Psychiatric Polypharmacy

Over the years I have had the pleasure to work with many people receiving services in our system. Our team typically gets called in, not when people are doing well, but when they are struggling. This can be from a medical standpoint, a behavioral standpoint, or often both. Many people, when reviewing their records, are noted to have a mental health diagnosis. Statistically we know that people with an intellectual disability are apt to have a greater risk of developing a mental health disorder than the general public. The statistics for this vary greatly from study to study but generally it is thought that 30-35% of people with an intellectual disability will also have a mental health disorder. So why am I telling you all of this?

 I have always been concerned at the amount of psychiatric medications the people we support are on. Many times I am astounded. Psychiatric polypharmacy, meaning the use of multiple psychiatric medications, is generally considered when a person takes two or more psychiatric medications. How many people do you support that are on two or more psychiatric medications? Each medication that a person takes will have an effect on the body. Some positive and some negative. Sometimes a physician needs to make the call as to whether the benefits of a medication outweighs the risks. For someone with a severe mental health disorder it may be necessary for their physician to prescribe multiple medications. Many times, though, we see someone on one antidepressant or antipsychotic with several others added when those were deemed to be ineffective. Many of these medications can have significant side effects such as tardive dyskinesia, a movement disorder.

A while ago our HCQU began contracting with a company called HRS to utilize the Health Risk Screening Tool so we could provide even better support to those we serve. Through this application you are able to pull out reports on those you have screened. Since I really wanted to delve deeper into the instances of psychiatric polypharmacy for those in our region, I looked at the medications for all of the people that we have done screenings on since we began using the tool. What I saw furthered my concern. So of the 51 people we currently have entered in our system 6 people either were not on psychotropics or their information was not completed yet as they were just being entered. Eight people were on only one psychotropic medication. Eleven people were on two medications. Eight people were on three medications. Of the 51 people, 18 people were on four or more psychiatric medications.

So again why am I telling you all of this information and what can you do with it? I think it is really important to be aware that every medication we put in our bodies has an effect. Should we ever discontinue a medication on our own? Absolutely not. But if the medication isn’t helpful for the person perhaps it’s a window to sit down with the treating physician and have an open conversation about the necessity of multiple medications. In addition, it is critical for supporters to know what side effects are possible with the medications they are assisting people to take.

So I guess the take away from this post is please be aware of the potential potency of the medications people are taking. Know how many psychiatric medications a person is receiving. Speak to their treating physician and pharmacist about potential concerns. Opening these conversations up can be a start to addressing psychiatric polypharmacy.