In my community there is a huge need for mental health services and not enough providers to meet these needs and so by default, these patients get seen in primary care settings. NPs in primary care need to be current with psych meds. Many patients come to us first with depression, anxiety, sleep disturbances, loss of interest in life, and changes in eating patterns. They are looking to us for help. How do you evaluate these patients? Who should you treat and with what? What kind of followup do they need? When should you refer?
What about the patients who come to you already taking medications for their mental health? Are they appropriate medications? Are they safe? Effective? How do you titrate, taper or discontinue these medications? Are you comfortable with the responsibility you have managing them?
So, what should you do to feel more confident about treating mental health issues? First, develop rapport with your patient. Get to know them and let them get to know and trust you. This can take time but plays a large role in how effective you can evaluate and manage your patient. Remember to do a thorough medical evaluation first. Here's an example of why this is so important. I had a patient who had gone to anther provider, said she was depressed and was given and SSRI without much of a work up. She wasn't much better after 9 months and I was seeing her for a gyn issue. I ordered a TSH which was 50. Once I treated her hypothyroidism, her depression went away. Surprisingly, she had few other symptoms classic of hypothroidism other than fatigue and "depression". Her weight gain had been attributed to being a side effect of the SSRI. So don't forget the basics.
Gain confidence in managing these patients. Take CE courses on mental health at conferences. Learn about these classes of drugs. Find a colleague to consult with, preferably a mental health specialist or another NP, MD, PA or pharmacist, that can help answer your questions. Get a quality medication guide that you can keep handy in your clinical setting to refer to. Identify the referral sources in your community to refer patients, to as needed. Be sure to communicate with your patient's therapist.
Many mental health issues are challenging for not only the patient and their family but also for the provider. Early intervention with effective and appropriate tools both pharmacological and nonpharmacological can enhance your patients' lives and is part of providing comprehensive primary care.
To furtherehelp you, we've just launched an online program for 2 CE with 2 hrs of pharmacology content called Neuropsychopharmacology Across the Lifespan to help you gain confidence and expertise in prescribing and managing these medications in primary care practices.
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