Frequently Asked Questions

  • Yes, our medication prescribers can work with patients who see Nurture Therapists, outside therapists or may not be actively engaged in therapy at all.

  • Based on your individual needs and preferences, the medication prescriber can collaborate and consult with your internal or external therapist to ensure continuity of care with your support team. A signed release form is necessary for us to consult and collaborate with any external therapists and other care providers.

  • At Nurture, we strive to meet you where you're at. We want you to feel informed and empowered to make decisions towards your mental health goals. We will review your symptoms, discuss options for treatments, and outline what to expect so that you can decide what, if any, steps you wish to take next. No pressure, just care and support. 

  • We hear you. Many clients come to us after feeling dismissed or misunderstood elsewhere. Or, maybe you've never spoken about this stuff before in your family or with your community. We prioritize inclusive, affirming care so you feel safe, seen, and supported.

  • Most psychiatric medications take time to work. Some improvements (like improved sleep or appetite) may appear in 1-2 weeks. It can take 4–8 weeks for full symptom relief, depending on the medication and your unique response.

  • Common side effects—like headache, upset stomach, or drowsiness—are usually mild and improve within 1–2 weeks. Some medications may cause changes in sex drive, appetite, or energy levels. We’ll monitor side effects closely and make adjustments if needed.

  • Not always. Some people need short-term support, others benefit from longer treatment. We’ll decide together based on your needs.

  • It’s important not to stop suddenly. Stopping abruptly can cause your symptoms to return or lead to withdrawal effects. If you’re thinking about discontinuing, we’ll help you taper safely and supportively.

  • This is a common fear. The goal of medication is not to change your personality, but to relieve the distress and reduce symptoms so you feel more like yourself. Many people feel more like themselves once their symptoms are better managed.

  • Due to ongoing shortages, especially with stimulants, try these steps:

    1. Ask your pharmacy if they carry the brand version (may require a prior auth or insurance appeal).

    2. Check other pharmacies—Costco often has supply. Email us to resend your Rx if needed.

    3. If you have BCBS, contact their pharmacy benefits team for help locating your medication.

    • For side effects or clinical concerns, email our nurse coordinator.

    • Emergencies: Please go to the nearest Emergency Room.

  • Let us know! Your follow-up is timed to match your start date. If you’ve delayed, please message us and request a new appointment 2–3 weeks after your new start date. If you decide not to start medication but wish to keep your follow-up, no further action is needed and we can discuss options and symptoms at your next appointment. 

  • Starting psychiatric medication can feel like a big step. We’ll talk through your concerns, provide education, and work collaboratively so you can make informed, comfortable choices—no pressure.

  • If it’s been a short gap, we may send a one-month refill. After 4+ months, a new appointment is required.

    • Stimulants: Require quarterly visits.

    • Benzodiazepines: Refilled case-by-case and only for short-term use.

  • Some medications require ongoing monitoring— We monitor your progress, manage side effects, and adjust treatment as needed. We want to make sure the medication is doing its job and that you feel supported.

  • For therapy or medication management, please give 48 hours’ notice to avoid a $100 late cancellation fee. Reach out to your provider directly.

    • Fastest way: Use the Nurture Portal to request changes.
      Appointment Tutorial »

    • Preferred communication: Email your provider directly

  • GeneSight testing may help identify medications best suited to your genetic makeup. It’s often considered after trying 2–3 meds, but some choose it sooner. Insurance may cover it; out-of-pocket max is ~$330.
    Learn more: genesight.com/for-patients

What to Avoid with Psychiatric Medications

  • It’s best to avoid alcohol. It can worsen symptoms and cause dangerous interactions, especially with anxiety or pain medications.

  • Marijuana can increase anxiety, depression, and interfere with your treatment—especially with long-term or high-potency use.

  • Herbal products can cause serious interactions. Always check with your provider before starting any supplements.

  • Some medications must be taken with food or on an empty stomach. Others, like MAOIs or lithium, require dietary caution. We’ll guide you.

  • Yes. Always share any prescriptions, OTC meds, or supplements so we can prevent harmful interactions.

How do you choose what medication to treat for anxiety and depression?

  • Yes. SSRIs are often the first-line treatment because they increase serotonin, which can improve mood, sleep, and overall well-being. We also consider diagnosis, past med history, and your treatment goals when choosing where to start.

  • If SSRIs aren’t effective or the presentation is more complex (like chronic pain or hot flashes), We may try an SNRI. SNRIs boost both serotonin and norepinephrine, which can improve focus and motivation in addition to mood

  • In those cases, we may add or switch to Bupropion (an NDRI). It works on dopamine and norepinephrine, and can help improve energy, motivation, and libido. It’s also a non-stimulant option sometimes used for ADHD.

  • Yes, especially with severe symptoms or when a single med isn’t enough. We may combine meds from different classes to target multiple neurotransmitters or symptom domains.

  • We always taper slowly or cross-taper when switching to avoid withdrawal effects or destabilizing symptoms.

  • Definitely. Like therapists use a toolbox, I like to give patients a many options—especially for anxiety flare-ups or panic. This might include non-addictive meds like hydroxyzine or propranolol, and occasionally controlled meds for very high anxiety or panic episodes.

Serotonin

  • Serotonin is often called the "feel-good" neurotransmitter. It helps to stabilize mood, reduce anxiety, and promote feelings of well-being.

  • Serotonin plays a role in the sleep-wake cycle. It helps to induce sleep and maintain healthy sleep patterns. 

