Geoffrey Di Bella, MD    Psychiatrist 

Unless I let you know differently about your medication, please adhere to the following guidelines:
Beginning a New Medication:You may stop at any time!   If you do choose to stop the new medication, you should schedule an appointment to see me. If you have been taking the medication for more than 4 weeks, please see our 'Stopping Medication' section below.
All medications that reduce BOTH depression and anxiety usually take at least two weeks to begin showing positive effects.
Pill cutters can be a good and affordable aid in reducing medication dosages and taking fractions of a tablet. If you are taking capsules, you may be able to open the capsule and sprinkle out small amounts (Cutting the tablets may negate some extended release effect of the tablets).
Read the handout that the pharmacy gives you about common side effects. If you request it, your pharmacy will usually be able to give you the complete package insert provided by the manufacturer.  The effects listed there have to include anything the patient reported as unwanted during the research phase, even if the patient complaint had nothing to do with the medication.


Stopping Medication:To avoid withdrawal, if you have been on a high dose of a medication or after you have been on medications for four weeks or longer, taper the medications about 4% less per day, or 20% less every 5 days (for example, if taking 100 milligrams every 24 hours, use 20 milligrams less every 5 days).
If this rate of reduction still results in feeling sickly, then reduce more slowly, such as 10% less per week. Please come in for an appointment if you are experiencing withdrawal effects or would like to reduce your medication dosage.

Let's see how the natural you works with the medication.

It may be best to avoid caffeine, nicotine, alcohol, and other non-prescribed non-food chemicals while taking medications - they all have some potential to cause side effects or alter the desired effect of the medication. 

Alcohol and Other Interactions:The medication information will usually say that you should not drink alcohol with the medication and sometimes advises that you should not drive. It is likely that the effect of alcohol is stronger when you use medication. Use your own judgment of its effects and proceed more cautiously accordingly.
If you find that moderate use of alcohol - two drinks or less (i.e. two glasses of wine) per day - does not create bad effects for you when you use the medication, then such moderate use of alcohol may continue.

Paying for your medications:

You can save time and frustration by obtaining a copy of the medication formulary of your insurance company. This lists medications that your insurance plan will cover, and will allow us to choose from that list to be certain you receive coverage for medications (usually the insurance company makes suggestions for medication that they do cover).  Some meds are often prohibitively expensive without coverage. When your insurance company does not cover a medication, please ask  the pharmacist to suggest an alternative in the same therapeutic category, then call us to let us know what is covered. Without this information, your medications may take up to a week or more to be modified or reviewed by your insurance company for coverage.

Another resource might be a free coupon at goodrx.com.!