Therapies that affect physical or biological processes of the body are known as “medical” therapies. These therapies can include medications, alterations in diets, changes in sleep habits, increased physical activity, stress reduction and more. At CNNH, we utilize a various approaches to therapeutic interventions, using medical therapies in conjunction with other therapeutic modalities (behavioral, cognitive, social, creative arts and others), and optimizing non-pharmacological approaches prior to consideration of medications. However, there are many situations where a biologically-based disorder will not necessarily be controlled without the assistance of medication or other medical therapies. Additionally, many individuals with epilepsy, autism, mood and thought disorders, Tourette Syndrome, ADHD, migraines, and more may benefit from medical therapies.
Although the brain is part of the “central nervous system” and has many layers of protection, the brain is still part of the entire body, and what happens in other parts of the body can influence the brain, and vice-versa. Medical therapies that target aberrant biological processes can help neurological function: for example, increasing physical activity can improve emotional states, improving sleep patterns can lead to clear thinking, and controlling allergies might lessen problematic behaviors. Medications, particularly when used as a broader and diverse treatment package, can affect brain chemistry or quiet neuronal (the main type of brain cell) excitability. Medications can also help to correct abnormalities and irregularities in other parts of the body.
Medications have potential side effects. Thus, when determining if a medication should be used, the benefits versus the risks should be carefully weighed.
When used judiciously and conservatively, drug therapy can be very useful. However, there are some important principles of medication therapy that we at CNNH adhere to:
- Do not use medications to make a diagnosis, but rather through appropriate diagnostic and other evaluations and testing ensure that there is a proper diagnosis, and utilize medications that target specific biological mechanisms and pathways, symptoms and/or signs.
- Prior to starting medications, be sure there is not some other identifiable reason for the presenting problem. Thus, it is necessary to understand that difficult behaviors, particularly in those with developmental disorders and brain injury, can be triggered by treatable conditions: for example, a tooth infection in a child with autism who is non-verbal can result in self-injurious or aggressive behaviors, and fixing the dental problem will alleviate the behavioral concerns.
- Utilize medications as part of a total treatment package, not in isolation. Understand that in most cases, drugs are not cures, but treatments.
- If possible, try to avoid polypharmacy (i.e. the use of multiple drugs simultaneously). When polypharmacy is necessary or unavoidable, use medications that are compatible, while monitoring carefully, understanding how various drugs may interact.
- Prior to starting a drug, perform appropriate baseline testing, and assess for any contraindications (i.e. reasons that a particular drug should not be used, such as a drug allergy for that particular medication).
- When starting a medication, work up to a starting dose going slowly, with a goal at achieving a minimally effective dose.
- Allow adequate time to assess for a response to a medication: some drugs work very quickly, others might take weeks until a benefit is realized.
- While on medication therapy, depending on the type of drug, ongoing examinations and laboratory testing may be necessary to assess for side effects and tolerance.
- Periodically review medication regimens and determine if they are still necessary or adequate. When, despite the use of medications, there is a lack of success or poor outcomes, re-evaluate the drug regimen and/or the person’s diagnoses.
- Ensure that a qualified and appropriately licensed health care provider is prescribing your medications.
All medical therapies at CNNH are individualized and personalized, so that specifics will vary from person to person. Some people respond to certain medications; others do not. Some tolerate certain medications without difficulty; others have side effects. These types of responses and reactions are not always predictable or preventable. There is exciting research into developing genetic and other tests for determining a person’s susceptibilities to drugs. Pharmacogenomic testing at CNNH allows our clinicians to find the right dosage amount as well as minimize side effects and avoid contraindications. Overall, our approach is to utilize a systematic and pragmatic approach to minimize drug choices with potential toxicities and to utilize medication classes that target specific disease processes or symptoms.
“All of the interactions with the staff have been positive and thoughtful. I feel like this is a partnership, which it should be.”