In this episode we’re joined by Carrie Hill, PMHNP-BC, CARN-AP—a seasoned psychiatric nurse practitioner with over 16 years of experience—to dive deep into the often misunderstood world of medication management in mental health care. Carrie shares her compassionate, patient-centered approach to treatment, blending personalized medication plans with therapy and holistic care for individuals aged 13 to 64. We tackle common fears about psychiatric medications, including public misconceptions and high-profile critiques, while exploring how open communication and ongoing assessment can lead to better outcomes. You will learn how combining therapy and medication can empower individuals on their mental health journey—and hear real-world success stories that show what’s possible when care is tailored, collaborative, and rooted in empathy.
Tune in to see Medication Management Through a Therapist’s Eyes.
Think about these three questions as you listen:
- Have you ever considered how medication might play a role in your mental health treatment plan?
- What concerns or questions do you have about starting or managing psychiatric medications?
- How do you currently monitor and assess the effectiveness of any mental health treatments you’re undergoing?
Links referenced during the show:
https://growtherapy.com/provider/c8riv32s3mws/carrie-hill
https://www.kiwihealth.com/provider/NC/Belmont/Carrie-Hill
https://growtherapy.com/provider/c8riv32s3mws/carrie-hill?utm_source=chatgpt.com
https://somawichita.com/blog/understanding-psychiatric-medication-management-what-you-need-to-know/
Intro Music by Reid Ferguson – https://reidtferguson.com/
@reidtferguson – https://www.instagram.com/reidtferguson/
https://www.facebook.com/reidtferguson
https://open.spotify.com/artist/3isWD3wykFcLXPUmBzpJxg
Audio Podcast Version Only
Podcast: Play in new window | Download
Episode #307 Transcription
Chris Gazdik: [00:00:00] This is Through a Therapist’s Eyes on April the 10th, 2025. I am Chris Gick, and as usual, we have Mr. John Pope hanging out with us. It is a pleasure
John-Nelson Pope: and an honor to be here.
Chris Gazdik: All right, man. But we got somebody else that’s hanging out with us today. Yes. Yeah, absolutely. Very excited. It’s a stranger. It’s No, not anymore.
I, not anymore. Every time you sit. Yeah. She is a part of Gaston County now. She is. She is a local medication prescriber. Welcome Ms. Carrie Hill to the show.
Carrie Hill: Thank you. I appreciate it. Thank you for having me.
Chris Gazdik: We are very excited about this particular episode because I, we don’t get to talk about medication management.
A lot and it’s a big part of our field, and it is, and it’s something
John-Nelson Pope: I think we should address. Probably more. More.
Chris Gazdik: Yeah. There’s a lot of things we should probably address more, I guess, but but yeah, and, and I’m excited personally, Carrie, ’cause I just, on my career, like I’ve always been [00:01:00] around prescribers, you know, usually psychiatrists and stuff.
Like I even, I even had experiences at the UNC neurosciences in Chapel Hill is where I had like, my first my first real job as an adult after school. Mm-hmm. And so I was with like, you know, psychiatrists in training even at the, at the neurosciences learning hospital up there. So I haven’t been working around psychiatrists or prescribers in like, well, how long has Metro IA been here for?
15 years for sure. Right? Definitely. No, we had Carol here, so even then I’ve had her for a little bit, but but I’m anxious to hear the newest pieces of prescribing these days. Oh,
Carrie Hill: there’s a lot, a lot of changes, a lot of new things going on and new medications.
Chris Gazdik: Yeah, and that’s one of my questions I wanna talk about is new medications.
’cause I am out of touch. But nevertheless, we are talking about medication management today with Carrie Hill. Do you want to say. We’re not. Oh, I will, yeah. We’ll, we’ll do introductions and stuff for sure. And so the three questions as we go through the show that I want you to think about is, have you ever considered how medications might play a role [00:02:00] in your mental health treatment plan?
Secondly, what concerns or questions do you have about starting or managing psychiatric medications? ’cause people have concerns. And then how do you currently monitor and assess the effectiveness of any mental health treatments you’re undergoing? And that’s kind of just a interesting thing about medications.
That’s kind of easier to do that with. But thank you, the listeners to you specifically, thank you for listening. And you followed up John, not more than an hour after in our show last time. We have another new YouTube member. Yay. Like to, yeah. Let’s welcome them in. Shane Jones, welcome to the Hey Shane, through a therapist eyes ate experience on YouTube live.
So, so we have Neil, what are we up to? Do you know we pushing? Oh, I thought, I thought it might have been 2 21. Okay. So we’re, we’re, we’re on our way to where we wanna be, which is like a thousand. So we’ll keep building that. Let me see. This is the delivery of therapy services, John, or is not, is not, it is [00:03:00] not, no.
We,
John-Nelson Pope: we have these topics we talk about, but we’re not doing therapy
Chris Gazdik: today. Yeah, not right now. Online you do
John-Nelson Pope: therapy. You have to have a, you need to talk to someone,
Chris Gazdik: but this is where you get information about mental health in your car or educ personal time at home.
John-Nelson Pope: And entertainment.
Chris Gazdik: Anyway. Yes. What else is part of my normal spiel, John?
And
John-Nelson Pope: you give a five star review, okay? If you want. That’s my spiel and spiel. And so and you can comment on it and and just give us some glowing positive reviews.
Chris Gazdik: Your job is to do what John asks five stars, not four job, four stars, if you like the show and the content that we give. Five stars.
Yes. For free. So this is the human emotional experience, which we endeavor to figure out together. So Carrie Hill is a, you’re gonna have to explain all these letters, first of all. Oh yeah. I don’t even know all these letters. Like these are a long letters behind, behind her name. John. So who did all the research?
This is Carrie pm hnp, BC comma C aap, a [00:04:00] board certified psychiatric mental health nurse practitioner and a certified addictions registered nurse with over the 16 years of experience. So seriously
John-Nelson Pope: psychiatry. Yes, psychiatric
Chris Gazdik: nursing psychiatrist. Seriously, welcome to show Perry. I’m, thank you. Very excited to, to have you have this conversation.
Tell us a little bit about yourself. What are the letters, seriously, and a little bit about Kerry, who you are, where you come from, what you do, what you like.
Carrie Hill: Well, I have been in the Gaston County area since 1990s for a long, long time now. I was actually born and raised in Charlotte, and I have been to quite a few schools in all over North Carolina.
Mm-hmm. I started at Gaston College and got my. My two year degree, my associate’s degree in psychology, but I didn’t really know what to do with it. And then I thought, well, I, I don’t know what I wanna do, what my path is. So I decided to go to Belmont Abbey College and get my computer science degree instead instead of medication
Chris Gazdik: and nursing.
Okay. Psychology, because I
Carrie Hill: didn’t [00:05:00] know what to do. I was, I was kind of lost, you know, John just kind out there.
Chris Gazdik: This means you’ve been in school like as long as you have. Yes. Yeah.
Carrie Hill: I like school, but I’m done with it now. Okay. We’re done.
Chris Gazdik: Good.
Carrie Hill: Yeah. This is it. So, and then after Belmont Abbey, I decided that I didn’t really wanna sit in a cubicle and work on computers.
Although I love computers. I do not want to be in a little, you know, it, it has come full circle though, and I’ll tell you about that. So then I went to back to Gaston College second time and got my. Registered nurse from Gaston College, then I went to Appalachian. You really have been to like every school in the
John-Nelson Pope: state.
You’re a mountaineer.
Carrie Hill: Huh?
John-Nelson Pope: You’re a mountaineer. I’m a lot. I’m
Chris Gazdik: a lot of, she’s a baby mountaineer. John, I gotta be honest with you. I gotta correct you and it drives me nuts when people try to call Appalachian state at mountaineers. Like I am a mountaineer. Okay. Okay. West by God, Virginia University came mountain near Carrie.
I’m so sorry for this. You’re in
Carrie Hill: North Carolina now.
