7 Facts That Make Psychiatric Medication Management Complicated For Patients and Psychiatrists Alike
1. Psychiatric Medications Can Really Help!
I have treated many patients who have described life-changing improvements to their anxiety, depression, and mood cycling once they were started on psychiatric medication.
Examples include:
-Antidepressants for generalized anxiety disorder and major depressive disorder
-Stimulants for attention deficit hyperactivity disorder
-Mood stabilizer treatment for bipolar disorder
2. Psychiatric Medications Can Really Help…But Don’t Have the Same Effect For Different Conditions
I have also treated many patients who have needed to try multiple medications because their first experiences with medications were not helpful. In some cases, this was because their symptoms more closely fit a different psychiatric condition, rather than the initial psychiatric condition they were treated for.
Examples include:
-Optimizing ADHD treatment in individuals with prior diagnosis of bipolar disorder
-Optimizing bipolar disorder treatment in individuals with prior diagnosis of ADHD
3. Psychiatric Medications Can Really Help…But Can Cause Bad Side Effects
I have also treated patients where their medication regimen resulted in negative side effects that required discontinuing them to improve their symptoms. Psychiatric medication management can also include decreasing medication, also known as deprescribing.
Examples include:
-Tapering off benzodiazepines
-Antipsychotic dose optimization due to weight gain or muscle-related issues
4. Psychiatric Medications Can Really Help…But Some Are Not Used Because of Fear of Side Effects
I have also treated patients where effective medications were not previously considered due to concern of side effects that turned out to tremendously benefit a patient.
Examples include:
-Consideration of tricyclic antidepressants and Monoamine oxidase inhibitors (MAOis) for treatment-resistant depression
-Consideration of lithium and valproic acid for mood instability and treatment-resistant depression and anxiety
5. Psychiatric Medications Can Only Have A Small Effect For Difficult-to-Treat Conditions
I have also treated individuals with very difficult-to-treat conditions for which medications may have a limited effect. When working with these patients, I try to also include other non-medication-based interventions to optimize their treatment.
Examples include:
-Treatment-resistant depression / bipolar depression
-Autism-spectrum disorder / Non-verbal learning disability (NVLD)
-PTSD / Complex PTSD
-Substance use disorders (alcohol use disorder, opioid use disorder)
-Chronic psychotic conditions (severe schizophrenia, schizoaffective disorder
6. Psychiatric Medications May Not Need To Be Continued Indefinitely
I have also discussed tapering off medication for individuals that may not need to stay on medications.
Examples include:
-Tapering off SSRIs for uncomplicated depressive episodes
-Tapering off antipsychotics and maintaining mood stabilizer treatment after resolution of manic symptoms for bipolar disorder
7. Psychiatric Medications May Need To Be Continued Indefinitely
I have also discussed the importance of adhering to medications for other individuals who require indefinite psychiatric medication treatment.
Examples include:
-Multiple prior episodes of mood episodes requiring psychiatric hospitalization
-Persistent psychotic symptoms