Consult the Pharmacist with Guest Dr. Shari Allen

Tina: Hey everyone, I'm Tina

Serena: And I'm Serena, and we are the Mental Health Mamas.

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Tina: Welcome to No Need to Explain. We are so glad you're here. 

Serena: First, as always, a quick disclaimer.

Tina: We come to not as mental health professionals or experts in the fields, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health.

Serena: If you or someone you love is experiencing a mental health crisis, please seek professional support. You'll find a variety of resources in our show notes and on our website noneedtoexplainpodcast.com.

Serena: A few weeks ago, we dropped an episode about medicating our kids. That was literally the the question. Should we medicate our kids? And that particular episode got a lot of attention. And as always, we work to share our personal experiences on our journeys as parents with some sharing of resources mixed in.

Tina: One of the people who noticed our episode was Dr. Shari Allen, who just happens to be a board-certified psychiatric pharmacist. We are thrilled to have Her joining us here today to talk more about this important topic. 

Serena: Dr. Allen is an associate professor of pharmacy practice at Philadelphia College of osteopathic medicine, School of Pharmacy, where she teaches the mental health and neurology components of the therapeutics curriculum. She also maintains a clinical site at the Atlanta VA Medical Center in outpatient general mental health. Shari, welcome to the podcast. 

Shari: Hi, I'm so excited to be here. Very excited for the opportunity. I was thinking about it this morning and I said, as nerdy as it sounds, if I could do stuff like this all day, every day, I would.

Tina: Well, nerd out with us because we love it too. So, Shari, we have to start out by asking how close were we in our episode about kids and psychiatric meds? 

Shari: It was good. It was good. I thought a lot of the points were spot on. I think a lot of the points too were questions that I think I get a lot from everyone. One of the points I think could use even more clarification because again, it's one of the main things that I hear from people all the time and that is there a difference between brand and generic medications. And like you all said, there is a difference between brand and generic medications, but I think a lot of people stop there and they're like, no, no, no, I don't want to be on generic or I don't want to be on a certain brand because of this difference. But for even more clarity, it's important to know that the FDA does allow some variability, but that variability is supposed to be less than I believe 10%. And so, even more so, that variability is not supposed to give mean like a difference between whether this medication works or whether it doesn't. And so, what that means is we usually when I see people and they have, they cannot tolerate a certain generic, it's not the active ingredient that you can't tolerate. It's the inactive ingredients. But there are certain people who I would say, yeah, if you are on a certain brand or you are on a certain generic stick with it. And that's if you have epilepsy or if you're being treated for seizures, because that difference can mean, it can mean the difference between having more seizures versus less. But in general, I would say, just I would say be open to using certain brands and certain generics because again, the FDA isn't just like, hey, let's just let all the generic drugs come out. There's a lot of testing that goes on and they do have to be able to prove that efficacy-wise, there isn't a significant difference between between the two. But either way, I think it was really good. 

Serena: Thanks. Yeah, so one of the things we talked about in that episode was about what it's like to take psychiatric meds and how they're clearly they're not a magic feather or a happy pill in any way. So let's take antidepressants as an example that many people are familiar with and there's actually been a lot of between the time we talked before and recording now there was an article in the New York Times and I just saw last night. There's a show on Netflix about meds and should we all be taking these meds. So talk about if you could what the antidepressants do for us and who might or might not be a good candidate for trying this type of medication? 

Shari: Yeah. So first, I think, so it's important to know that antidepressants are used for more than just depression, but we use them for traditionally most commonly, we use them for depression and also for anxiety. But I think thinking more about depression, one of the reasons why we think depression happens or what contributes to depression is low amounts of these chemicals, norepinephrine, dopamine, and serotonin are like the main ones that we think for whatever reason are low when someone is experiencing depression. And so what all of our antidepressants do is they increase dopamine, norepinephrine, and or serotonin. And then when they do that, they can help to they can help us to feel certain things. So if I have someone who is like, who is depressed, but they have no motivation, they're not able to concentrate, they're feeling just like low, low energy, then I might want to use something that can increase a little bit of dopamine. If I have someone that has difficulty with sleep or they're sleeping too much or not enough or just sleep is imbalanced as a part of, as a part of their symptoms of depression, then I might want to use something that has that can increase or alter serotonin. 