Chris Gazdik: You know what, ma’am? I’m sorry. We are the should we just
Carrie Hill: move on? Yes, yes.
Chris Gazdik: Okay, let’s move on. [00:06:00] Then.
Carrie Hill: After I got my bachelor’s, I went to University of North Carolina Chapel Hill and got my master’s degree. And so the P-M-H-N-P-B-E-C is the psychiatric mental health nurse practitioner board certified.
Ah, so I went to school specifically for psychiatry. I did not go. There was no route taken for medical. I wasn’t interested in anything. But you knew what you
Chris Gazdik: wanted to do.
Carrie Hill: I knew immediately that what I wanted to do, although a lot of my, you know, when I was in school, a lot of the, the nurses and the teachers would say, you really need to do medical first.
But I, I was not interested in that. I had seen enough in my clinical rotations and I had done enough learning throughout my school to know that, no, that’s not my, it’s not my thing.
Chris Gazdik: Gotcha.
Carrie Hill: So, and then about five or six years ago, I started doing addiction treatment. And So the C-A-R-N-P-A karn Yeah, the [00:07:00] karn, yeah, the Karn AP is, certified addiction registered nurse advanced practice. So that means that I went back and got a certification specifically for addiction treatment because I enjoy taking care of, of clients that have, you know, problems with both mental health and substance use issues.
Chris Gazdik: Right. What’s that? John? You had a thought?
No,
John-Nelson Pope: I was, I was just in awe. I just, I think it’s wonderful that it does. Right. Because you know as
Chris Gazdik: well as I do, right, right. How valuable is a prescriber who knows anything about substance abuse? Right, right, right.
John-Nelson Pope: Unicorn sitting with us. Yes.
Chris Gazdik: Yeah, seriously. I mean that as a compliment really. That is super, super cool.
Or, or even
John-Nelson Pope: other psychiatric areas as well. I mean, it’s just a,
Chris Gazdik: there’s still such a great divide in our field where you work with mental health and you refer out for substance abuse, or you work with substance abuse and you refer out for mental health, and it drives me crazy. Anyone listening to this show, I’m sorry if I’m stepping on toes or upsetting anybody, but really we all need to have substance abuse.
Straining is [00:08:00] my staunch belief because it creates such a blind spot when you don’t know what you’re doing with that. And my gosh, Carrie, can you imagine all of the addicted individuals that are getting prescriptions for all sorts of things and the prescribers don’t have any idea that that’s what’s going on?
Carrie Hill: That’s exactly right. Again, I can just rant a lot of times and a lot of times if people aren’t trained specifically on what to look for, they might be trying to help a problem that somebody came in for originally, but it was stemming from the substance use and because that client doesn’t feel comfortable enough talking about it, or it was never really asked the questions regarding that, then they don’t.
They don’t know what Yeah.
John-Nelson Pope: We’re preaching to the choir. Yeah. This is absolutely simply ask the questions. Simply ask the questions. Yeah.
Carrie Hill: Right. So I really enjoy what I do and it’s my passion. And addiction is not just, it’s not. Only drugs. This is all kinds of addiction. This is food addiction, this is, you know, [00:09:00] even caffeine can be an addiction.
It, there’s all kinds of things. It does not have to be, just don’t step on
John-Nelson Pope: my toes. Caffeine’s
Carrie Hill: always been my, my in food. But yes, there’s a lot of other and behavioral addictions. A lot of people don’t realize that, you know, a lot of people after work wanna come home and they, they wanna get on their, their phone or whatever and zone out and that’s fine to disconnect from whatever for a while.
But you shouldn’t, you know, be sitting there for five, six hours and
John-Nelson Pope: screen time.
Carrie Hill: Right? Yeah. So a lot of things can be,
John-Nelson Pope: yeah. So you’re talking in terms of process, addictions, gambling, you’re talking about the internet addiction, porn addiction. Exactly.
Carrie Hill: Yeah. ’cause all those things, sex addiction can cause, you know, problems in relationships and mm-hmm.
You know, and, and end up. In lots of trouble sometimes with the law on the ladder too,
Chris Gazdik: so, right.
Carrie Hill: Yeah.
Chris Gazdik: Cool. So yeah, let me, let me jump in with what, what is your, what is your philosophy? I mean, I, yeah, the, there’s some stuff that you’ve got [00:10:00] on the Insight or in the internet sites and such, and road to Recovery is well, well, let’s first cover, how do people find you?
Carrie Hill: Oh, they’ve just, they can either search my name, so Carrie Hill, and then the, all those letters. Right. Don’t try to put all those letters in.
Chris Gazdik: So Carrie Hill, the Underwood comes up. Yeah. Yeah. Carrie will come up as Underwood, but that’s not the right one. Thank you, John.
Carrie Hill: Yeah.
Chris Gazdik: Now what’s the website and where they find you?
Carrie Hill: Oh, so my website or my, the name of my company is Road Trip to Recovery, so it’s road, road trip to with a two recovery.com. And I, my. The way I approach treatment is very holistically. I like to look at the patient as a whole. It’s not just about what symptoms they came in with, it’s about what is going on in their life.
What may have, you know, led up to what’s going on. The social aspects, the, you know, sometimes the spiritual aspects of things. Sometimes, you know, people don’t know where they’re headed or going in life. They feel a little, oh, sorry.
Chris Gazdik: Yeah. [00:11:00] Rookie mistake. My phone just went off. Yeah,
Carrie Hill: that’s okay. And, and then of course all the medical background and all the mental health background.
I am very good about keeping up with what medications people have been on and what they’ve tried and how they reacted to it and what, you know, if they had side effects. ’cause I never wanna put anybody back on something they’ve already tried. So I, I’m keep a really good records.
John-Nelson Pope: Yeah. I’m, I’m gonna have a bunch of questions, so that’s cool.
John, I just don’t wanna, I don’t wanna step on your on No, you’re fine. Jump in anytime you need to. Questions. One of the, the issues that I’ve seen with some of my clients that are on medication SSRIs or SNRIs or what, whatever they don’t take it long enough for, for a length of time or they take it sporadically.
Yes. And and I’m just wondering why that is important that, that the, that the patient or [00:12:00] the client is. Is consistent in taking.
Chris Gazdik: So that’s an awesome little segue, John. Let me let, let’s, let’s finish up with, with first quick thing I told you. No, no, no, you’re fine. You’re fine. You’re totally fine. I just wanna say like our show notes, we have totally the links up and, and how to find Carrie.
We will view that at the end of the show kind of as well. And really, I mean, if you’re local here, you know, they, they can, they can actually be able to soon, I think have a, an office, but you do a lot of virtual stuff as well, which is the way we do everything nowadays. But but you’re also, I wanted to make sure and get in, like you’re kind of different as well in that you’re licensed in multiple states and whatnot.
Is that, like, how does that work for you? Like, I was shocked at that. Like when that was the case. So how, how does that work for you?
Carrie Hill: So I am licensed my home state, of course in North Carolina. And eventually I will have an office in either Belmont or Mount Holly. We’re, we’re working on those things, but but virtual care still, you know, 24 7 right now.
So, but I am licensed in 18 states and oh [00:13:00] my goodness. Wait, John. Yeah,
John-Nelson Pope: but see that’s the thing is, is that I’m, I’m thinking your practice your profession, they’re a lot further ahead than social work or counseling. Mm-hmm. Fair. And that is because we don’t really have portability. Right. And I think you probably have portability, don’t you?
Carrie Hill: Well, and it’s interesting ’cause I’ve talked to some psychologists and found out about the psych pack ’cause I didn’t know that that was something that they had been working on. And it does need to be for therapists and, you know, counselors, social workers for and for nurse practitioners and mental health.
And it needs to be. Where we don’t have to worry about these state lines and, and you know, it would be nice one day to not have all these hoops to jump through, but some states I have to get an RN license and an NP license in. Mm-hmm.
Chris Gazdik: And this is, this is just so important. So you listening public, which by the way, if you would give us a specific list of those 18.
