Psychiatric Medication Second Opinions

A medication second opinion is a focused consultation for people who are unsure whether their current treatment is right. It can help when medications have not worked, side effects are hard to tolerate, several medications have accumulated over time, or the diagnosis itself is in question. It is a fresh look at the whole picture, not a judgment of your current prescriber.

How our physicians help

Our physicians carefully review your diagnosis, symptoms, medical history, and each medication you have tried, including how it helped and what side effects it caused. We also look for factors that may have been missed, such as sleep problems, medical conditions, or substance use. With your permission, we coordinate with your current prescriber and share clear recommendations, which may mean adjusting, simplifying, or keeping your current plan.

Signs a second look could help

• The benefit you noticed early on has worn off.
• You were given one medication to manage the side effects of another.
• You feel flat, foggy, or unlike yourself, and you are not sure why.
• You have been on the same plan for years, and no one has asked if you still need all of it.
• Your life has changed, such as planning a pregnancy or a new medical condition.

Why a medication may seem not to work

Before deciding a medication did not work, we ask if it had a fair chance. We look at how long you took it, how much you could tolerate, and whether doses were missed for any reason. There is no blame in these questions.

• The diagnosis may need another look. Bipolar disorder can look like depression for years, and ADHD, trauma, and anxiety can resemble one another.
• A symptom may be a side effect. Restlessness, poor sleep, or emotional numbness can come from a medication as well as the condition.
• Something else may interfere, such as another prescription, a supplement, alcohol, or cannabis.
• A medical problem may add to symptoms. Thyroid disease and sleep apnea can both cause fatigue and low mood.

What can come out of a review

Sometimes the best answer is that your current plan makes sense. Other times, we may suggest options for you and your prescriber to consider.

• Giving a current medication more time, or adjusting it under your prescriber's care.
• Simplifying a long list of medications, one careful step at a time.
• Trying a different class of medication, such as another type of antidepressant or a mood stabilizer.
• Adding psychotherapy, such as cognitive behavioral therapy (CBT), which teaches skills medication cannot.
• Looking into care we do not provide, such as brain stimulation treatments (TMS or ECT), ketamine treatment, or neuropsychological testing of memory and thinking. We can coordinate referrals.

Second opinions for children and teens

Young people change quickly. A plan that fit at nine may not fit at fourteen. We look at growth, appetite, sleep, mood, and school, and we listen to the child or teen as well as the parents. We also look closely at any antidepressant, since these carry a warning about suicidal thoughts in young people, especially when one is started or the dose changes.

Keeping changes safe, and when not to wait

Our recommendations are advice for you and your prescriber to weigh together. Please talk with your prescriber before you act on them, even if a suggestion seems simple. Even a sound plan can take some trial and error, and no medication helps everyone.

A second opinion is for questions that can wait a little. If a medication seems to be causing a severe reaction, contact your prescriber right away, or call 911 if it feels life-threatening. If your mood has dropped sharply, or you are having thoughts of suicide or self-harm, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service.

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