Psychopharmacology is important
If you prescribe psychotropic medications, it is important to focus on if you prescribe these medications. Psychopharmacology is a complex science and art.
Some people seem to think that you don’t need to know much–what the recommended dose of the medication is, any major side effects, etc. Then, they practice psychopharmacology by taking the approach, “Let’s try X”, followed by, “In my clinical experience….”
There is a lot more to psychopharmacology than that!
But, more needs to be done
The current state of the teaching of psychopharmacology leaves much to be desired.
Psychopharmacology versus treatment of specific disorders
While of course there is huge overlap, some things pertain mainly to the medications rather than to their use in particular disorders. So, to some extent, we have to learn separately about the medications.
What’s in a name?
Don’t take the names of medication categories (e.g., “antidepressants”, “antipsychotics”) literally.
For example, the medications called “antidepressants” are used to treat many conditions other than depressive disorders. The same is the case for medications called “antipsychotics”.
We should probably do air quotes every time we say one of these terms!
Categories of psychotropic medications
Below are some category terms that are commonly used. Note that they are based mainly on an important purpose for which that group of medications is based.
In recent years, there have been efforts towards developing a “neuroscience-based nomenclatures”, but as of July 2018, this kind of terminology has not been widely adopted yet. Nor has its clinical utility been demonstrated.
“Anxiolytics” or “Antianxiety medications”
“Sedative-Hypnotics” or just “Hypnotics”
“Psychostimulants” or “Psychostimulants and wakefulness-promoting agents”
The medications generally tend to work equally well
It is a surprising fact that medications in a particular class tend to work with generally similar efficacy overall.
In every category, there may be some medications that have been claimed to be more efficacious than others. But this tends to be controversial and expert don’t always agree on this.
At least start with the maxim that all medications in each category tend to work equally well and then look out for exceptions to this general rule.
Here are some proven or controversial assertions you may hear. I’m not saying on this page whether I do or do not agree with them.
– Clozapine is more efficacious than any other antipsychotic
– Risperidone and olanzapine are more efficacious (and or more predictably efficacious) than other second-generation antipsychotics like aripiprazole, brexpiprazole, and cariprazine.
– Escitalopram is more efficacious than citalopram
– Escitalopram is more efficacious than most other antidepressants
– Mirtazapine works faster than other antidepressants
So, how do we choose a medication?
Most importantly, based on different side effects associated with different medications from the same class.
But also, based on duration of action, potential drug interactions, pharmacogenomic information, etc.
Diagnosis does predict treatment-response
There is a widespread tendency among clinicians to treat based on the symptoms. If the person is depressed, given him an “antidepressant”.
Polypharmacy is not a sin provided it is “rational
Apps and websites
Non-adherence is the biggest problem in psychopharmacology
How to reduce and manage side effects is key to successful treatment
How to learn psychopharmacology
What we need to know versus what we can easily look up. Less emphasis on remembering factual information and more on understanding concepts and knowing where to look things up
If you are going to be a clinician, learn what is of practical use rather than what is “interesting”
Which textbook? Consider reading the chapters on psychopharmacology in Kaplan and Sadock’s Synopsis of Psychiatry to have a base of knowledge to start from.
Practice Guidelines. Most of them are available FREE of cost. Links are available at https://simpleandpractical.com/guidelines. But beware outdated guidelines; look at year of publication before you use a practice guideline. Practice Guidelines are not a solution to all problems but are a good starting point. They are particularly useful for clinicians with less experience.
The importance and utility of the Prescribing Information/ Product Label/ Product Insert. To find this, type into Google the brand name of the medication followed by “PI”
How to look up drug interactions. https://online.epocrates.com
Which app? Consider Epocrates
P450 table simpleandpractical.com/p450table
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