I have the luxury of a blister pack now which is filled by the pharmacist for all of my medications. It also provides me with a record of all medication prescribed, when to take them, dosages, repeats etc., and as I gaze at the list I shudder questioning “ should I be on this myriad of medications, and for how many years now?” According to my psychiatrist, I should.
Maybe it’s time to reexamine just what I’m taking, but need to ensure there would be no huge regrets. Previously, at my appointments, it was considered, yet over the years I’ve struggled with some very dark times and meds required adjusting. I’m coping better now, so perhaps time to reassess the meds and also my psychiatric diagnosis from 1994.
An article on PsychologyToday.com talks about this subject, written by Eugene Rubin, M.D., Ph.D.
Many patients who show up in our emergency rooms or clinics are taking a large number of psychiatric medications. For instance, it is not unusual to see people on several different antidepressants, several different antipsychotics, a mood stabilizer, pain pills, and a sleeping pill. Why? And does this reflect good clinical care?
We want to state up front that we are strong advocates of the appropriate use of medications to treat people who suffer from psychiatric illnesses such as schizophrenia,bipolar disorder, severe depressions, and severe anxiety disorders. When someone is ill with a disabling psychiatric illness, one or a few medications in combination with appropriate psychosocial interventions are often extremely helpful at decreasing or eliminating the painful symptoms. Appropriate medications can be life-saving.
However, we find that we are spending a lot of time teaching psychiatric residents (physicians who are doing 4 years of training after medical school in order to become psychiatrists) how to simplify drug regimens for patients. These days, we frequently encounter patients on 5 or more psychiatric medications (including pain medications). Occasionally, complex combinations of drugs may be useful and understandable, but we believe that this is the exception, not the rule. Why, then, is this “polypharmacy” (the simultaneous use of large numbers of medications) occurring? Here are a few possible reasons:
- Incorrect diagnosis – Patients frequently report that they have a certain diagnosis – let’s say bipolar disorder, for example. Careful evaluation may indicate that they have mild mood fluctuations but not the dramatic symptoms or typical time course of true bipolar disorder (for instance, episodes of very rapid speech and very rapid thoughts, grandiose beliefs of special powers, and very high energy despite little sleep). In other words, mildly exaggerated mood fluctuations are misdiagnosed as bipolar disorder. If a person is not diagnosed correctly and is then treated for an inaccurate diagnosis, the results are usually poor. Often, more medications are added and a vicious cycle begins.