Why Should You Care About 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. When reviewing their records, many people are noted to have a mental health diagnosis. Statistically we know that people with an intellectual disability 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 when a person takes two or more psychiatric medications. How many people do you support that are on two or more psychiatric medications?

All medication has positive and negative effects

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 outweigh 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, like tardive dyskinesia, a movement disorder.

Several years ago, we began using the Health Risk Screening Tool (HRST) so we could provide even better support to those we serve. Through this application, we are able to pull reports on those who have been 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 1,192 people we currently have entered in our system, 123 people (10%) were on only one psychotropic medication. 141 people (12%) were on two medications. 161 people (13%) were on three medications. And of the 1,192 people screened, 301 people (25%) were on four or more psychiatric medications!

What can you do?

So what can you do with this information? 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.