PSYCHIATRIC MEDICATION MANAGEMENT
Medications are a mainstay of treatment for mental health problems. These include but are not limited to antidepressants, anxiolytics, antipsychotics, and mood stabilizers.
There is no one-size-fits-all approach when it comes to using psychiatric or psychotropic medications in different patients. Mental health professionals know that the efficacy of psychiatric medications vary from patient to patient. Medications that work for one person may not work for the other or may stop working after some time.
That said, if taken as prescribed, psychiatric medicines improve your symptoms, prevent relapses (recurrences) and hospital stays, and improve your quality of life. In mental health care, medication treatment is combined with other forms of treatment, especially psychotherapy.
Challenges During Medication Management of Psychiatric Illnesses
One of the biggest challenges faced during medication management of psychiatric illnesses is compliance or medication adherence.
A staggering 49% of patients with mental health problems do not take their medicines as prescribed by their providers.
Poor compliance with psychiatric medications can have serious repercussions, including but not limited to:
- Relapse of the illness
- Poor outcomes and overall quality of life
- Excess hospitalizations and wastage of limited health care resources
- Reduced responsiveness to subsequent treatment
Causes of Poor Medication Compliance in Psychiatry
Numerous variables can play a role in drug non-compliance, such as:
- The diagnosis of the patient
Though medication compliance is an issue regardless of the type of illness, bipolar disorder, and schizophrenia appear to pose the greatest challenges to the prescribing clinician. Anosognosia’ — a fancy term for the lack of insight into the presence of an illness — is the most likely culprit behind poor compliance. People with these disorders are most often in denial that they are sick and need treatment.
Patients with a major depressive disorder are also at risk of medication non-adherence. The most probable underlying cause is the concern for potential adverse effects or negative experiences with the first trial medication.
- Unbearable side effects
We understand that it may be hard for a patient to follow a treatment that produces discomfort.
Common adverse effects of psychotropic medications include drowsiness, weight gain, brain fog, reduced libido (sex drive), involuntary movements, and diabetes.
While most side effects subside with continued use of the medication, it may take you a while to overcome this barrier. Consequently, you may not take your medications as prescribed (take less than the prescribed dose) or may quit taking it suddenly.
Compliance also may be impacted when a patient is not warned, upfront, of the potential side effects of a drug.
- The number and frequency of medications
It is no surprise how a complex drug regimen can negatively impact medication compliance. Psychiatry polypharmacy is the use of multiple medications to manage a patient’s condition. It is a common challenge faced by community psychiatrists and presents greater risks due to drug interactions or increased risk of side effects. If a medication needs to be taken more than once daily, the chances of doses getting missed become higher, resulting in suboptimal effects.
How is Medication Non-Compliance Addressed?
Now that we know what triggers medication non-compliance, we can implement patient-specific strategies that can address the non-compliance issue.
1. Practicing Shared Decision-Making (SDM)
SDM is a process whereby clinicians and patients work together to come to a decision. It is highly recommended in mental health care.
To get the most out of psychotropic medications, we help patients make an informed choice by discussing the available options and the potential benefits and risks to treat an illness. At Orange County, patients are encouraged to research the medication options on their own and then talk about the pros and cons with our providers.
Patients who are actively involved in managing their care have better outcomes. Being proactive in their care paves the way for higher‐quality decision making and improved medication adherence – all of which optimize outcome. For instance, because of SDM, a patient with a major depressive disorder may be willing to tolerate an antidepressant’s side effects after receiving assurance that the medication will provide relief in the long run.
2. Educating How and When Medications Work
Educating patients about what medications can do to help improve their symptoms can greatly optimize medication compliance.
At Orange County, we also set realistic, meaningful goals about medication treatment. For instance, it’s essential to inform patients receiving a new antidepressant that the medicine will take about 3 to 4 weeks (6 weeks at most) to work.
At the same time, it’s important to know that medication therapy is not the only treatment for mental health conditions and that medications work best when combined with other forms of therapies. Why? That’s because when patients wrongly assume that medication will improve all their symptoms, they might often stop taking them when this doesn’t happen.
Thus, we recommend individual psychotherapy as well as support groups to our patients in addition to pharmacological (medication) treatment.
3. Simplifying the Medication Regimen
At Orange County, our group of experts will work with you to simplify a drug regimen if it’s too complex by finding out the best available alternatives. Simplifying the regimen boosts the odds of medication compliance.
We also provide you with options to switch to a different drug or dosage if you’re unable to tolerate side effects with a certain class of psychotropic medication. At Orange County, we also educate our patients upfront what measures they can take in the event of an adverse effect.
4. Figuring out your Concerns about Medication
It stands to reason that patients’ perspectives on medication will impact their willingness to take it. Therefore, we strive to figure out any predetermined fears or beliefs about a specific drug.
One way to assess your attitude, experience, and beliefs about psychiatric medications, in particular antipsychotics, is via using the Drug Attitude Inventory-10 (DAI-10). The DAI-10 is a 10-item self-report that serves as a predictor of medication adherence in psychiatric ailments. The total score ranges from −10 to 10. The higher the score, the greater is the level of positive mindset toward psychiatric medications.
If you or your loved ones have been battling anxiety, depression, or similar conditions, we’re here for you. We help create an optimal treatment plan that will help you attain wellness in the long run.