’cause you know, our show does go to all sorts of states and actually countries, but, you know, I wanna get those exact [00:14:00] states that you’re licensed in and, and so we can put it get that to Neil and I so we can have that Sure. Noted so people can, can know which specific states they are. And I’m not even gonna try to ask you to repeat ’em all, but I was gonna say, I, there’s so many
Carrie Hill: I don’t think I Yeah,
Chris Gazdik: yeah.
But, but look at that. Will you get us that information, because that would be very helpful. Didn’t
Carrie Hill: start,
Chris Gazdik: and then John, to your transition. Yeah. Let’s, let’s talk a little bit about the nuts and bolts here. Like right, like what happens underneath the hood with medication management and stuff. And there’s lots of aspects to this about, you know, people’s fears and, and how it operates, how it works.
You’re bringing up a, some specific stuff about, you know, being consistent. Mm-hmm. But some, you don’t need to be consistent with like, you know, some of the benzos or the anxiety agents or sleep agents or, you know, over the off-label kind of purposes for, you’re Right. So there’s a lot,
John-Nelson Pope: I’m amazed at how many of my clients are on benzos when they probably don’t need to be on on, right, right.
And so.
Chris Gazdik: Yeah, a hundred percent. Yeah. So, Carrie, what are the, how do you manage all that? Like, I’m sure people, you know, we have different [00:15:00] classifications of drugs, we have different, you know, medications for anxiety, for norepinephrine, for dopamine, for serotonin, for sleep. I don’t know if we’re doing much for gaba, but like, how do you address.
John’s sort of question and a lot of the depths that I’m sure clients, you know, are having. Oh yeah.
Carrie Hill: And I, and I always tell my, my patients, I want them to know as much as we can. Of course we can’t tell ’em everything ’cause there’s gonna be a thousand side effects listed. That does not mean that they’re gonna get all of them, but I always tell them the most important ones that they need to know.
And I tell ’em, you know, I’m gonna tell you the good, the bad, the ugly. You need to know what a medicine is going to do, what it’s not supposed to do, and what the side effects are. Because the more knowledge that they have about what to expect is easier for them to understand what is the medication, you know, and what do I need to, you know, immediately notify about versus what do I just need to, you know, tell her the next time I see her.
But so with SSRIs specifically and SNRIs, we use those for [00:16:00] depression. And those are serin
Chris Gazdik: reuptake inhibitors.
Carrie Hill: Yes. And and norepinephrine on the SNR side, selective
Chris Gazdik: serotonin reuptake inhibitors. Sorry to be formal.
Carrie Hill: So when somebody comes in with depression and anxiety, it’s typically ’cause they don’t, they’re not producing enough serotonin.
They already have, we already have serotonin in our body and so, you know, we need a little bit more to try to get tho combat those symptoms. And, you know, you as therapists, you sometimes you will get the client first and they wanna come in and they wanna work on these things because they don’t wanna do medication, which is perfectly fine.
But after you’ve been with them for a while, you know, therapy has been good, but they’re still not progressing, then sometimes y’all will recommend, you know, seeing, potentially seeing somebody if you feel like it’s a fit. Oh yeah.
Chris Gazdik: Like all the time. Good point
John-Nelson Pope: is that it’s when medication in done with psychotherapy, effective psychotherapy, the kind that Chris does.
And you and me and [00:17:00] Victoria mm-hmm. Is that it is a lot more effective and it makes a progress go a lot faster because you can and, and it’s more permanent, I think, in terms. Well, yeah. I think
Chris Gazdik: what you guys are touching on, I mean, I’ve talked about it on the show, what I call Carrie, an overview of mental health with a subtitle, A Tale of Two Tapes, and you’ve got, you know, almost like a formulaic.
Way of thinking about somebody’s trouble. You know, with mental health is what I look at. The biological component on one side, you know, genetics, biological exercise, eating as well. But then you got the other side of the equation, social and emotional realities in life. The primary relationships that you have, the primary life experiences, the daily stress and the grind.
Like there’s this dynamic combination. Maybe it’s 60, 40, 80, 20, 70 30, whatever. Mm-hmm. On, but you have to treat both. So I’ve landed on the fact that the statement I’ve said thousands of times is that medications are an awesome tool to help manage mental health. But they’re just not a solution. [00:18:00] Right. So that’s where this combination of therapy and mental much more,
John-Nelson Pope: Efficacious, I think effective.
Yeah. If you have a combination of both. But I, I can understand a lot of my clients are reticent or reluctant to, to just go into the medications and because I think part of our culture right now, of the atmosphere. But anyway, that’s another, another point.
Chris Gazdik: Yeah, we’ll get to that. Actually, I wanna talk about that, but but do you have like a particular, or go ahead, if you, do you have thoughts?
Carrie Hill: Well, no, we can talk about, we can talk about that later. The political atmosphere has, has changed things and
Chris Gazdik: Yeah, we, we, I wanna talk about some current events here in a little bit. For sure. We’ll, we’ll, we’ll get a little political guys, hold off opac, because, ’cause it’s, it’s significant, it’s important.
And it, it does hold, it does hold people out. But there’s a lot of reticence anyway. I mean, people are afraid of medications. Carrie, they’re terrified.
Carrie Hill: Yes. And I don’t blame ’em. Yeah, because they should be, you need to know what you’re getting into because I, [00:19:00] I would never take taking a medication lightly.
You need to really know what to expect. Because these things, they change and they help. But we also know that they can do the opposite. And that’s what we don’t want them to do, is, you know, have the opposite effect. And I always tell my patients, you need to let somebody know who’s close to you, whether it be a spouse, or whether it be a parent, or whether it be whoever you feel is most comfortable that you’re taking a medication.
And they need to be able to look out for symptoms and changes and, and as well, so not only the, the person who’s taking the medicine, but also somebody else.
Chris Gazdik: So the formal for that is we look for collateral information.
Carrie Hill: Right.
John-Nelson Pope: Let me ask you this, how, how long is your typical interview? With a client or a patient,
Chris Gazdik: You’re gonna love this answer, John.
Carrie Hill: My typical, usually it’s 60 minutes, however,
Chris Gazdik: I told you you’re gonna love this answer, John.
Carrie Hill: However, it could be upwards of 90 minutes. It depends on what,[00:20:00]
John-Nelson Pope: ah, wonderful. I do a
Carrie Hill: lot of screeners at the very beginning and I cover. The PHQ nine, which is what we use. It’s a screener that we use for depression. Mm-hmm. The GAD seven, which is what we use for anxiety. Oh.
Chris Gazdik: You guys aren’t gonna start geeking out about, I’m peeking out. Sean. Are, they’re all very effective.
John, you can’t, you guys can’t go for a half an hour and talk about all the little screening tools that you love to use and all the print jobs, you don’t use all of them. I use seven
Carrie Hill: of them. Don’t
John-Nelson Pope: you use Beck? See, I told you he’s gonna geek out with you, but he loves this stuff or whatever. So anyway, just and you use the, the substance or alcohol use.
Like Neil, we’re losing control. Okay, well
Carrie Hill: now for that, I have a clinical, so separate from my screener. So I have seven screeners and I have one clinical history form. Um-huh And then of course, the consents that they have to sign in order for me to treat them
Chris Gazdik: is great.
Carrie Hill: So, you know, let me, let me
Chris Gazdik: give you some of the [00:21:00] background listener.
The, the, the John and I sort of glowing is, and, and I don’t, I don’t intentionally wanna sound critical, but it’s a problem. I mean, I started out years ago, you know, in the early nineties, learning about all this stuff and graduated grad school in 97, you know, and there were psychiatrists that still did therapy.
And, you know, it was just a, it was a totally different functioning at the time in, in the field. And, and managed care kind of came in. And John, you could probably speak way louder than I can to the progression that you’ve seen in your career because it’s gone from like what care you just described was the typical, totally went away.
