Medication Management in Psychiatry in North Kingstown

Medication can be a key part of treating mental health conditions such as depression, anxiety, bipolar disorder, ADHD, and others. Proper medication management is an ongoing process, not a one-time event: it means evaluating symptoms, selecting the medicines most likely to help, and monitoring how they affect you over time. The goal is always to find the lowest effective dosage that offers the most benefit while limiting risk of serious side effects.

At SCP, psychiatrists (MDs), psychiatric mental health nurse practitioners (PMHNPs), and physician assistants (PAs) provide medication management as part of an integrated approach to care. Our prescribers take time to understand each person's medical history, preferences, and life context, and coordinate closely with therapists and primary care providers as part of your broader health care team. Follow-up visits are where we review how a medication is working, adjust the treatment plan, and discuss any concerns openly, so medication is used safely, and effectively alongside the rest of your care.

The topic of psychopharmacology is a very long and complex one. Until not long ago,  psychiatry was known as “the talking cure,” frankly because no medications were really available to help people. People know about dramatic depictions of psychiatric care in such movies as ONE FLEW OVER THE CUCKOO’S NEST, which shows versions of the lobotomy (which thankfully was left in the dustbin of history) as well as electroconvulsive therapy (which is still practiced today and one of the most effective treatments in all of medicine). In the 1950’s we started to see dramatic developments of both antipsychotic and antidepressant medications that were able to restore people to functioning and allow the closure of many state mental hospitals. The first benzodiazepines came along in the early 60’s with Miltown, and then lithium became widespread in the 70’s for treatment of bipolar disorder. Prozac has been around since 1989, which  allowed the treatment of a group of patients who were never safely able to be treated before. Over the past few years, esketamine has come into practice showing one of the first novel mechanisms of action for antidepressants in over 60 years, and right now, at Johns Hopkins, psilocybin is being studied for us as well.  

How We Evaluate Medication Options

Proper medication evaluation takes into account many factors, especially when a patient is already taking multiple medications:

• Diagnosis and symptoms
• Age, weight, height – older adults, for example, often process certain medications differently
• Comorbid medical and psychiatric conditions
• Possible drug interactions and complications with prescriptions or supplements
• Side effects
• Medical and medication history with a list of prior dosages, effects, and side effects, if applicable
• Patient preference – which matters most of all

Because everyone's health history is different, finding the right medications sometimes takes a little trial and adjustment. We encourage patients to be upfront about all the medications and supplements they're taking, since that single conversation can make a big difference in avoiding complications.

What to Expect at Your First Visit

The first session is always treated as a consultation, in that the doctor is offering their assessment of the problem and treatment plan recommendations; if the two parties are on the same page, treatment can proceed. If the two parties are not in agreement, it is not a good match as conflict is likely to arise. The best care happens when the doctor clearly tells the patients their diagnosis and helps the patient clearly understand the risks, benefits and alternatives of treatment so that informed consent can occur.  Sometimes patients do not want medications; often, we do not even recommend them (and many patients are relieved). The doctors job is not to prescribe medications, but to recommend the best course of treatment possible.  And over time, the best way to engage in treatment is slowly, carefully, and methodically, changing one thing at a time.

Common Psychiatric Medications

You'll notice a lot of similar-sounding names below. That's because drug companies often take an existing medicine, adjust its chemistry, and test the results — which is how entire drug classes expand over time. A pharmacist can also help answer questions when you go to fill a prescription, but your prescriber is the one who determines the right medications and dosage for your situation.

Some include:

SSRI: Prozac (fluoxetine), Paxil (Paroxetine), Zoloft (Sertraline), Celexa (Citalopram), Lexapro (Escitalopram), Luvox (FLuvoxamine)

Tricyclics- Imipramine, Desipramine, Nortriptyline, Amitriptyline, Clomipramine, Doxepin

Other antidepressants- Wellbutrin (Bupropion), Remeron (Mirtazapine), Trintillex (Vortioxetine), Effexor (Venlafaxine), Cymbalta (Duloxetine), Viibryd (vilazodone), Desyrel (Trazodone)

Mood stabilizers: Lithium, Depakote (valproate/Valproic acid), Lamictal (Lamotrigine), Tegretol (carbamazepine)

Atypical Antipsychotics: Geodon (ziprasidone), Abilify (aripiprazole), Risperdal (Risperidone), Seroquel (quetiapine), Zyprexa (olanzapine), Vraylar (cariprazine), , Latuda (lurasidone)

Benzodiazepine: Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), Xanax (alprazolam)

Stimulants: Ritalin, Concerta, Ritalin LA/CD (methylphenidate), Adderall (amphetamine), Dexedrine (dextro-amphetamine), Vyvanse (lisdexamfetamine).

Medication management involves overseeing all of a patient’s prescribed medications to ensure they are taken as directed and achieving the desired therapeutic outcome.

Medication management psychiatry includes regular outpatient evaluations and the management of psychotropic medications for mental health conditions like ADHD, depression, anxiety, and bipolar disorder. It involves managing the medications a patient takes to treat mental health disorders and regular outpatient evaluations.

Medication management includes ongoing medication review to monitor safety and adherence, working to reduce adverse effects, patient education, and engaging with patients and their caregivers. These programs reduce costs and improve care for patients.

A psychiatric or psychotropic medication is any drug that is taken in order to change the chemical makeup of the brain and nervous system in order to treat mental illnesses. There are many different classes and types of psychiatric medications.

The main types of mental disorders that may be treated with medication include:

• Mood disorders, including depression or bipolar disorder
• Anxiety disorders
• Personality disorders
• Psychotic disorders, including schizophrenia
• Eating disorders
• Trauma-related disorders, including post-traumatic stress disorder
• Substance abuse disorders
• Impulse control disorders 
• Attention deficit disorder

Psychopharmacological drugs are another term used to describe medications that treat mental health conditions. Some patients can find relief with medication alone, but others are best served by a combination of medication and psychotherapy or other treatments.

Psychiatrists utilize a number of different treatments, depending on a patient’s needs.  These include various forms of psychotherapy, medications, psychosocial interventions, and other treatments, like electroconvulsive therapy.