Dear Alice,

I recently went to a new psychiatrist and he requested a blood test. I was wondering what he was ordering a blood test for, so I asked him and he said many things. I was wondering if he is testing me for drugs? I am not a huge smoker (marijuana). But I do smoke usually multiple times a week, and did not feel the need to share that with my doctor yet. Could you tell me what they are testing me for?

Dear Reader,

No one likes to feel forced to show their hand before they’re ready. While it’s impossible to know exactly why your psychiatrist ordered blood tests, it’s not an uncommon practice. By the way, it’s absolutely reasonable for you to ask your psychiatrist (or any other health care provider) questions if you need more information about any aspect of your care. Good communication and trust is important between patient and provider.

Diving right in, possible reasons a psychiatrist may order a blood test include:

  • To determine if treatments will be safe and screening for certain conditions that may necessitate prescribing certain medications over others (e.g., blood, heart, thyroid, and kidney conditions).
  • To obtain baseline measurements before starting some type of treatment. For example, a psychiatrist may examine glucose and lipid levels if a patient is starting anti-psychotic medication in order to measure medication effects.
  • To monitor levels of various compounds in the blood if a patient is taking lithium or similar medications for effectiveness, toxicity, or adherence.

While none of the above is related to drug testing, it’s pretty important to let your psychiatrist know about any other substances you are taking (even vitamins); this provides her/him with a fuller picture, allowing for more comprehensive treatment. It’s also important to note that smoking could be contributing to your symptoms. While more research needs to be done, marijuana use has been associated with anxiety and depression in some people. For individuals with certain conditions, marijuana use can have an especially strong effect on their mental health.

Reader, you don’t talk about the reason why you’re not ready to share your marijuana use with your new psychiatrist. Perhaps because it is an illegal activity in some places, you are worried about getting into trouble? While there are certain exceptions — such as disclosures of child abuse or threatening the safety of self or others — psychiatrists are required to keep much of a patient’s information, such as drug use, confidential. Perhaps, you’re not ready to talk about marijuana use with your new psychiatrist due to a lack of trust. Do you feel comfortable with your new psychiatrist? Do you feel adequate care and attention are paid to your emotional needs? The related Q&A Therapy's working, but I don't always feel like going may be a good starting point for discovering how to address concerns that may be getting in the way of the therapeutic relationship you want.

Alice!

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