And now it’s like the initial appointment with a prescriber oftentimes is 20 minutes and take a follow up maybe John. Right. And the follow up appointments are five to 10 minutes. That’s what you get your doctor time
John-Nelson Pope: and the person and if you get somebody that’s a PA or an np. [00:22:00] They aren’t specifically trained in psychiatric nursing or or being a pa in, in psychiatry with the specialty yeah.
For that. And so you don’t get, you don’t get the quality of and the depth of questioning. And some of my clients have had a lot of problems with medications. That’s horrible. They get a stato, for example, I’m mispronouncing it a Eter Austedo. Austedo A aoto, okay. And it caused a whole bunch of horrific, it’s a good drug, good medication, but it has to be used correctly, I think.
And as a non-medical person, just my experience with that. So I think that’s important that somebody is trained specifically to be able to use, use those medications.
Chris Gazdik: And spends time with your, your client spend
John-Nelson Pope: time listens.
Chris Gazdik: This is, this is really, I mean, do you realize how much a, of a thing [00:23:00] that is, I mean, seriously that might seem just so common to you, but what have no, what have you noticed?
Yeah. It’s,
Carrie Hill: that’s what I hear from my, from my, all of lot of, pretty much every
Chris Gazdik: man, woman, and child, it sees you.
Carrie Hill: It’s
Chris Gazdik: I say, where have you been? You know,
Carrie Hill: sometimes they don’t even look up at me. And, and if you don’t look somebody or if you’re not looking at them, you know, how can you tell what’s going on physically?
’cause nonverbal cues tell you a lot of information. Oh, yeah. And so it’s not just the conversation, it’s, you know, you’re
Chris Gazdik: saying that the clients are saying to you that their previous prescribers didn’t look at them.
Carrie Hill: Right.
Chris Gazdik: Is that okay? Yeah.
Carrie Hill: Like they were in there, like you said, five or 10 minutes and they never looked up from their, they don’t want computer or they never looked up from their, if they’re still.
Old school and writing things out. Yeah. It’s just,
Chris Gazdik: it’s so unfortunate. I, I’m so passionate about mental health care and substance abuse care that, you know, it, it really drives me nuts that that is the standard. That that’s what we’ve gotten down to. And I can tell you a lot of prescribers don’t like that, but it’s, it’s just such that the way the market goes [00:24:00] and the way the finances of practices are and stuff, that that’s what they, they feel compelled because that’s where insurance is driving them to.
And thus a lot of people in different markets prescribers won’t take insurance for that reason. Mm-hmm. That’s true. Because you’re driven by that. And so there are a lot of prescribers won’t take insurance, whereas you, you do. And I just, I respect that, that a lot that you’re able to traverse that.
Carrie Hill: Yes. ’cause the insurance companies can, they can be very hard to deal with. And so there’s a lot of providers that are cash only private pay. Mm-hmm. I’ve seen
John-Nelson Pope: more and more of that recently. Well, in our
Chris Gazdik: area, that’s like the standard. Mm-hmm. That’s just what, I don’t know. I, I think, I think psychiatrists basically got together, John and had like some secret meeting you and I were not incorporated into.
Mm-hmm. You know, we just, you know, about five years ago he was like, boom, that’s it. We’re done’s what happened.
Carrie Hill: Yeah. Yeah.
John-Nelson Pope: What do you think of psychologists being prescribers? There are some in some states that do that. There are, there are. I did not know that Louisiana, [00:25:00] Texas is looking at it. Illinois. Iowa.
I think Idaho. Really? Colorado. Yeah.
Carrie Hill: I think that we need all the help that we can get. So if, you know psychologists want to go learn like a, you know, just like another certification type thing for prescribing, then you know, that’s, I don’t know exactly. What that would entail for them. But, but as long as, you know, the educational piece is there.
And also I did wanna circle back to when you were saying PAs things have changed in the PA world. Now they can get a certification in psychiatry, but be, but before it wasn’t their, but they have to do certain things of course to meet the requirement, to be able to be. But I have had some colleagues that are PAs.
See, I don’t think
John-Nelson Pope: a one rotation necessarily, and I know, and I love PAs, I love ’em. Which
Chris Gazdik: by the way, physician assistant students or, or professionals is what we’re talking about. Right. Physician assistants. So,
John-Nelson Pope: but, but I don’t, I don’t think one rotation through is, is enough.
Chris Gazdik: Meaning what their training is.
[00:26:00] Yeah. What
John-Nelson Pope: their training is, right.
Chris Gazdik: Yeah. There’s, there’s definitely pitfalls and fallbacks. I mean, I didn’t know that it was being considered for psychologists to be prescribers. There’s a lot that goes into prescribing. I’m kind of rather shocked by that, to be honest with you. Mm-hmm. I mean, it, you know, you, and
John-Nelson Pope: I think, I think in our professions social work and in clinical mental health counseling is, I think it’s important that we all take psychopharmacology, in fact.
Oh, a hundred percent. Yeah.
Chris Gazdik: That’s, I mean, I feel like I could prescribe, ’cause I’ve been doing this for a long enough time to understand the, the titration and the tapering, you know, that’s medication dosing and all of this. You, and that’s the
John-Nelson Pope: thing for my doctorate, I, I, I took. Three, three courses. Yeah.
So
Chris Gazdik: yeah, it’s, it’s, it’s a lot. I forgot a lot.
Carrie Hill: Well, there’s a lot of information, so,
Chris Gazdik: yeah. So Carrie, I guess, I guess what are some of the complicated nature of things? You know, when you look at a you know, personalized treatment or, you know, individualized care. These are some buzzwords that we, you know, we all try to aspire to [00:27:00] in, and we don’t wanna just, you know, car blanc people through, you know, I mean, a lot of prescribing offices are cattle.
I mean, that’s what we were just talking about. Mm-hmm. Is five minutes cattle in cattle out? It’s terrible. Oh, yeah. But, you know, when you, when you talk about the individualized nature of things, what, what do you really come across or what do you see? What are some of the, the bigger issues that you come, you know, across when you’re trying to deal with complicated cases and circumstances with people?
Carrie Hill: Well, it’s just a lot of education because when people come in, you know. When we look at all the medications together, we wanna make sure that the medications that they’re taking medically or mental health wise aren’t causing any symptoms that they might be having. A lot of people will come in, you know, with complaints of being tired all the time, and, you know, a lot of people can’t tell, is that depression or is that something that they’re already taking?
Or, you know, it’s, it’s just very or another medical
Chris Gazdik: circumstance.
Carrie Hill: Right, exactly. So I always ask, you know, when’s the last time you had a physical and you know, your [00:28:00] blood work and everything, because that is so important to know the whole picture. And you know, when we think about depression and anxiety, we think thyroid first, we wanna make sure there’s nothing going on with the thyroid, and then we wanna look at vitamin levels, and then we wanna look at, you know, make sure there’s no anemia.
I mean, there’s so many things that we think of to be sure that’s medically. You know, so you’re
Chris Gazdik: screening a lot all the time. Yeah.
Carrie Hill: And I, I don’t do labs myself, but I do have them go see their primary care doctor to do that. Mm-hmm. And and tell them, you know, what I recommend, most of the time they already have, you know, the general labs anyway for their physicals.
But, you know, I definitely want them to make sure that they have their thyroid and their vitamins, vitamin levels and things like that so we can be sure. Everything’s okay. And then anything specifically that we’re looking for?
Chris Gazdik: Yeah, I think that I’m, I’m just, I’m talking about on, you know, you’re, you’re, you’re sophisticated over there.
Because what I’m thinking about is like, just, just the regular side effects, the different challenges that people have. ’cause one of the things I always, I, I try to do some prep with people that I’m referring [00:29:00] to, that they hear some spiels that I have that are standard things to talk about. ’cause as you said earlier, the more they know coming in, the better they’re gonna feel about taking and even get there and then Right.
Have better outcomes as a result. ’cause of what you said, John mm-hmm. The consistency of taking things. But, you know, you get, some people have side effects and other people don’t. Mm-hmm. So, you know, the, the, the dosages that you might need, I might need more or less, not just because of body weight or size, but ’cause of metabolism and all sorts of things.
