Reassessing a Treatment Plan

Revising a psychiatric treatment plan might be necessary if significant time has passed without any symptom improvement or if your medication side effects are extreme. While it’s often more clear-cut to know when psychiatric medication needs changing, it can be complicated to determine whether psychotherapy sessions need to be reconsidered.

This mental health care reassessment guide covers both medication and therapy, helping you recognize the signs that treatment isn’t working for depression, anxiety, and other conditions. It will cover:

• When to change a mental health treatment plan.
• How to know if therapy is working.
• When medications may need adjusting.
• Common treatment plan alterations.
• How treatment plan evaluation in psychiatry can guide next steps.

Signs It’s Time to Change Your Treatment Plan

Whether a particular psychiatric treatment will work for you depends on many variables. Each individual person will have a unique experience and different ideas about what constitutes treatment success. Different mental health conditions also come with their own specific treatments and prospective timelines for success.^[1]

However, some clear signs can help you decide when to change a mental health treatment plan. These include:

Significant Time Has Passed Without Results

Understanding when treatment isn’t producing results is a core part of treatment plan evaluation in psychiatry.

Typically, doctors and mental health professionals will indicate how long you should expect to wait until you see results from medication. For example, people who are prescribed antidepressants may be advised to persist with their medication for between four and six weeks.^[2]

A small number of psychiatric medications work quite quickly, but most of them need to be taken over several weeks or months until you see an improvement.^[3] If your medication’s adjustment period has passed without significant change to your symptoms, it’s probably time to revise your treatment plan.

How to know if therapy is working is a separate matter from medication. It is much harder to accurately estimate when you can expect to see results for counseling and psychotherapy. However, the American Psychological Association does provide some general timeframes for reference:^[1]

• 50% of people show meaningful progress in recovery with 15-20 therapy sessions.
• 20-30 therapy sessions over 6 months can create better symptom remission long-term.
• People with co-occurring conditions (such as personality difficulties) may require 12-18 months of therapy for it to be effective.
• For some individuals, treatment outcomes improve with a longer stay in treatment.

Even if you treat these figures as rough guidelines, you should typically wait longer to see results from therapy than from medication. However, if you’re experiencing the following, it could be time to change your therapy:^[4]

• A lack of collaboration or trust with your therapist.
• A lack of consideration for your spiritual beliefs, sexuality, cultural or racial background, gender identity, attachment style, and preferences for the therapy style.
• An unresolved rupture with your therapist, such as a disagreement or period of distrust.
• Inadequate space and acceptance for strong and negative emotions.

Medication Side Effects Are Significantly Disruptive

Psychiatric medications have a strong influence on chemicals in the brain. This can be both positive and negative.

While medications should work to alleviate symptoms of conditions such as depression, anxiety, or psychosis, they can also produce unwanted side effects.^[3] For example, antipsychotics and antidepressants can cause:^[5]

• Weight gain.
• High blood pressure.
• Sedation.
• Sleep disruption.
• Sexual dysfunction.

One or more side effects are to be expected when taking psychiatric medications, but these vary in intensity and frequency. The best approach is to find a balance that works for you so that you can function as you’d like to in daily life.

You should speak to your treatment team immediately if you’re struggling with the side effects of your medication.^[5]

Other Medication Factors

Sometimes, it might not be that you’re experiencing unpleasant side effects from your medication. It could be that:

• You’re taking a dose that’s too low.
• Your medication has stopped working.
• The practicalities of the medication don’t suit you.

For example, you might find it difficult to take a pill at regular intervals in the day. Many psychiatric medications come in the form of liquids, dissolvable tablets, patches, or injections. If you’re struggling with your current method of administration, it’s worth talking to your doctor about which form you would prefer and if you can switch.^[3]

Additionally, it may be that your medication is mostly working, but it’s not helping your symptoms to the degree that you’d like. Often, psychiatrists will start you on a low dose and gradually increase it. However, this can come with increased side effects, so again, finding a balance is crucial.^[3]

Finally, up to 33% of people on antidepressants find that their medication eventually stops alleviating their symptoms.^[6] This can be caused by:^[6]

• New life stressors.
• Other medications.
• Pregnancy.
• The use of drugs or alcohol.

If this happens, you should speak to your doctor about making an adjustment. Recognizing the signs that treatment isn’t working for depression or anxiety early allows for faster course correction.

Common Treatment Plan Alterations

There are multiple ways a treatment plan could be altered. Your doctor’s new approach will depend on the ways in which your current treatment is succeeding and the ways it’s failing to help.

