Letting your providers know when a medicine is working or if you feel like it is causing side effects are essential to getting you to the right treatment as soon as possible.
Since these medicines take so long to work, some folks may stop because they think they are not effective. Do not do this. When you stop taking them or miss doses, the clock starts over and it may take even longer to reach effectiveness.
Now more than ever, many of us are grappling with maintaining our mental health. Whether it is daily life, what you see in the news, or anything else going on, it is important to understand our mental health and the impact all these things can have on it. Living with HIV can pose challenges and raise some questions about how to be the best advocate for yourself and your well-being.
As a psychiatric pharmacist, I have specialty training to better understand the ins and outs of medication to help people with their mental health. I also have the privilege to work a couple days each week with people living with HIV, which has helped me better understand some of the unique challenges they face. Below are some questions patients often ask about their mental health and their medicine that you may be wondering as well.
What impact does not take care of my mental health have on my HIV management?
Short answer, a lot. A diagnosis of HIV can be life-changing, which may lead to symptoms of different mental health diagnoses, like depression or anxiety. It’s important to reach out for help if you are feeling more sad or worried than usual. Help can come in many forms, from talking with a trusted friend or a healthcare provider to going to a therapist or taking medicine. If you find yourself currently in crisis, like feeling as though you may want to attempt suicide, it’s best to go to the nearest emergency room, reach out to your doctor, or use national hotlines like the Suicide Prevention Hotline at 800-273-TALK (8255). Uncontrolled mental health problems can lead to people not taking their HIV medicines consistently, which may cause detectable virus levels, make you more likely to catch other illnesses (from the common cold to opportunistic infections), and overall decrease the control you have over HIV.
Taking medicine has become a habit for managing my HIV, and I know how important it is to stay undetectable. Now my provider wants to start me on a medicine for my mental health.
Is that okay?
Medicine is also an important tool in the treatment toolbox for someone living with mental illness. Given the importance of HIV medicine to getting to undetectable, it’s important to make sure there are not any problems like drug interactions with your new medicine. HIV medicines and medicine for mental health can be broken down or used by the body in similar ways, which can lead to one or both medicines not working as well, causing more side effects, or sometimes both. It is best to make a habit of telling all your providers and pharmacists about all the medicine you take, including ones you buy over-the-counter, and asking them to be sure they are accounting for any potential issues.
Having medicines that interact sounds a little scary and I am not sure how I feel about that. How serious can these interactions be?
It is good to always ask these kinds of questions because some interactions are serious and should be avoided. Basically, they can fall anywhere on a scale of how severe they are and what kinds of effects they may cause. Some medications may cause your HIV medicine to not work as well, either through increasing how fast your body processes it or by blocking it from getting where it needs to be in order to work. These are best avoided.
However, some interactions may not be as severe. For example, a few antidepressants can have their metabolism slowed down by HIV medicines. When that happens it may lead to more side effects. But, in those cases we start with lower doses and increase those doses much more slowly to make sure the medicine does not cause any problems. Or if it does cause a problem, we can address it sooner. Regardless, as a patient, letting your providers know when a medicine is working or if you feel like it is causing side effects are essential to getting you to the right treatment as soon as possible.
What should I expect if I start taking medicine for my mental health?
Most medicines for mental health take some time to work. That is often not what someone wants to hear because they feel bad now. I would give anything to have a medicine that could work instantly, but until then, it is best to stay informed.
As an example, antidepressants may take six to twelve weeks to relieve all your symptoms. During that time, you may experience some improvement, but it is likely to take a while to feel at your best.
There also may be a need to try different medicines. Since each person is unique, it is difficult, if not impossible, to predict how each of us may respond. So long as you are not having intolerable side effects, what is important during this time is to keep taking your medicine. You may have heard it before, but a medicine you never take never has a chance to work. And since these medicines take so long to work, some folks may stop because they think they are not effective. Do not do this. When you stop taking them or miss doses, the clock starts over and it may take even longer to reach effectiveness. Things that may help during this period would be trying therapy or engaging in healthy coping habits (art, exercise, etc.) to bridge the gap, which can always be helpful with or without medicine.
Speaking of coping, some days I just need something to drink when the day is finished. Can I still do this if I start medicine for my mental health?
Generally, alcohol or other drugs are not recommended to take with prescription medicines, especially medicines for mental health. A side effect of some medicines for mental health can be that they may lead to not being able to sleep as well. Alcohol, for example, contrary to popular belief, actually worsens peoples’ sleep cycles. So, combining them may worsen a side effect of a medicine or worsen a symptom of your diagnosis.
Medicine aside, alcohol and other drugs can worsen mental health problems. From causing mood changes to worsened depression symptoms, it is best to avoid using alcohol and drugs for your overall mental well-being.
Additionally, some combinations of medicines with alcohol or other substances can lead to overdoses and can be lethal. If you do decide to drink or use a substance, be honest with your provider or pharmacist about it. The more we know, the better we are able to care for you. It may be scary to think about admitting to doing something you think others will think is “wrong,” but by being honest and open, we can better find treatment that best fits you.
I have started a medicine for my mental health, now what?
Great. Having that initial conversation and reaching out for help can be really difficult, so you should be proud of yourself.
A lot of people wonder if they will be on medicine for their mental health for a long time, or even for the rest of their life. It really depends. One, it can depend on your specific diagnosis. Some mental health diagnoses do require long-term treatment with medicine, sometimes years up to the rest of their life. Others can be more short term. For example, if you are currently going through a stressful time in your life and you and your provider discuss and agree to try medicine, you may only need to take it for a short period of time, maybe just a few months. An open discussion with your provider will help you both settle on the best course for you.
Taking medicine is something that should not be taken lightly, but it is a central piece of helping you feel better in many cases. First and foremost, safety is very important. This article may leave you with still unanswered questions, or questions that are more specific to you. Your doctors, pharmacists, nurses, and other healthcare providers can give you important information about your specific medicine and what to keep an eye out for. But do not forget, you are your own best advocate. Having open communication with your providers can help us work with you to find the best medicine and treatment for you.
Jacob Peters, PharmD, BCPP, BCPS, is a Clinical Pharmacy Specialist in Psychiatry for Indiana University Health – Methodist Hospital in Indianapolis.