Like, there’s a lot of, in inexact science about starting doses and where we titrate up to and side effects and how we manage that. I mean, it’s, it can get complicated. Right. Yeah. Be careful with Dr. Google. Yeah. Well, and do you find that too, you know, or more people? Yeah. Oh,
Carrie Hill: yes, yes. There’s a lot of, well, there was a lot of anxiety, you know, after Covid and so a lot of people who didn’t know what anxiety was they found out what it was during Covid.
Yeah. Which was, you know, good and bad. I mean, it was bad. You know, that, the way that things were in that [00:30:00] time. But it was good because now those people can understand what people who already had anxiety were going through. So it’s been a, you know, better on that level. But with, with medications and side effects, especially SSRIs and SNRIs, the top three side effects that people will absolutely stop their medication for.
Number one, sexual side effects hands down.
Chris Gazdik: Yeah.
Carrie Hill: Somebody, if they have John called it, that was John
Chris Gazdik: clapping. If they,
Carrie Hill: if there is a sexual side effect, they will not tell their doctor and they will stop taking it. And I always tell my patients, you need to tell me because we can figure something out if this happens, don’t stop taking your medicine until you see me.
The second thing, so
John-Nelson Pope: you could do like like Viagra or something like that and, and can, or what is it? Cialis, I’m using the normal term.
Carrie Hill: Yeah. Well, sometimes it depends because if the medicine is working very effectively and we, and that’s the only side effect that’s going on. Then yes, we would definitely do something to help with that problem.
But if the medicine, if [00:31:00] there’s another side effect going on with that side effect and it’s not working as well as we want it to, then we probably are gonna change that to something else.
Chris Gazdik: I know you’re listening to other big ones, the top three, but I mean, this is terrifying for people. Yes. It’s, I mean, really like.
And I’m sure you realize that, but we, I think we forget being so engaged with this, you know, so commonly and regularly now for however long we’ve been practicing, a decade plus, you know, you listening out there, like this side effect thing terrifies people and so I mm-hmm. I want you to hear this stuff because there are some common things and there are some ways that we manage that.
Mm-hmm. And also there are a lot of people that have no side effects. Right. That’s what I mean by this crazy individual care. Mm-hmm. I may have zips in my mind, you know, electrical p impulses with some of these medications, or I may have the sexual side effects or I may have nothing. That’s what’s wild, you know, because
Carrie Hill: everybody’s different.
Yeah,
Chris Gazdik: yeah, yeah. But you’re listening to the, the [00:32:00] what Do we got the top 10 or are we just going three? Top three? How about top three?
Carrie Hill: Second two. The next one’s weight gain. Weight gain. Yeah. Yeah. We, and, and I always tell patients this, we are not trying to solve these problems and start new ones.
That’s not the goal of treatment at all. Yeah. So. Also with the sexual side effects. A lot of prescribers don’t tell the patients. They wait until the patient comes back and says something and it’s like, no, you don’t wanna scare the, you don’t wanna leave that out and scare the patient when they’re like, oh my gosh, why can’t, or why am I not interested?
Or why can I not finish what I started, you know, my sex drive
Chris Gazdik: just went away. What’s the deal? Yeah, exactly why
Carrie Hill: I have, I recently had somebody who’d been on the same medicine for five years and had no clue that that was even what was going on. Oh, no. So, yes, I tell everybody, even if they come to me on one from somewhere else, we go back over everything.
John-Nelson Pope: Yeah. You, and you also determine if, if somebody’s been on a medication for 20 or 30 years, like mm-hmm. The, the, the be all, end all Prozac, which has been around for [00:33:00] a gazillion years. Doesn’t it lose some of its efficacy or efficiency? For some people
Carrie Hill: it can, because our brains are very smart and it can get used to the pattern of the medicine and it can stop working.
Some people can go. I’ve seen, I think the longest I’ve seen is probably 20 years. I recently had somebody on Alexa for 15, and so it can last a very. Very long time. And, and some people may be wondering why somebody’s staying on a medicine that long. That’s individual as well. It’s a, it’s a personal thing.
A lot of people, when they start an antidepressant and they see the difference between the way that they feel on it versus being off of it, they don’t ever wanna go back to feeling the way that they did. And so they’ll continue taking their medicine and they, and that’s. Perfectly fine, but they can always stop it if they want to.
John-Nelson Pope: Now, there’s a couple of my clients said, well, I don’t want to take medication because it’ll change who I am, who I really am. And what do you, how do you respond to that?
Carrie Hill: Well, that’s what we’re looking for. We don’t want it to change because when these [00:34:00] medications work too good. So, so if we’re treating anxiety, just, just to
Chris Gazdik: add to that, yeah.
There’s, there’s a big concern. A lot of times we hear, we’re like, I feel all drugged out. I’m all numbed out. I’m, you know, I don’t, yeah. I don’t feel like myself, you know, there’s real specific experiences people have.
Carrie Hill: Right. And that’s, that’s right. ’cause we want the anxiety to calm down and we want it to be manageable.
We want it to be mild and infrequent. We don’t want it to be moderate, severe, or panic. So, you know,
John-Nelson Pope: I usually say, and, and I, I don’t give medical advice, but I usually say it, the purpose is to make you feel more the way you want to feel, the way that you, the more you, the more authentic you. Is, is a result of that medication.
Carrie Hill: Right. And when it, sometimes it’s usually dose related. Sometimes it can be on the starter doses, but it’s usually dose related. If we get it a little too high and people can say, you know, I feel emotionally numb. I don’t feel like I’m having feelings, I can’t cry. I get that. You know, sometimes when it’s too high it, it’s [00:35:00] appropriate to cry and.
And, you know, certain circumstances, but it not crying every day. That’s not typical. So
John-Nelson Pope: yeah, we don’t want that. Staying in bed, not, and crying all the time. You don’t want that.
Carrie Hill: Yeah, that’s, that’s usually the first symptom actually, that goes away. Crying spells are typically like within the first week.
That’s the first, the first thing that starts to subside to get better. Yeah. Mm-hmm.
Chris Gazdik: Yeah. Yeah. So what’s the third? So, because I’m sitting here thinking, it’s like I got the weight and I got the sex and I’m thinking, I, I, but I actually, I wish we would’ve played a game. John, do you know the third? Yeah.
What’s the
Carrie Hill: third?
Chris Gazdik: I don’t, I don’t know. The third, my guess is sleep. Guess the third. That’s the only big thing I can come up with is sleep factor. Sleep impact. Do you have a guest, John?
Carrie Hill: It’s a little related that, that, but not, not sleep specific. Sort of related.
John-Nelson Pope: I’m right, but I’m wrong. What does that mean being just kind of tire of maybe is that tired?
Chris Gazdik: So lethargy and energy and whatnot? Yeah. Yeah. Okay. Fatigue. Fatigue.
Carrie Hill: Which fatigue is the biggest thing? Fatigue. Yes. Uhhuh.
Chris Gazdik: That medications can have side effects of
Carrie Hill: Oh, yes. Of
Chris Gazdik: fatigue.
Carrie Hill: SSRIs, the biggest ones that could potentially, not all of them, but [00:36:00] potentially could as Lexapro and Zoloft, but I dose my Zoloft at night.
And Lexapro is typically morning medicine, but if fatigue was a factor, it, you know, could be switched in bedtime.
John-Nelson Pope: And I think selexa is, is a, a mirror a molecule. I mean, it was the first one, right. Citalopram. Mm-hmm. And Celexa is, if you’re older, they take you off of that because it may cause heart, heart issues.
Is that correct? Yes, that’s correct. It could, and Lexapro, QT Lexa, it doesn’t, has fewer side effects, right?
Carrie Hill: Mm-hmm. Yeah. Yeah. So the Lex Pro. I, I would say, you know, is because it came out after Celexa, it’s a little bit more superior, you know, maybe a baby step more. But, but yeah. So of course Prozac was the first one.
