Psychiatric Medication Management

Overcoming Polypharmacy and “Pill Pusher” Stereotypes

Oftentimes, psychiatrists get the bad rap as pill pushers, and we are finding these days that there is often the opposite issue, which is that people are on too many medications, and they don’t know what’s treating what, especially for patients with personality disorders. There’s very limited evidence for any medications being helpful for them, and uh yet they tend to be the ones on the most because at times they appear very depressed and so then they’re on antidepressants, and at times they appear paranoid, and so they’re on antipsychotics; and at times they are panicking and so anxious, and so they’re on a benzo. It just quickly turns into them being on five or 10 medications by the time that they come to us.

Achieving Diagnostic Clarity and Tapering Off Unnecessary Meds

What’s very important to me is having a good initial assessment, diagnostic clarity, understanding what is actually evidence-based and helpful for them, and then working collaboratively with them about whittling down medications to the least necessary for many of our patients; that’s zero medications. In many ways, you know, The Annex is a place where we are often tapering medications for people with personality disorders.

Optimizing Care for Long-Term Outcomes

I think that that’s something important to emphasize, and for people, you know, with other diagnoses still there’s ways that we can optimize things to where they’re on one or two or maybe three medications, maybe a few supplements, what ideally things look like after working with us.