  • Serotonin helps regulate appetite and digestion.

  • Serotonin is involved in cognitive functions, such as learning and memory.

  • Serotonin contributes to social interactions and feelings of bonding.

  • Serotonin can affect blood pressure and heart rate regulation.

Norepinephrine, e.g. Noradrenaline

  • Norepinephrine stimulates the sympathetic nervous system, leading to increased heart rate, blood vessel constriction, and higher blood pressure.

  • It enhances alertness, arousal, and cognitive function. 

  • Norepinephrine is involved in the experience of emotions such as anxiety, fear, and excitement.

  • It triggers the release of glucose from the liver, providing the body with energy during stressful situations. 

Types of Medication

  • Alprazolam is a short-acting benzodiazepine used to treat acute anxiety and panic attacks.

  • It starts working in 15–20 minutes and lasts about 4–6 hours.

  • Most adults start with 0.25mg; higher doses may be needed for intense symptoms.

  • Due to its short action, it’s best for situational use. Long-term use can lead to dependency. Avoid alcohol while taking this medication—it can cause dangerous sedation.

Alprazolam (Xanax)

Clonazepam (Klonopin)

  • Clonazepam is a long-acting benzodiazepine used for ongoing anxiety or insomnia.

  • It begins working within 45–60 minutes and lasts 6–8 hours.

  • 0.5mg is a common starting dose for adults.

  • This medication can be habit-forming with regular use. We recommend short-term use only and avoiding alcohol due to risk of sedation.

  • Hydroxyzine is an antihistamine often used to treat anxiety, sleep issues, and nausea.

  • It can start relieving anxiety or help with sleep within hours of the first dose.

  • No. Hydroxyzine is not habit-forming and is a non-controlled alternative to benzodiazepines.

  • Drowsiness, dizziness, dry mouth, headache, or fatigue. These are usually mild.

  • It should be avoided during the first trimester and while breastfeeding. Talk to your provider to weigh risks and benefits.

  • Yes. Your provider may prescribe it for daily or “as-needed” use, depending on your symptoms.

  • Avoid alcohol and other sedating medications unless directed. These can increase side effects like drowsiness.

Hydroxyzine (Vistaril)

Lorazepam (Ativan)

  • Lorazepam is an intermediate-acting benzodiazepine used to treat anxiety and insomnia.

  • It starts within 30–60 minutes and lasts 4–6 hours.

  • Most adults take 0.5–1mg.

  • This medication is best used short-term or as-needed. It can lead to dependency and should not be taken with alcohol.

Mirtazapine (Remeron)

  • Mirtazapine is an antidepressant used in low doses at night to aid sleep and boost mood.

  • It generally begins working within an hour.

  • 7.5–15mg at bedtime.

  • It is not addictive and can be used long-term. It may increase the effect of another antidepressant when used together.

  • Prazosin is used off-label to treat PTSD-related nightmares.

  • It is taken at bedtime and works overnight.

  • Start with 1mg and increase by 1–2mg every few days up to 15mg.

  • It is not addictive. Blood pressure monitoring may be needed during titration.

Prazosin (Minipress)

  • Propranolol is a beta-blocker used for physical symptoms of anxiety like rapid heart rate or performance anxiety.

  • Starts in about 30 minutes and lasts several hours.

  • 10–40mg as needed, up to twice daily.

  • It is not addictive. It should be used cautiously in people with low blood pressure.

Propranolol (Inderal)

  • Sertraline is an antidepressant used to treat depression, anxiety, PTSD, OCD, panic disorder, and PMDD.

  • You may notice improved sleep or appetite in 1–2 weeks. Full benefits may take 6–8 weeks.

  • Nausea, headache, diarrhea, dry mouth, insomnia, or sexual side effects. Most improve with time.

  • Yes, sertraline is safe for long-term use when taken as prescribed.

  • Discuss with your provider—there may be risks, but untreated depression also carries risks. Caution is advised during breastfeeding.

  • Avoid alcohol and certain other medications that may increase side effects or serotonin levels. Always check with your provider.

  • Take it as soon as you remember—unless it's close to your next dose. Don’t double up.

  • Don’t stop suddenly. Stopping can cause withdrawal symptoms or mood changes. Talk to your provider about any changes.

Sertraline (Zoloft)

  • Temazepam is used to treat insomnia by calming the brain and reducing anxiety.

  • It works within 1 hour and lasts through the night.

  • 15–30mg before bedtime.

  • Temazepam may cause dependency with long-term use. We use it only when truly needed and avoid alcohol.

Temazepam (Restoril)

Trazodone (Desyrel, Oleptro)

  • Trazodone is an antidepressant commonly used in low doses to treat insomnia.

  • It works in about 30–60 minutes.

  • 50–200mg at bedtime.

  • Trazodone is not habit-forming and can be safely used long-term. It may enhance the effect of other antidepressants.

  • Used for sleep onset and maintenance (to help fall and stay asleep).

  • Begins within 30 minutes and lasts 6–8 hours.

  • 6.25mg for women, 12.5mg for men.

  • It can be habit-forming. Do not take with alcohol. Short-term use only is recommended.

Zolpidem CR (Ambien CR)

Zolpidem (Intermezzo)

  • Used for waking up in the middle of the night with at least 4 hours of sleep time remaining.

  • Starts within 30 minutes and lasts 4 hours.

  • 1.75mg for women, 3.5mg for men.

  • It may be less habit-forming than standard zolpidem, but still should not be combined with alcohol.

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