Polypharmacy in Psychiatry

What is polypharmacy and Why is it Important?

Polypharmacy is when multiple medications are used concurrently in a single patient, usually in an attempt to find the perfect ‘cocktail’ of medications that provides a patient with relief from the maximum amount of symptoms. For example, a patient with a history of chronic depression and anxiety may get the most relief from her symptoms if she is prescribed two different medications to treat these conditions. Another patient may fare equally well when she is prescribed one medication to treat both conditions. There are many instances when polypharmacy is helpful and necessary to keep debilitating symptoms at bay. However, it remains important to reassess these medications at intervals, and you may be surprised to learn that the same amount of work that went into creating a complex treatment regimen may be necessary when that same regimen needs simplifying.

Multiple Medications can Provide much Needed Relief, but Polypharmacy Needs to be Delicately Managed

The National Institutes of Health published a study in 2013 on the ‘Clinical Consequences of Polypharmacy’. In the study they reviewed many of the topics we’ll discuss in this article but their conclusion was: “Unfortunately with this increase in the use of multiple medications comes an increased risk for negative health outcomes such as higher healthcare costs, ADEs [adverse drug effects], drug-interactions, medication non-adherence, [and] decreased functional status …”. Essentially, polypharmacy, or taking multiple medications, whether they are taken for one medical problem or multiple medical problems, increases the likelihood of experiencing medication side-effects. It also makes it much more difficult to determine which medication is the culprit when an adverse effect occurs. Patients taking more medications make more medication errors and are at greater risk of medication interactions.

Patients Should Consider Whether Their Psychiatrist Has the Right Attitude towards Polypharmacy

It is okay for patients to want to reduce the number of medications they are taking. In fact, since polypharmacy has become a particular problem in psychiatry, patients have started asking about it more frequently. The conversation emphasizes the need for both patients and psychiatrists to have the right mentality regarding polypharmacy. For a time, it may be helpful to prescribe multiple medications to a patient who is experiencing many ailments or suffers from a treatment refractory condition. However, psychiatrists shouldn’t allow a patient to get ‘comfortable’ taking multiple medications, or the maximum number of medication, indefinitely. Rather, psychiatrists should continue to re-evaluate the utility of each medication that a patient is taking at regular intervals, and making reductions to medications when possible.

To be clear, there are patients who will need to remain on multiple medications for the rest of their lives. We are not advocating for those patients to have their medications reduced. The point is that psychiatrists and patients should regularly assess whether the medications such patients are taking are the right medications for them, or if they need adjusting. It’s a subtle change in approach, but an important one, as it discourages maintaining patients on medications that may no longer be helpful or necessary.

Psychiatrists Should Seek Better Medications Not More Medications for their Patients

It is the responsibility of physicians to ensure there is a demand not only for more medications, but for better medications. As the National Institute of Health study suggested, there are ways in which the problem with polypharmacy and the threats it poses can be minimized. If a patient feels that polypharmacy has been doing more harm than good, that patient should feel comfortable approaching their psychiatrist to reconsider the treatment plan and examine whether there are perhaps other options. Patients proactively seek treatment from qualified and experienced psychiatrists. In turn, those psychiatrists should aim to reduce the number of medications being used where possible.

Patients Should Prepare for Rewarding but Challenging Work

The process of reducing the number of medications being taken is a rewarding but challenging one. It involves committing to small, slow changes. Patients must be observed carefully for any noteworthy changes, particularly when they have been on many medications for many years. It can be a slow and difficult process to safely transition a patient away from a medication in order to reduce the number of medications taken overall. The benefits of committing to this process, however, are well worth the dedication.

Polypharmacy is a Helpful Tool that Must Be Implemented Responsibly

Prescription medications should be approached with the gravity they deserve both by patients and their doctors. Every year, improperly used polypharmacy results in side effects for numerous patients, while bringing the same patients limited or no relief from the concern that brought them to the physician in the first place. It is the responsibility of psychiatrists to be more mindful of how and why they prescribe drugs, and to monitor their patients to ensure that their medication is taken effectively. Similarly, patients should always feel comfortable asking their psychiatrist about whether it’s appropriate to reduce the number of medications they are taking.

For general information, please feel free to email our office at Amanda.Itzkoff@gmail.com. To schedule an appointment, call our offices at 917-609-4990

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