Do y’all remember when it came out? It
John-Nelson Pope: was like the eighties, late eighties when it mm-hmm.
Carrie Hill: Yeah.
John-Nelson Pope: I remember it being, I was at on the psychiatric ward as, as a chaplain at, at the Naval Hospital, and that’s where they [00:37:00] started prescribing it at that time.
Chris Gazdik: So, listen to this. Carrie, what do you think about this?
This is a, a. A list of medication side effects. See how terrifying this is with people. But listen, don’t turn me off listening. Public, you hear it all the way through Here are side effects of a specific medication. I’m not telling you what medication it is for a reason. Abdominal stomach pain, cramping or burning?
Black. Tear stools, bloody and cloudy. Urine. Change in consciousness. Chest pain or discomfort? Confusion. Constipation. Convulsion. Severe or continuing? Dark urine. Increased frequency and amount of urine. Diarrhea. Difficulty breathing. Drowsiness. Fainting. Oh, I don’t want fainting. Fast breathing. Fast talking.
I didn’t add fast talking. I just add that ’cause that was a joke. But fast breathing isn’t, that’s a side effect of I can’t tell you yet. Feeling some terrible thing will happen. Fever, general tiredness, weakness, headaches, heartburn. Increased thirst, indigestion, irregular heartbeat. I could go on. Do you wanna know what these are side effects of coffee.
Yeah. Neil’s off the [00:38:00] mic. He says Coffee. No. Aspirin. Aspirin. Yeah. These are side effects of aspirin. Well, it would, John. Yeah, definitely tar and I could’ve gone on for a lot. Longer. Longer. Too much. It cause
John-Nelson Pope: bleeding. Yeah. Yeah. So
Chris Gazdik: I’m not diminishing any of these that we talked about. It is terrifying. But I want to make the loud point, obviously to you, aspirin would’ve been
John-Nelson Pope: a pre would be prescription if it were invented.
Well, right. I mean, they, they’re
Chris Gazdik: prescription things, but I just, I don’t want you listening freaking out about side effects and medications. It’s scary, it’s terrifying. But when you know and understand they’re the exception to the rule, it’s not terrifying. Right. It is
John-Nelson Pope: the exception. If there is a a problem, they black box it, don’t they?
Carrie Hill: Yes. So with speaking of black box, with the SSRIs and SNRIs, so antidepressants do have a black box warning for suicidal thoughts. So
Chris Gazdik: we’re jumping to that, that, for that
Carrie Hill: is, that is more specifically for children or people under the age of 23 or 24. So the people whose frontal lobes have not fully developed yet.[00:39:00]
So, and the reason being is that when, if medications do the opposite effect, which would mean if somebody has depression and instead of it making it better, it makes it worse, and they start to have dark thoughts or suicidal thoughts as an adult, they know to get help. They, there’s the impulse is not as.
Much as it is for people under the age of 23 and 24, tho that age group, we go over that side effect very thoroughly because the parents need to know, the child needs to know, everybody needs to know that that’s could potentially happen.
John-Nelson Pope: Is that, you said it wasn’t, I’m sorry.
Chris Gazdik: Yeah. Here, here’s the thing.
Let’s, let’s stay with this a little bit and I, and I, I want, I wanna set this up a little bit because this is one of the, you know, I mean, to think that you’re taking an antidepressant that may cause, you know, suicidal ideation mm-hmm. Is something that people get really confused about, and that’s obviously terribly upsetting.
Mm-hmm. But I wanna, I want to, I wanna go through this slowly for a moment [00:40:00] and tell you like what I tell people and I wanna see if you subscribe or if it makes sense or if it’s on point. Because the, it isn’t, I don’t even see it as that it’s been shown as being a side effect of taking Prozac or. Paxil, isn’t it?
That’s an SNRI, isn’t it? It’s ss r It is an SSR. Mm-hmm. Okay. You know, to taking, you know, Selexa or Paxil or, you know, Prozac, you know, these are, these are the medications for depression. You know, I don’t know that it’s demonstrated that it causes suicidal ideation. Instead, what happens is you have, you know, the negative symptoms of depression where your energy’s low, you get more energy.
Yeah, your energy’s low, your motivation’s low, your stam is low, and you also see the world as a sad place, a dark place, and you don’t have hope. And the different depression symptoms. When you start taking medication for depression, it helps with only some of the side effects immediately, right? It gives you motivation and energy.
[00:41:00] John, as you say, that you would have the
John-Nelson Pope: ability to carry it out, but you still
Chris Gazdik: have a horrible view that the world is such a dark place, so. It isn’t really a causal relationship. It’s oftentimes I go to my medical prescriber, which is my family general practitioner, and they, they give me this medication and they say, come back in six months, and you don’t get any contact, you don’t get any care, you don’t get any psychoeducation.
That helps people understand what’s going on. Right. And so ultimately you can have death from, but not from medication death, from getting better, but only partial. Do you
John-Nelson Pope: hear the nuance that he’s, he’s saying, I’m saying that to the pod to the audience. Right. It’s a, it’s a nuance thing, but it’s, it’s very true, I think.
Very important. Would you agree with Yeah. How do you see all that?
Carrie Hill: Yeah, that’s true. How did, how did we do? Well, I think a lot of times with depression too, is like people will let it go on and on and on and on [00:42:00] before they get help and. That’s one thing that really needs to change. It’s like you don’t wanna let depression put you in such a dark hole that once you’ve come, you, you, you’re looking for something.
Unfortunately, you’re the last
John-Nelson Pope: resort.
Chris Gazdik: Right.
John-Nelson Pope: We, in
Chris Gazdik: therapy also,
John-Nelson Pope: were the last resort, Brian Wilson back in the sixties with Beach Boys. Mm-hmm. He stayed in bed for over a year because he was so depressed. Yeah. And of course I think he had mood disorder as well. But just absolutely confined and hopeless and helpless and we don’t want it to get that far, do we?
So, so,
Chris Gazdik: so it is fair to say in your assessment as you see the medications, that it’s not a site effect. Of taking an SSRI. It is more some of the dynamics that go into our care as a profession to the person. Right. Is that generally con, does that mm-hmm. Hold water?
Carrie Hill: Yeah. Because it, and what you were saying about, you know, it helps to a certain degree, like with the energy and the motivation and then people are more impulsive to actually do something.[00:43:00]
And that’s, those folks that have thoughts like that should be followed a lot. Like you said, they don’t need to go six months without, you know, seeing somebody Yeah. Follow up
Chris Gazdik: care in a month max. And if you have some self-harm thoughts and discussions next week. Right.
John-Nelson Pope: You know? Yeah. I was going also, you treat not, I know you do motivational interviewing.
Yes. And that’s correct. But you want to get to that. Right. Go ahead. Okay. You use motivational interviewing. Do you use any other theories or, or therapy modalities. Therapy mod modalities.
Chris Gazdik: Yeah. Like do you do therapy still?
Carrie Hill: Yes, I do. Yeah, I have coach
Chris Gazdik: John. She’s a unicorn man. Crazy. Well, I, I see a halo.
Carrie Hill: It’s a halo.
Chris Gazdik: It’s amazing.
Carrie Hill: I I enjoy, I don’t have many talk therapy patients, but I do, I think I have five right now and I try to keep it minimal. ’cause I do, you know, I do focus on medication management the most. So so I do have a handful of taught therapy and I do have another handful of addiction.
So with the [00:44:00] addiction treatment, I do the motivational interviewing. And then I do, you know, just psychodynamic person centered for for child therapy. And, and I
Chris Gazdik: I agree. Absolutely. I feel like I’m in 1999, John, we’ve time warped back with a prescriber who does therapy, like Yeah. Oh, it’s, it is, it’s awesome.
Yeah. It’s totally awesome. They give you
John-Nelson Pope: 30 minutes that, that even in 99, but it used to be 45, I remember it used to be 50 minutes with a psychiatrist. Mm-hmm. And now it’s, it’s, it’s certainly just collapsed. Question is so. You would say you would do the motivational interviewing pri primarily with substance use or alcohol use disorders
Carrie Hill: or, or any of the other I have a lot of gambling patients as well.
