for side effects are when they might see those wear off, so forth and so on. I think that it’s huge to understand that we have to be our own best advocate when we’re going into these situations, because we have to be able to communicate what’s going on in our own body. And sometimes people have a hard time with that. I think really communicating what has been going on with them
Jennifer: Because it makes it difficult. Sometimes if the patient is not telling everything because they don’t feel comfortable for whatever reason, then as a provider, if we don’t know the whole story, then we can’t adequately treat. I think a lot of times we don’t maybe get the whole story because of fear of judgment or shame or whatever. But I know in our practice, that’s not our job. Our job is not to judge or to guilt someone or to shame them. Our job is to figure out, okay, how do we move forward? How do we get back? Let’s figure out what our best plan is, but you can’t do that. If you’re not comfortable enough to share what’s going on, really got to find somebody that you can build that relationship with.
Carrie: Awesome. So as we’re getting towards the end of our podcast, I like to ask our guests to share a story of hope, which is a time in which you received hope from God or another person.
Jennifer: I think for me, probably one of the most hopeful things was sort of born out of something really traumatic in 2009. 10 days after I got married, I had a very traumatic car accident and we spent our first month of married life in the hospital. And I was in a wheelchair for like three, nine specific three months until I could walk again. And just with the amount of prayers and people coming by and my sweet husband’s help driving me back and forth to the doctor, changing stuff at our house, like going to work and then coming back and picking me up and taking me to physical therapy.
And I was able to walk a month earlier and basically made what would be considered pretty much a full recovery. Over 10 years later, no real complications and have been able to sometimes use that story for people who have had something really traumatic physically happen to them. And they’re in that moment of why, what am I going to do? This is terrible and being able to say things like, listen, you can come out the other side of this, like I know right now it does not feel like that, but if you put your faith in Him, you can come out the other side of this and being able to use that sometimes in my practice.
Carrie: That is really encouraging and hopeful because when you’re in that, the middle of that situation going okay, what am I going to be able to walk? When am I going to be able to do things for myself?
Jennifer: Normal stuff. Yeah.
Carrie: That must’ve been a very hard situation. Thank you so much for coming on and sharing your wisdom about medication. We’re going to put the information in the show notes for a safe Harbor in Murphysboro, and they also have telehealth appointments. So if you’re in Tennessee or in the area at all and are looking for a new provider, now they know a little bit more about you.
Jennifer: Yes, we are accepting new patients. So give us a call.
Carrie: Awesome.
Jennifer: Thank you so much for having me.
Carrie: You’re welcome.
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I hope that you found this interview valuable and helpful. I wanted to give you a quick update on our subscription service for the podcast. There have been just so many struggles and challenges as I’ve sought to do this in our original. I saw that we were going to be able to have a good monthly subscription service on the website, buy me a coffee that I had been using for people to give to the show who wanted to give and what I realized as I got further into the functionality. That I wasn’t able to share all of the audio files and different things that I wanted to be able to do on that website. So I’ve actually created a Patrion page that we’ll put in the show notes for Hope for Anxiety and OCD. If you’re not familiar with Patrion, it’s a website for podcasters and other creators to go on.
And it gives the opportunity for people to be able to support what you’re doing with a monthly gift that we have a smaller, monthly amount that you can give. If you just want to help support our editing efforts and help pay for our assistant to do social media, reach out to guests and so forth. If you’re looking for a little bit more self-help materials, I created a higher tier on Patrion for those of you who are listening to the show, but just feel like you want more content and more information. We’re going to have monthly question and answer times. I’m sharing some thought hush audio on there for dealing with difficult thoughts, whether you have anxiety or OCD, just very practical strategies, audio that you can listen to you exercises that you can go back in and practice over and over and over again until you feel like you become better at managing the anxiety and OCD that you’re experiencing.
So that’s something that’s of interest to you. You certainly can hop on for a month or two, try it out if you don’t like it, and you can cancel it at any time. If you do happen to hop on and try it out, I would love to hear what you think. And if some of those things are helpful and as well as if there’s any ways that we can make improvements to that subscription service, because I definitely want it to be of value to you. We’ll leave that link in the show notes, if you’re interested and thank you so much for listening.
Hope for Anxiety and OCD is a production of by the local counseling in Smyrna, Tennessee. Our original music is by Brandon Mangrum. Until next time may you be comforted by God’s great love for you.
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