Irrational Polypharmacy2022-08-28

As to diseases, make a habit of two things — to help, or at least, to do no harm.


In most medical fields currently, over-prescribing is a problem. Some of the reasons for that have to do with: 1. fear of not (being seen as) doing enough, or 2. desire to treat aggressively a problem to get it under control fast, usually using the latest heavily promoted medications, or 3. lack of precise knowledge about what medications and what doses best fit a particular patient. Comparatively little attention is paid to whole-body health, side- effects and interactions between medications, and adverse life consequences for that patient.

The problem of irrational polypharmacy is particularly acute for psychiatry, and has reached shocking levels in child and adolescent psychiatry. It takes an experienced, confident, and thoughtful doctor to be able to say no to going down this path of over-prescribing. It would be much easier if mental health routinely used measurement- based care and blood tests, like other fields of medicine. Flying with instruments, as opposed to flying blind.

Fortunately, there is a solution. Most mental health encounters are initially with primary care doctors, pediatricians, or allied professionals. In general, while not immune to over-prescribing, these clinicians are more hesitant to prescribe high doses of multiple psychotropics, and are used to measurement- and laboratory tests-driven care. That is an area where the tide can be turned initially, by providing them with the tools to deliver mental health care with confidence, and for the long-term. We look forward to working with primary care providers using the science-based tools we have developed, and are looking for opportunities to extend our evaluation of such approaches in younger patients.

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