Gambling
John-Nelson Pope: process. Okay. Good. Well, let me ask you this. When you get a combination of people dual diagnosis what do you normally [00:45:00] treat first? Or do you treat ’em both? Concomitantly. Concurrently? Yes. Concurrently. Oh, that’s a good question. We’ll see, we’ll see that she
Chris Gazdik: does with traditional substance abuse counseling.
John? Yes. So this is a trick question, Carrie.
Carrie Hill: Yes. Concurrently. So I, I only for the. That part of it. For the addiction treatment, I get people into partial remission at least three months. And then once they’re, at that point, I ask them if they’re ready to start working on the things that brought them to the substance or whatever, you know, they’re, and then that’s when I find y’all and y’all can take over the care.
Got you. So that’s you know, but in the, you know, during that time also using medications, ’cause there’s so many. Better medication options now for treatment of substance use. Any type of impulse control, there’s something out there for it. Now
John-Nelson Pope: are you, are you even doing like GLP ones and things of that sort?
Not Yes. Where you’re dealing with some of the addictive behaviors or
Carrie Hill: I not yet. I would love to. So, okay, well
Chris Gazdik: first of all [00:46:00] mm-hmm. John, you have to explain your question ’cause I don’t follow it and I’m sure listeners don’t. Well, in other words, like Oz, then follow up with what that is.
John-Nelson Pope: There been, there has been recently a flurry of, of articles, of studies of, of using GLP wants, which are what people take for wegovy or Embi.
So these are the cool commercials with cartoons on them. Yeah. Yeah. Go. Got so tired of these commercials. I hate them, but I just say that using them, using them to reduce compulsive buying and spending gambling. And I’m just thinking that’s a whole area of practice that is, is out there. Good.
They would actually need motivational interviewing, I think would do well with that. Well, and before you
Chris Gazdik: respond also, John and gambling, you can’t, you can’t geek out on all the therapy modalities. We did a show on that. We’re done with that. John. You have to stay, stay with. We didn’t even touch. Yeah, I know.
We didn’t even scratch
Neil Robinson: the [00:47:00] surface. I’m
Chris Gazdik: sorry man. We’ll go back to that issue. But, but, but you’re bringing up something interesting that I want you to respond to. Carrie, and, and I didn’t realize this, but you and I created a, a, a thought not too long ago is, am I correct to say that Wegovy and those types of medications and whatnot are managing hormone?
Production and influencing hormones and whatnot. Is that a, is that a correct statement, Carrie?
Carrie Hill: In the gut? Yeah. In the gut. The gut. In the gut. So everybody knows the gut brain connection and so how, right. But hormone
John-Nelson Pope: specific affected by those, right. Those, John, do you remember our, apart from the brain itself, that has more neurons in it.
Okay.
Chris Gazdik: Right. The brain. But, but do you remember our conversation that I kind of wondered, we created at the same time that is this sort of strange experiences that we’re seeing with menopause and other types of things related to hormones. Right. And I didn’t know that Will Govi and these HP, what did you call ’em?
Glp. GLP one. One [00:48:00] Medications, right. That are used for weight loss and weight management and whatnot are being prescribed. Off-label question mark. They’re doing a lot of research because
Carrie Hill: these things have only been out for, what, five, four or five years now? So, so what are
Chris Gazdik: the impacts on compulsions?
Carrie Hill: It helps, it’s amazing.
It’s not really ozempic. I have. I haven’t seen that much. I mean, Ozempic can be helpful. It’s the other one, it’s Eptide. So the Zep bound I can’t pronounce Monro right. Those, well just let Carrie
Chris Gazdik: pronounce it.
Carrie Hill: So those medications have been very beneficial. I’ve had quite a few people stop drinking alcohol with them, and I, I can’t prescribe those myself.
But I do a ton of education because I want people to know that I want them to choose that one, everything. Why
John-Nelson Pope: can’t you prescribe them?
Carrie Hill: Okay, so I’m not family practice and I did not do that side of things. So I don’t do the medical side. However, if it’s a side effect of a medicine, then I can’t. So back to the Viagra, if it’s a side effect of a medicine and [00:49:00] it’s a medical medication, then I can do it related to the side effect.
But that hasn’t really been signed off yet.
John-Nelson Pope: That’s almost like how VA does things, which is not very well in that area. I think they, there should be a broader. See, I’m, I’m, I’m trying to bring you more business. Alright. Yeah. Let, well, let’s, let’s get back on. Thank you. I appreciate it.
Chris Gazdik: Yeah, we could go for hours with that.
I mean, that, that’s a, that’s a deep hole that I wanna pull us out.
John-Nelson Pope: Well, well,
Chris Gazdik: and, and, and, and, and I wanna move to, before we run out of time some of the current events, some of the things that’s kind of going on now. So we told, we said we get political a little bit there. There’s, there’s two, there’s two main areas that I kind of want to go into.
’cause we’ve already talked about the self-harm and the suicide thing, and I know that’s in the public eye and a big concern and, and, and how that works with medications. So there’s, there’s two areas that I wanna get your thoughts about Carry. One is just the newer medications. Like I’m cu curious about what generation of drug we’re on.
Like I know third. Generation, some of these fourth generation are gonna be familiar to me, but [00:50:00] I know we start getting into fifth and sixth. I, I’m starting to get lost with the new medications. Like I I, and I don’t like that. So I wanna ask, we probably need a whole nother show for that. But the other is the Bobby Kennedy’s claims and concerns specifically with SSRIs and what you’re seeing with patients that are coming in with these fears.
I mean, hopefully we’ve addressed a little bit of this already, but those are two areas that I want to go into.
Carrie Hill: Yeah. Well, with the politics and things, we’ve tried so hard, all of us therapists and everybody in the mental health field has tried so hard to keep, you know, help the mental health stigma.
And now the politics have, it’s really almost tearing down the things that we’ve worked so hard to get to and to the point where I’ve had some primary care doctors who won’t now start medication. They are sending. Sending people who need antidepressants to mental health providers. I don’t know why. I don’t know.
Wait a minute. Say that again. I’ve had [00:51:00] doctors that would not start antidepressants, like general, like usually when you have depression or anxiety, you’ll get screened. You know, they ask you a like one or two questions at the doctor’s office, and then typically a general practitioner or a PCP, a primary care physician will start an antidepressant.
Yeah. Because they, they, that’s back in the day. They used to do, they used to do everything. Right. Now, but now, now I’ve seen recently, this has just been within the past couple months, patients have come to me and their doctor didn’t, would not start them on
Chris Gazdik: Really.
Carrie Hill: And I was shocked. And I don’t know if it has to do with, these changes that have been going on have
John-Nelson Pope: fears and stuff? Well, that, yeah. Or even, or hhs I should say. Sorry. Think. I think maybe the doc, the, the healthcare providers are probably scared that there might be a lawsuit down the, the road somewhere down the road. I hope
Chris Gazdik: that’s not,
John-Nelson Pope: but, but I think part of it has been the scaremongering of, of certain politicians [00:52:00] and that don’t have any.
A particular education. They’re there. A lot of times they’re lawyers and I love lawyers, but they need to stay in their lane. Mm-hmm. And practice law. Practice law,
Chris Gazdik: not medicine. Yeah. I, so Carrie, how much are you hearing this from people? Like, what’s happening in your, in your practice with the, I mean, I’m gonna imagine you might even have people that are already, you know, prescribed and working with you and now come in with new fears, hearing things.
Are you, are you even seeing that level?
Carrie Hill: Not yet. Because I think that the people that I’ve already been working with, you’ve educated them. Yeah. They know and they know the difference too because, you know, I tell them what to, what to expect and you know, how things are supposed to be and, and things like that.