So again, what the antidepressants do is they alter these chemicals, but then those chemicals can do certain things in our body or are responsible for certain things in our body. And I think when people meet me, they think, oh, I'm a pharmacist, like all my patients, they think because I'm a pharmacist, that I'm going to say, oh, you've all got to be on meds, like everyone start your medications, I'm just going to add all the meds to everybody. But that's not true. And I even tell my pharmacy students that work with me. I say, listen, just because you're a pharmacist, it doesn't mean when we meet somebody, the first thing we have to do is give them 10 different medications to try. I think when it comes to depression and anxiety, I will forever stand by the point that therapy is the go-to. Like, I would, I tell my patients every day, you will have much better outcomes if you go to therapy and take medications versus only relying on the medications to help with whatever it is that's going on. So, but guideline-wise, if depending on how severe your symptoms are, you, it's not recommended for everybody to take an antidepressant. But to then, depending on how severe the symptoms are, the more severe it is, then yeah, I might say, with med, I will never not recommend therapy, but I'll say with therapy, plus medications, depending on the severity, yes, an antidepressant can be helpful. But again, I would say it's not, antidepressants are not, everyone doesn't need to be on an antidepressant because you have depression or anxiety. It depends on the severity of your symptoms.

Tina: Yeah, so we often talk about our toolbox, right? Like, what's in your toolbox? And we will just, you know, kind of openly share that the gold standard is therapy and medication for kind of severe cases, right? And we shared our experience that with medication, the therapy was much more effective. But again, those are just two tools in a very wide toolbox, right? There need to be a lot of tools in that toolbox for success. So, thanks for all that. Yeah, that's awesome. So, our audience should know that they can find you on Instagram and we have that link in the notes, where you share lots of really helpful information about psychiatric meds. We'll make sure that we share all of your Instagram info. But tell us why you decided to start this page. 

Shari: So, you all know, you two know that I have two children. I have a one-year-old and a three-year-old boys 

Tina: Who are adorable. 

Shari: Thank you. They're growing on me. They, I think like most people, when I first have my children, I like, and even to this day, I don't know what I'm doing half the time. But as a result of that, I am on all these like Facebook groups and I'm on Google searching, all of this stuff. But the main thing was Facebook groups. And so, I'm in a couple of Facebook groups, parenting groups. And with good intention, I think people will always post on these things and I would see like parents posting things like, you know, hey, I'm experiencing postpartum depression. My doctor wants to start this. What do you all think? And then someone else might say, hey, I'm on this medication and I don't really like it or it's causing weight gain. What do you guys think I should do? And with good intention, I will say that with amazing intention, people would respond and say things like, oh, you should just stop that and do this instead. Or you should tell your doctor that this is what is more helpful than that. And the pharmacist in me would cringe because it doesn't quite work that way. And I understand that people's intentions are really good. It just doesn't work that way. Like the, I'm not going to say unfortunate, but the thing about mental health medications about all of our psychotropics is what works for me may be amazing for me. And it may do nothing for you. And, and, and my one of my biggest rules for my patients is if you don't want to be on a medication, tell me, but don't just stop the medication. That could mean even worse outcomes. So I started the page as like a place where I would hope that not just like other healthcare professionals, but anybody, anybody, parents, caregivers, patients, my students follow the page sometimes. Other healthcare professionals, you can come here and get what I hope you would find is reliable information about mental health medications. 

Serena: Yeah, it's awesome. I encourage anybody, anybody and everybody to check it out. So what are, what are a couple of the sort of biggest misconceptions you that you see people having about medication? 

Shari: I think the biggest one is that you think that they don't work because you still feel something. And, and that's the thing. I don't want you to not feel you should still feel something. I think, and I've talked about it with patients and students and anyone who's willing to listen, I've talked to them about that when feelings are natural. So when you have something sad happen in your life, I teach at a pharmacy school. And unfortunately, you know, when we have tests, some of the students don't do well on this test and you don't get a passing grade. It is natural and normal, I think, for you to feel a little bit sad about that. And just because you're on an antidepressant doesn't mean that you're not going to be disappointed or sad that maybe you didn't do as well as you thought you want, you were going to do. But same thing, if something good happens to you, it is natural for you to feel excited and happy about that something good. I think that people think when you're on antidepressants or even on antipsychotics or mood stabilizers, whatever they are, you think that you're going, that you'll never be sad again or you'll never be anxious again or you'll never hear things or see things again. And you will, you probably will. The goal though is that you have, I tell my patients, I say, your goal is to have more good days than not so good days. And I think it's a win if I had a patient the other day who is still hallucinating, he's on an antipsychotic, but still experiencing hallucinations. But for me, it's still a win because his hallucinations are a lot less than when he was not on the medication. So we still, while they're not gone, it's still a win because it's a lot less than than before medications.

