North Star Conversations Transcript: Who Decides on Medication—Brandon Gimbel, M.D.

Hi, I'm Brandon Gimbel at North Star Behavioral Health. Before we begin, this video is for general informational purposes only. It is not medical advice and it is not a substitute for work with a licensed provider. Unless we have a pre-existing treatment relationship, I am not your licensed provider. Today I'd like to talk about medications, how we decide whether or not to recommend them.

Psychiatry is unique. Unlike in other fields of medicine, we don't have blood tests or imaging that can definitively tell us what's going on. Instead, we're dependent on something much harder to quantify: the patient's experience. And this can feel unfair, especially to patients, as we know their brain and their body are experiencing symptoms that are painful.

But until our field advances with more objective tools, in psychiatry, we lean on the tools that we have. This means we trust our patients. Our patients are the authority on themselves. That does not mean that all symptoms lead to a diagnosis or that all diagnoses lead to a medication. It does mean that the patient is the authority on their own experience. And it's our job to listen.

I have a few rules in psychiatry. The one that's topical for today is it is my job to make a recommendation. It is my patient's job to decide what to do with it. I may be the expert in psychiatry, but my patient is the expert on themself. So if I make a recommendation for a medication, it is up to the patient to decide whether or not they wish to take it. When do I recommend medications?

We do have a few tools in the world of psychiatry. We have non-medication tools such as different psychotherapies, and there are many, mindfulness-based treatments, lifestyle changes, and some newer interventions such as TMS and Ketamine, as well as medications. If someone is in significant distress, I am much more likely to bring up the idea of medication.

If someone is uncertain about what they want, we'll look at physical symptoms to decide how to move forward. If someone is anxious, they'll often have physical symptoms such as insomnia, restlessness, suppressed appetite. If someone is depressed, they might have physical symptoms that we call neurovegetative symptoms: low energy, low motivation, increased need for sleep, changes in appetite. If people are exhibiting these symptoms, that might guide us to make a recommendation of a medication.

Ultimately, what we wish to create is a collaborative approach where we serve in our function as expert in psychiatry and the patient serves in their function as expert on themselves.