And we always keep, and they know that they can contact me anytime ’cause, and they know to contact me by email. ’cause that’s the best way to get me. So, you know. There’s always that open communication. And, you know, I don’t want anybody to have any fears about things when it comes to medications and, and things [00:53:00] like that because they can be so helpful.
But I want them to be educated enough to be able to make a great decision for themselves of them.
Chris Gazdik: So, yeah, it’s, I don’t know how.
Through a therapist size is here to blow up stereotypes, myths about mental health and substance abuse, and then disseminate as much information as we can about these topics and things. And I, I guess I’m, I, I’m, I’m not sure about how big and wide this net goes that people are fearful. I actually thought that there would be people developing new fears even though they’re educated.
’cause you hear so much and it’s, there is fear-mongering. Mm-hmm. John scary kind of reports. And the suicide thing is just terrifying for sure. Like, you know, it’s, it’s a, it’s a lot of
John-Nelson Pope: That’s been an issue for 20 years though. Yeah.
Chris Gazdik: Right. That exactly. And, and so I guess I’m, I guess I’m wondering like how big of an issue this has come or is this chasing a red, airing that people aren’t having new fears about this?
I don’t know.
Carrie Hill: Well, I think I know that one other drug [00:54:00] that is. There’s a lot of being
Chris Gazdik: targeted. Yes. Being targeted.
Carrie Hill: Adderall, no, not Adderall. Oh, well, we got another one too. Suboxone. Suboxone is one of the absolute best medications to help with opiate use disorder. Whether somebody is addicted to heroin, fentanyl, opiate pills, it doesn’t matter what.
Now Raum yes. Hate, hate to say that, but Oh, it’s a thing. Because people don’t even know what that is. But you creative is it is a thing
Chris Gazdik: another derivative of, of opioids. Yeah. It’s it’s in the same
Carrie Hill: thing. So you know a lot of, a lot of people. And you can get it
John-Nelson Pope: in stores. Yeah, I can, around North Carolina.
Anyway, I knew an officer, a police officer that was using it because it wasn’t being tested. Mm-hmm. So, mm-hmm. Right. But, but it has a lot of side effects.
Carrie Hill: Oh, yes, it does. And so suboxone is, is. There’s not enough education about how wonderful that medicine is to help people with cravings, help people with withdrawal.
The two biggest reasons why people use and can’t stop on their own is cravings and withdrawal. If they get sick, they need [00:55:00] something, they don’t wanna be sick, and it’s very hard to go through that all the time, you know, use and then, then start with drawing. And that’s why the pattern continues. And families will say if they, if, you know, sometimes I’ve heard patients will come for treatment with Suboxone and the families will say, oh, you’re just trading one drug for another.
Absolutely not. You are trading an illegal substance for a substance that is legal and gonna keep you off the streets and off from buying things that you shouldn’t be buying or getting you in trouble with the law.
John-Nelson Pope: Do you use a Vivitrol.
Carrie Hill: Yes, naltrexone and Vivitrol use that a lot too. So
John-Nelson Pope: Vivitrol goes into the butt, doesn’t it?
Basically every, yeah.
Carrie Hill: Once, once a month.
John-Nelson Pope: Oh, wait a minute. Wait a minute. We get turnstile. Do do the, because I have some clients that, that are on that and have had great experience with that. What, what is your opinion of that?
Carrie Hill: I think it’s great. I think it keeps the levels well, wait, it’s a
John-Nelson Pope: Vivitrol is [00:56:00] what John, and, and, and we use it for, what it’s naltrexone is for alcohol use disorder could also be opiates, right?
Mm-hmm.
Carrie Hill: It’s, yeah. For opiate or alcohol, use another one of the same
Chris Gazdik: types of things as methadone, Suboxone, sub Suboxone. Yeah. You know, those types. Well, the
Carrie Hill: only difference between them is that it’s not a controlled medication, so it helps with cravings. It helps for people. So say somebody can just,
Chris Gazdik: basically these are substance abuse treatment, medication world.
We, we just switched to that. Yes. On different domain. Yeah.
Carrie Hill: Yeah. So for people who have been able to stop on their own but they’re still kind of struggling and still kind of having periodic cravings and things like that. Naltrexone and Vivitrol is wonderful because they, you only have to be seven to 10 days free of alcohol or opiates to start it.
And the, the dose for the tablet, which is the naltrexone, is just once a day. And there’s no increasing that. It’s just one pill, 50 milligrams once a day. I do have some people I have to take a half tablet if they have side effects, but it’s still a better option. It can also help with food related.[00:57:00]
So, I don’t know if everybody’s heard of Contra, but Wellbutrin no Contra. Yeah. Yeah. Wellbutrin and Naltrexone is in contra, so that helps with food cravings and it’s issues of that. Wellbutrin
John-Nelson Pope: is used for smoking cessation.
Carrie Hill: Yes. For, well, and I use a lot of Wellbutrin.
Chris Gazdik: So really personally or professional.
John-Nelson Pope: Sorry.
Chris Gazdik: God just hit me. And the way you said that, I was like, what do you mean? Do you use a lot of Wellbutrin? Well, I use a lot of Adderall. I, that I have,
Carrie Hill: I have my favorite medications that I like to prescribe.
Chris Gazdik: Now I lost my train of thought. I had a thought that I, well, you
John-Nelson Pope: need some, some Concerta or
Chris Gazdik: Yeah.
S
Carrie Hill: Vyvanse, that’s,
Chris Gazdik: people have said I have a, he has five is the best adhd, but I think it’s a learning disability that I have. Not a DH adhd, but that’s, that’s a whole nother. Todd. Well, I can give
John-Nelson Pope: you a, an assessment. I, I am curious to go, John. I’m not taking your
Chris Gazdik: test. John. I I’m getting here. We’re not going backwards to the, the surveys and everything but I am kinda curious real quick ’cause because we’re, we’re needing to wrap up time-wise.
What what are generation of drugs we’re on now at this point? I mean, [00:58:00] you know, we’ve, we’ve had different iterations of medications that have improved over the years. First generation just means like an old, old medication that we used to use that now we don’t like Trazodone as a first generation medication antidepressant, I believe.
Yeah. That, that now we don’t use for anything, but like a mild sleep agent. Right, right. So, so generation 3, 4, 5, we up to six seven. Where are we at?
Carrie Hill: Well, that’s more for the antipsychotics. So that’s specifically for first generation antipsychotics like Haldol and then second generation like Seroquel and Zyprexa and Ol.
And that
John-Nelson Pope: be a lot of the weight gain issues come with that. Yeah. Second second’s
Carrie Hill: where that goes.
John-Nelson Pope: Oh, yeah, yeah. But, but the newer generation seem to be less. Yes. So the, so
Carrie Hill: any medicine after Abilify after or or starting with Abilify after. Are supposed to be better as far as weight gain goes, or you know, increased appetite and and weight.
Emphasizing
Chris Gazdik: the word supposed to means supposed to
Carrie Hill: be, but we [00:59:00] still know, and I still tell people, and with those medications dependent upon if they have to have it. So, you know, with some diagnosis, you have to take your medicine, bipolar disorder, schizophrenia, you have to take your medicine regardless of if there’s weight gain, which is good that that GLP ones came out because now.
The weight gain can be managed with the GLP one. So it’s, it’s good now, but yes, Abilify and On’s not supposed to cause as much weight gain, but it’s still possible.
Chris Gazdik: So I told you we would not be able to cover everything that we wanted to cover. Right. Because I have like a lot of questions in my mind as well, and I know people would have, but John, I wanna make sure you have space to, did you have other things that we’re helping up with?
No,
John-Nelson Pope: no. I just want her to come back. Probably Will. Yeah. Yeah. If
Chris Gazdik: we can give answer. Sure. I want her to, I just want her to come back. I want her to come back too. John, do you think she will? Maybe because there’s a lot of questions about you know, people are curious like, is this gonna be the [01:00:00] rest of my life?
Can I take these for a season of my life? You know, is there, are there some of these medications that I can take what’s called PRN, just when I need them? Or do I have to take them every day? And the answer is.