Tina: Yeah, that is such a good point. That is such a good point because it's, you know, we have dealt with OCD and it's not like those symptoms will go away forever. They will wax and wane like they have for a lot of years in our world. And it's the management of it. Like, how can I have that tool that's going to help me manage? And like you said, have way more good days than bad days, right? So awesome perspective. Thank you for that. So I can speak personally, you know, for my personal experience about medicating my child. And that was a really tough decision for us. So I'm curious, what advice do you have for parents being a parent yourself, right? About, you know, people who find themselves in a stuck place, what advice would you have about medication? I mean, I did share on the medication episode that I fired my first doctor who said my child need to be on medication medication. I said, no, no, no, goodbye. We're never seeing you again. So what advice do you have? 

Shari: You know, I would say a couple of things. I would say, and this is not just for children, but for everyone, because I think a lot of people are like, oh, I don't know if I want to start something for my mental health. But I think look at it like this, if my child had, and my children have you all know, my children were sick when we first met. My, when my kids have an ear infection, hands down, I never question like starting an antibiotic, because I'm like, you have an ear infection. That's what you do. You start an antibiotic. Or my, my one child, my oldest son had, I think, strep throat not too long ago. So not a problem, starting an antibiotic, but same thing with adults, when we have diabetes, we're like, all right, cool, gotta start insulin, gotta start something for that. When I have high blood pressure, gotta start something for that. You're to me, and I know it's easier said than done, but to me, I think your mental health is the same concept. It's, it's, we treat it as like, it's like a special thing. It's different than our, than our medical concerns. It's all the same. So just think about how, for me, it's all the same. Just think about how the same way that you would treat high blood pressure, the same way that you would, you would likely treat your, your, your child with an antibiotic is the same way that maybe you should think about treating them for something that's going on with their, their mental health as well.

But I think, and I love what you all said in the, the podcast that, that I like refer back to a lot, is that I think you should educate yourself. For me, my concept is this, when, and I've, I've treated pediatric patients before, when patients, when parents come to me, and they want to know like, what's the best thing to do? I say, listen, it's not my job is not to sit here and tell you, this is what you need to do. My job is to give you the best, the pros and the cons. My job is to tell you, educate you the best way that I can, so that you can make an informed decision.

So I would encourage all patients to do like you all said that you do is question your providers, question them, ask them, if they say that they want to start a medication, ask them why, I teach my students this, I say anytime you make a recommendation to start a medication, you need to have at least three amazing reasons why you wanted to start that in that specific patient, and it can't just be like, it can't just be because that's how we treat depression. No, it has to be patient specific reasons why, so I think, I think as parents and people in general like ask all the questions and be comfortable with the decision, and I hope that everybody also finds a provider that understands that not everybody is comfortable with starting medications, and I'm willing to work with you on that until you get comfortable. I'm here to support you in whatever decision that might be. 

Serena: I love that. I'm just thinking as you're talking about our shortage of providers in our country right now, and I'm sure there's no easy answer to this, but yeah, so what are you, just tell me what you're seeing in terms of your work and are you guys stretched thin right now? 

Shari: You know, I love what I do, but we are stretched super thin, so with where I work in outpatient mental health, I love what I get to do, I get to see a ton of patients every day, but that can be draining isn't the word, it can just be a lot to manage. We have a shortage of psychiatrists and even the clinical psychiatric pharmacists like myself, where I work, there's only I think five or six of us, but and then specific to the clinic that I work at, we have over 4,000 veterans that we that we service all the time. And so think about having five psych pharmacists and maybe 45 or 50 psychiatrists all throughout are like our facility that service all of Georgia, the load is is high, the load is high. And I think when it comes to mental health too, you get kind of numb. My students all the time, they're like, how can you listen to like some of the things that the patients say day in and day out, you do get a little bit numb to it, but I always try and check myself when I'm getting numb to it because I don't want to get, I don't want to get numb, I don't want to be like, you know, everything's like a checklist, like all right, come in, let's what's going on here, here, here, here's the medication, goodbye. I try and stay very well, like vested and alert and aware of what's going on with patients, but I think as the load gets higher and higher and you have less time in the day, that can get really hard, but you just have to sometimes take a step back and and just remind yourself what you're here to do and what you're here for on your purpose. 