You can expect one or more of the following changes:

• Medication changes: Adjusting medication might mean increasing or decreasing your dose, adding a second medication, or switching to another entirely. For example, when antidepressants stop working after a long time, doctors may prescribe a different SSRI or SNRI. Or, they might prescribe something like bupropion, which doesn’t cause the sexual or weight gain side effects.^[6]

• Using alternative treatments: Typically, alternative treatments are prescribed when symptoms have been resistant to treatment. For example, people with depression may be referred to ketamine therapy or electroconvulsive therapy, which are potentially effective but less commonly prescribed approaches.^[2]

• Changing the therapeutic approach: Adjusting the therapeutic approach in adults means switching to a different type of therapy that has an alternative focus or method. For example, if someone with post-traumatic stress disorder (PTSD) wasn’t seeing changes from cognitive behavioral therapy (CBT), they may be referred to Eye Movement Desensitization and Reprocessing (EMDR). This can help people process traumatic memories via controlled eye movements.

• Introducing lifestyle psychiatry changes: Improving treatment outcomes in psychiatry can often involve lifestyle changes, supported by the field of lifestyle psychiatry. Depending on your condition, abilities, and preferences, your doctor might discuss things like nutrition, exercise, cold water therapy, light therapy, or sauna bathing, to name a few.

How to Safely Change Your Treatment Plan

Your safety is of the utmost importance when making a change to any psychiatric treatment plan. Typically, safety is focused on medication alterations because there are physical and emotional changes to be aware of. The following steps can help you navigate changing medications for mental health safely:

Make a Note of Your Reasons and Symptoms

Things will run more smoothly at your next appointment if you have a written log of what’s been going on. Make a note of any symptoms, side effects, difficulties, and concerns you’ve been having about your treatment.

Adding your symptom log to your medical record means that any future changes will be well-informed. Plus, if you ever want to seek a second psychiatric opinion, the second doctor will be able to read about your experience so far.

Having a written list can also make things easier for you if a medical appointment feels daunting.

Change Your Medication Gradually

When you’re stopping a psychiatric medication prescription, it must be tapered off slowly. This means gradually lowering your dose over several weeks instead of suddenly not taking any.^[3] At a minimum, antidepressants should be tapered off over a period of four weeks.^[7]

Tapering off allows the chemicals in your brain to adjust gradually, while stopping medication suddenly can result in adverse side effects.^[3] If you’ve been taking an antidepressant for six weeks or longer, the side effects of stopping medication suddenly could include:^[6][7]

• Headaches.
• Nausea.
• Anxiety.
• Diarrhea or constipation.
• Suicidal thoughts.

Tapering psychiatric medication or switching therapists or treatment programs runs the risk of the return of mental health symptoms, which is why your doctor should monitor the process.^[7]

Most likely, your doctor will suggest a gradual tapering down of your first antidepressant and then a brief “washout” period with no medication. This could be anywhere from two days to several weeks. After that, you will be given a low dose of the new antidepressant, which is gradually increased in dose.^[7]

There are some circumstances in which antidepressants are swapped immediately without a washout period, and even the possibility of taking two simultaneously in a short overlapping period. However, these options tend to be for people who are at a higher risk of symptom relapse. Clinical expertise is required because these methods are likely to result in drug interactions.^[7]

Ask Questions About Treatment Plan Changes

Trying out medications and reassessing treatment plans can be an exhausting and frustrating process. Asking your psychiatrist questions can alleviate a lot of confusion and equip you with the necessary information about your journey.

For example, you might want to ask about:

• Side effects.
• How the new medication works.
• When you can expect to feel better.

Asking your psychiatrist questions can feel awkward sometimes. However, you’re entitled to understand your treatment plan and have as much information as possible in order to know what’s normal and ask for what you want.

Get Personalized, Evidence-Based Mental Health Treatment With Mission Connection

Mental health care decision-making can be tough if you’ve tried multiple treatment options already to no avail. When people are seeking second-line mental health treatments, they often want greater clarity and assurance from the professionals supporting them.

At Mission Connection, we prioritize working collaboratively with you to develop a treatment plan that suits your unique preferences and needs. Not only do we rely on evidence-based treatments, but our personalized mental health care plans put you at the center.

We offer several options for effective outpatient treatment, including in-person programs, virtual telehealth, and a hybrid program that combines in-person and virtual care.

Mission Connection is Joint Commission-accredited. We also accept almost all insurance providers, so that your recovery is not hindered due to financial issues.

If you’re looking for a supportive team to help you reassess your treatment plan, reach out to us online or call us at 866-833-1822.