Mental Health Disorders and the Weight of Polypharmacy
Written By: Dr. Michelle Montoya
Edited By: Dr. Zemen Habtemariam, Kenneth Dandurand
Approximately one in five Americans suffer from mental illness with, over 40% receiving some form of treatment. For mental health conditions this includes counseling, and often the use of medications, also known as psychotropic drugs.
Psychotropic drugs are prescription medications that alter mood, awareness, thoughts, emotions, and behavior. This can be helpful in the treatment of a variety of mental health conditions, including but not limited to depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, obsessive compulsive disorder (OCD), and schizophrenia. Some examples of psychotropic drugs include antidepressants, antianxiety medications, antischizophrenic agents, stimulants, and mood stabilizers.
Mental health treatment is not always straightforward because psychotropic drugs work within the complex brain neurotransmitter system including dopamine, serotonin, and adrenaline, among others. Often this results in using multiple psychotropic drugs (polypharmacy) that affect different neurotransmitters to achieve the desired effect. Frequent changes to a drug treatment plan can lead to miscommunication and confusion for patients. This can lead to poor adherence, and treatment failures. . . A patient with polypharmacy may be at increased risk for experiencing interactions between drugs, unwanted side effects, and combined toxicities. For example, a patient receiving multiple antipsychotic drugs is more likely to have serious side effects involving movement dysfunction. Fortunately, a patient may avoid unintended polypharmacy by being involved in their own care.
Below are some ways patients and/or patient agents can act to safely improve outcomes:
1.) Ensure your entire healthcare team knows your full medication list.
Providers and pharmacists do not automatically communicate with each other when changes are made to your treatment plan. Be sure to update your doctors and your pharmacy any time your medication list changes and try to use only one pharmacy. Everyone involved in your care should have identical medication lists for you.
2.) Maintain an open line of communication with your prescriber.
When changes and/or additions are made to your treatment plan, double-check your new medication list with your prescriber. You should be aware of what each drug is and why you are taking it. Some important questions you could ask include:
Should these drugs be taken together?
Is this new drug replacing something else?
Are there any side effects I should call about if I experience them?
3.) Have a say in your own care!
One of the best ways to be a safe patient is to advocate for yourself or engage a pharmacist medication advocate. Make sure that each drug in your treatment plan is necessary for your care. For psychotropic drugs that you have been taking for a while, check that the reason for which you are taking it still applies. Ask your provider about non-drug strategies, such as therapy and exercise, to assist in the treatment of your mental health condition.
Do not suddenly stop your medications or take them in a manner other than how they are prescribed. If you are experiencing serious side effects, contact your provider immediately. If you have concerns about your medications, be sure to ask your pharmacist, who is a medication expert.
References:
Mental Health by the Numbers. National Alliance on Mental Illness. June 2022. https://www.nami.org/mhstats
Mental Health Medications. National Institute of Mental Health, U.S. Department of Health, and Human Services. June 2022. https://www.nimh.nih.gov/health/topics/mental-health-medications
Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy in psychiatry: a review. Mens Sana Monogr. 2013;11(1):82-99. doi:10.4103/0973-1229.104497
Carmona-Huerta J, Castiello-de Obeso S, Ramírez-Palomino J, et al. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. BMC Psychiatry. 2019;19(1):78. Published 2019 Feb 21. doi:10.1186/s12888-019-2056-0
About the Author:
Michelle Montoya, PharmD
Pharmacy Practice Fellow for Clinical Pharmacy Associates
Dr. Michelle Montoya is a Post-Graduate Year 1 Pharmacy Practice Resident for Sibley Memorial Hospital - Johns Hopkins Medicine. She received her Bachelor's in Biomedical Sciences from the University of Central Florida in Orlando and her Master's in Pharmaceutical Nanotechnology and Doctor of Pharmacy from the University of South Florida in Tampa. Dr. Montoya has experience in the community pharmacy and inpatient care settings. She is passionate about pharmacy research and is currently seeking publication for multiple projects. Her major areas of interest include emergency medicine, critical care, toxicology, psychiatry., and drug information. Additionally, she is completing a teaching certificate in the hopes of becoming an effective pharmacy preceptor in the future.
Kenneth Dandurand, RPh, MS
Co-Founder and CEO of Clinical Pharmacy Associates, Inc. and Co-Founder and President of MedNovations, Inc. Board Member Asperger/Autism Network
Ken is an ASHP residency trained clinical pharmacist with a BS from Northeastern University and a Master’s from Oregon State University. As an entrepreneur and researcher for 35 years he co-founded Clinical Pharmacy Associates and MedNovations successful leaders in providing direct pharmaceutical care via tele-pharmacy. He is dedicated to improving the delivery of medication therapy management to consumers. To that end, Ken has authored a chapter in the Book “Misadventures in Health Care: Inside Stories” titled “Prescription for Error.”