Client, counselor prescriber Counselors can serve as an important link between clients and the medical professionals who prescribe them antidepressants
R oughly one in 10 Americans over the age of 11 takes .antidepressant medication,
according to data released this past fall by the Centers for Disease Control and Prevention. Antidepressants are the third most common prescription taken by Americans of all ages and the most common among Americans ages 18-44. The rise in popularity of antidepressants has been meteoric in recent decades. Since 1988, the rate of antidepressant use nationwide among all ages increased almost 400 percent.
These data, collected as part of the National Health and Nutrition Examination Surveys between 2005 and 2008, don’t surprise Dixie Meyer. In fact, they further support the message she tries to share with counselors: You need to know about the antidepressants your clients are taking.
Antidepressants, which are prescribed not just for depression but also for anxiety disorders, pain disorders, learning disabilities and more, are the medication most requested by patients, says Meyer, an assistant professor in the Department of Counseling and Family Therapy at St. Louis University and a member of the American Counseling Association. She notes that primary care physicians prescribe the majority of antidepressants. “This suggests that a large portion of our clients on antidepressants sought out the medication without knowledge of why individuals need medications, and in most cases, an expert on psychotropic medications did not prescribe the medications,” says Meyer, who teaches psychopharmacology and has been researching the topic since 2007. “While counselors are not experts on antidepressants either, counselors need
By Lynne Shailcross
to understand when their clients may need to have the medication reassessed or when the counselor may need to meet with the medication prescriber.”
Elisabeth Bennett, chair of the Department of Counselor Education at Gonzaga University, says even though counselors are not prescribing the medications, they are in a prime position to assist clients who are taking antidepressants. “Medical professionals see their psychiatric patients an average of about eight minutes each … three to four meetings per year. This is not enough time to do all the tasks they must do, let alone to build a relationship [with the patient, which] is likely the most critical element contributing to successful compliance and treatment,” says Bennett, an ACA member who also works as a counselor in private practice and has researched, taught and presented on neuropsychology and psychopharmacology.
Counselors, on the other hand, see their clients two to four times per month for an average of 50 minutes per session, Bennett says. When counselors understand what an antidepressant is meant to do and what side effects it may cause, they can better prepare their clients to follow the regimen prescribed by the medical professional, she says. Counselors can also help prepare clients to note negative side effects that might need immediate attention, note when the medication is effective or when there are breakthrough symptoms, and to otherwise gain the most benefit while experiencing the least harm.
A second set of eyes Meyer echoes Bennett, noting that
the regular interaction counselors have with their clients positions them to help
38 I Counseling Today | July 2012
with management of antidepressant medications and, in some cases, to act as the liaison between clients and the prescribing doctor. To play that role effectively, however, Meyer emphasizes that counselors must educate themselves about antidepressants. “It is important for counselors to be knowledgeable about potential side effects of antidepressants, the empirical support for antidepressants and how antidepressants work, including how they alter neurochemistry,” she says. “Counselors also need to understand the neurochemical differences of depressive symptoms and how to monitor symptom improvement when clients are taking antidepressants. This is especially important when clients think their antidepressant is not working.”
Bennett points out that the liability and authority for all elements of a medical regimen remain with the prescribing physician but says counselors can be of great value to clients by educating them about the medications and the regimens that doctors prescribe. “Oft:en, the time limitations of the doctor make such educational sessions rushed, and the counselor can supplement at a time when the client is better able to understand, thus increasing compliance,” she says. Among the topics Bennett suggests that counselors consider discussing with these clients:
• How antidepressant medications work
• Why complying with the regimen is critical
• How long it takes to reach therapeutic windows (when enough medication is in the bloodstream to be effective)
• Potential side effects that might arise
• Which side effects to be concerned about and which to endure
• How to talk with the prescribing doctor about symptoms
Meyer encourages counselors to stay alert to the side effects their clients are experiencing. If the side effects appear to be getting out of hand, Meyer suggests talking with the client and perhaps encouraging him or her to ask the prescribing physician to reassess the medication or dosage. Sometimes, too many side effects mean the dosage of the antidepressant is too high, Meyer says. “Other side effects may lead a physician to prescribe an additional medication to alleviate the unwanted effect,” she says. “For example, for individuals experiencing sexual side effects [such as] lack of desire, a physician may prescribe Wellbutrin, which has been shown to help with unwanted sexual side effects.”
The counselor’s role in medication monitoring is to check in weekly with the client, Meyer says. “It is important
for counselors to ask their chents if they are noticing anything unusual physically or mentally,” she says. “Counselors then need to be knowledgeable about what may be expected during the course of treatment. For example, some individuals report increased anxiety when they begin taking an antidepressant, but the anxiety subsides after a few weeks of treatment. It is important for counselors to know if certain side effects are transient.”
Sattaria Dilks, a licensed professional counselor who teaches at McNeese State University, says some antidepressants can have serious or even life-threatening side effects that counselors should be aware of and educate clients about. For instance, certain foods can have life-threatening interactions with monoamine oxidase inhibitors (MAOIs), a class of antidepressants, Dilks says. Other medications potentially can produce a life-threatening rash. Being knowledgeable of such side effects will alert counselors that a client needs to see a medical professional immediately, says Dilks, an ACA member who works in private practice as a psychiatric nurse practitioner in Lake Charles, La.
All medications have side effects, but there are two major concerns when it comes to antidepressants, Meyer says. One is increased risk for suicide among
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