Serena: Yeah, it's a lot. Yeah, for sure.

Shari: I find myself, I don't know why I'm finding myself getting emotional.

Serena: Yeah. Oh.

Shari: I genuinely like, I don't know, and I've told you all this before, you can't see me, but I told you whenever I get excited, I talk with my hands. So I just, I can't even express how passionate I am about about it. I love the patients I get to see. I genuinely, when people ask me questions about about their medications or just about mental health in general, I that's like, that's my thing. You know how people say like, find the thing that you love to do? That's the thing that I love to do. I could talk about this all day if you let me. I want it. 

Serena: Yeah, yeah, it's that's awesome. We're just, we're grateful that you're out there doing that and that there are people who are passionate because I can imagine it is, you know, easy to burn out in in the field. So as we spoke prior to recording, we were talking about sort of the pharmacist as being part of your medical team and how we don't always think about consulting with the pharmacist, but you've gone to school for a whole bunch of years, right, to learn this information. So when, when should we as parents or individuals be talking with the pharmacist? 

Shari: All the time. 

Serena: All the time. OK. 

Shari: I like, anytime that you have a question, here's what I would hope that people would do. Anytime that you have a question or a hesitation about medications and honestly, not just about medication. So as pharmacists, we don't learn, we, we spend six plus years learning and studying medications, but we also know about disease states as well. So I think anytime that you have a question or a concern about your medications, my hope is that you would feel comfortable reaching out to a pharmacist to ask them. Now, I will say that the feedback that I get a lot of is the pharmacists that are most accessible are my colleagues that work in community pharmacy. So those that are out like in the public working at different chain pharmacies or independent pharmacies. And yeah, I know because I've worked in that field too that it's busy and sometimes it can appear that the pharmacists may not have, you know, time to sit down and talk about certain things with you or answer your questions, but that's something that I think as a profession that we have to try and tackle, but that's like a whole different story. But I think if you can to reach out to your pharmacist, anytime that you have questions, so whether you schedule an appointment or call during off peak hours, go to the pharmacy, during off peak hours or, you know, by doing this, people that are listening to your podcast, if you reach out to me, every Friday, I do Q&A Friday and people send me questions. And as broad as I can, so I don't answer questions that are like super specific about here's like what you should do about your certain disease date or your your specific case, but I make myself available to answer questions that are that that people have. So I think just that's my biggest thing. You should always reach out to a pharmacist. I hope that you'll always reach out to a pharmacist whenever you have any type of question about about a medication. I hope you feel comfortable doing that. 

Tina: Well, I felt so comfortable doing that, but literally when I left our last home and moved, I cried when I left the pharmacist because I liked I really liked her so much. She really helped us in so many ways in stuck situations. And yeah, I can't say enough about that. So Shari thank you for joining us today and answering some of our questions. I would again remind people to join her Instagram just to, you know, make sure follow, I guess, I don't know. Is that what you do? Follow Instagram? I don't know. Anyway, we're going to put the link in. Just go to the link and click on it and you get connected in some way. But I also loved your reminder that medical health and mental health are one in the same and that it's it's about all of us, right? So yeah, so I can imagine that we might reach out to you in the future and that people will really appreciate being connected.

Shari: Thank you for having me 

Serena: And so podcast friends. We are, as always, grateful for all of you listening and supporting us. We know you have a million choices out there and we appreciate that you've given us the time to listen to what we and our guests have to say. You can help us out by visiting Apple Podcasts, leave us a review, subscribe and share with others. You'll find more content on our website. Noneedtoexplainpodcast.com. Connect with us on the social, the socials call and leave us a voice message with lots of options. Share a bit of your story. Tell us what you think of the podcast or just call to say hi.

Tina: And this is your gentle reminder to take good care of yourself while you are also take care of your people. 

Serena: Thanks for listening. 

Tina: Bye!

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