Medication: Making Decisions and Truly Informed Consent

This is the real life experience of a family member of mine. I’ll call him John, and he okayed sharing his story. I hope that his story, combined with ours, will help you make decisions about medication with truly informed consent.

A few years ago, John was involved in a serious accident that almost took his life and then left him permanently disabled, dealing with chronic pain and PTSD. He is also a veteran, who survived combat duty, and has spent the majority of his life in one form or another in service to the country.

During recovery from the accident, John was prescribed a rather copious amount of various pharmaceuticals, which, after long-term use, started having terrible side effects on his mind, body, spirit, and on the rest of his life and his relationships. Chaos ensued. So, he made a decision, when he was not in the most coherent frame of mind.

He quit taking the meds cold-turkey – a decision that had consequences.

While the medications that John was taking were not specifically psychotropic, I’m bringing it up because whenever meds are involved, it’s important to have the facts. His is a cautionary tale.

If professionals are suggesting medications, here are several considerations.

My daughter has been on psychotropic medications for a decade. She may have to stay on them (an antidepressant and a mood stabilizer) for a long time to come. Or not. We–and by we I mean us, her parents, my daughter herself, and the mental health system–simply do not have enough information about long term medication use and our teens and young adults.

The meds did what they were designed to do, but we wonder. Has her young brain been altered permanently? If so, how? To what effect? What other effects may have happened in her body? Because medications don’t only “hit” the intended “target.”

About the only thing I know for sure is that if she decides she wants to taper off of them, a knowledgeable medical professional must be involved and willing to take the process slowly and deliberately.

If you are being asked to consider medication for your teen (or yourself), or are thinking about titrating down, or helping a loved one do so, please have detailed discussions with the prescribing psychiatrist. (See below for a list of questions to ask.)

Do not undertake the process without medical support.

Informed consent is an important part of treatment. Right now, we usually glance at a piece of paper thrust in our face and sign it. That document covers the prescribing doctor’s butt, yes, but there’s a larger overarching point. Most prescribed drugs are powerful, and the decision to include them in treatment protocol should not be taken lightly, considered a “given,” or done in haste.

And remember, many meds are not inherently supposed to be taken for forever. Yes. There are certain diagnoses that will likely require lifetime use. Ask your professional, at regular intervals, if it’s appropriate for dosages to be reduced. Maybe it will not be advisable. But maybe it will.

The idea that persons taking mental health medication will need them for the rest of their lives without question is an idea whose time must end.

Hyperbolic tapering, introduced by Dr. Mark Horowitz in 2019, offers an alternative to the traditional linear tapering method for discontinuing antidepressants.

Make sure both you and the prescriber are aware of hyperbolic tapering – here’s more on this topic.

Psychotropic medications affect brain chemistry in complex ways, and their proper use requires an in-depth understanding of mental health disorders, medication mechanisms, and potential side effects. Specialists, such as psychiatrists or psychiatric nurse practitioners, are trained to evaluate each individual’s unique needs, monitor for adverse reactions, and adjust dosages or medication types as necessary.

They also consider factors like co-occurring conditions, other prescriptions, and lifestyle when crafting a treatment plan, reducing the risk of complications or ineffective treatment. Additionally, specialized providers stay updated on the latest research and advancements, so that patients receive evidence-based care tailored to their mental health journey. This expertise not only maximizes the benefits of the medicine but also minimizes risks, supporting overall well-being and recovery.

Understanding the bio-chemical mechanisms of the drug can give insight into why it’s being prescribed and help set expectations around how it will help manage symptoms.

This clarifies the typical side effects to expect, which ones may be temporary, and which might persist, helping you weigh potential pros and cons.

Psychotropic meds often work gradually. Knowing the timeline and signs of effectiveness helps you and your psychiatrist monitor progress effectively.

Some medications have effects that emerge only with long-term use, so it’s helpful to understand any potential risks and benefits over an extended period.

Understanding interactions can be crucial for both safety and effectiveness, particularly if you have other medications, health routines, or dietary habits.

This question helps you understand the signs or criteria that could indicate a readiness to reduce dosage and gauges your psychiatrist’s knowledge of hyperbolic tapering—a gradual reduction method designed to minimize withdrawal symptoms by lowering the dose more slowly at the end of the taper.

If a doctor prescribes psychotropic medication without thoroughly assessing your loved one’s symptoms, reviewing the history, or providing a clear diagnosis. A lack of discussion about potential side effects is also cause for concern. A good provider should clearly explain the risks and benefits of any medication, ensuring you know what to expect and what to monitor. And, resistance to collaboration or dismissiveness when you ask questions is another warning sign. Trustworthy providers should prioritize open communication and value your input in decisions about your care.

The video below is interesting, because it is directed at nurses who have specific duties relative to informed consent (about anything, not just medications.) So while it is, in part, specific to psychiatric situations, it is a potent reminder of the team approach. It’s good to know who is responsible for what.