Medication Management

Comprehensive Medication Management

Standard medication management often consists of 15-minute appointments focused solely on medication adjustment without investigating why symptoms persist. Our approach integrates psychiatric medication expertise with comprehensive medical assessment—ensuring medications work optimally while addressing underlying factors that affect treatment response.

With 19 years of ICU experience managing complex medication regimens in critically ill patients, I bring systematic medication optimization to psychiatric care. This includes understanding drug interactions, managing side effects proactively, and recognizing when medical factors affect medication effectiveness.

What's Included

Initial Medication Evaluation

Before prescribing or adjusting psychiatric medications, comprehensive assessment includes:

• Complete medication history and previous treatment response patterns

• Current medication regimen review (all medications, not just psychiatric)

• Potential drug interactions and contraindications

• Medical factors affecting medication metabolism and effectiveness

• Lab work to establish baseline and identify optimization opportunities

Ongoing Medication Optimization

• Systematic dose adjustment based on symptom response and side effects

• Proactive side effect management and minimization strategies

• Regular assessment of continued medication necessity

• Deprescribing when appropriate (medication reduction or discontinuation)

• Coordination with other providers for integrated medication management

Medical Factor Integration

• Thyroid optimization to enhance antidepressant response

• Nutritional support to minimize side effects and improve efficacy

• Sleep disorder treatment to reduce medication requirements

• Inflammatory marker monitoring for treatment-resistant cases

Common Medication Management Scenarios

Starting New Medication

When psychiatric medication is appropriate, evidence-based selection considers your specific symptom profile, medical history, previous medication responses, and potential drug interactions. Starting doses are individualized, with close monitoring during the initial weeks to optimize dosing and manage any side effects.

Medication Not Working

Before assuming "treatment-resistant" depression or anxiety, systematic investigation explores why medication isn't effective. Often, unrecognized medical factors—thyroid dysfunction, nutritional deficiencies, sleep disorders, or drug interactions—prevent psychiatric medications from working properly. Addressing these factors often restores medication effectiveness without needing higher doses or additional medications.

Too Many Medications

Polypharmacy (multiple psychiatric medications) sometimes develops over years of trial-and-error treatment. Comprehensive reassessment often reveals opportunities for simplification. When underlying medical causes are treated, many patients can reduce or discontinue some psychiatric medications while maintaining or improving symptom control.

Medication Side Effects

Side effects aren't always inevitable. Sometimes they indicate suboptimal dosing, drug interactions, or underlying medical issues amplifying side effects. Systematic investigation often identifies strategies to minimize side effects without sacrificing effectiveness.

Safety & Monitoring

ICU training emphasizes patient safety and proactive monitoring. Psychiatric medication management includes:

• Baseline lab work before starting medications with metabolic effects

• Regular monitoring for medication side effects and long-term safety concerns

• Clear protocols for managing emerging side effects or complications

• 24/7 on-call availability for urgent medication-related concerns

• Detailed medication education and written information for each medication