Increased Psychiatric Med Use Means Expanded Pharmacist Role

As the use of psychiatric drugs continues to increase in the United States, pharmacists have a greater role in ensuring these medications are taken correctly and are not misused.

According to a research letter published in JAMA Internal Medicine, approximately 1 in 6 adults in the United States reported taking psychiatric drugs in 2013.

The findings in the letter, written by Thomas J. Moore, AB, and Donald R. Mattison, MD, MS, were determined by using data from the 2013 Medical Expenditure Panel Survey [See Fig. 1].

Fig. 1These high levels of use for psychiatric drugs may be due to several factors. “There does seem to be an increased number of psychotropics being prescribed,” said Cherry W. Jackson, PharmD, BCPP, a Clinical Pharmacist and Clinical Professor in the Department of Psychiatry and Behavioral Neurobiology at the University of Alabama, Birmingham. “A lot of those seem to be being prescribed by primary care providers as opposed to psychiatrists, so a lot of those folks may not realize that there are other treatments out there that are evidence-based that might work without side effects.”

Jackson said she’s seen the biggest increase in the prescribing of antipsychotics, antidepressants, and drugs used to treat ADHD.

“It does seem like there’s a growth in the prescribing of psychotropics to children and the elderly, and those are two big causes of concern for us,” Jackson said.

Stephanie Higashi, DC, Founder and Chief Executive Officer of Health Atlast, an integrated health-care franchise that provides patients with access to medical doctors, doctors of chiropractic, physiotherapists, acupuncturists, and massage therapists in one location, also voiced concern about the growing use of psychiatric medications.

“I think my biggest concern is that I just see that it’s typically overprescribed or overutilized and probably, honestly, over-requested by patients,” she said.

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Higashi works with patients to find any alternative forms of treatment, whether it’s chiropractic care, lifestyle changes, vitamin or mineral supplements, or using prescriptive amino acids.

For instance, some studies have shown that good nutrition can improve memory, mood, and alertness, Higashi said.

Jackson added that research has also shown that meditation can also be helpful for depression, anxiety and patients with attention deficit issues.

Another common concern for Higashi is that many of the patients she sees are often being treated by multiple care providers who are often unaware of the entire list of medications a patient is taking. She typically asks patients to carry a list or physically bring in all of their medications so care providers are able to get an accurate list of all of a patient’s current medications. “I know it takes a millisecond more time, but the time we put in now is going to fix our future, and the more we don’t spend the time now the bigger the problem is going to be in our future,” she said.

Up next: The Pharmacist's Role

Pharmacist Role

Pharmacists can play a critical role in evaluating and promoting medication adherence, said Jackson, who works regularly in an outpatient clinic that treats patients with serious mental illness. Nonadherence can be a contributing factor in overprescribing because physicians may increase the dose of a medication or write a prescription for an additional medication without knowing the patient is not taking the first prescription as prescribed.

Jackson said she regularly uses motivational interviewing techniques that include asking the patient how they take their medication and what time of day they take it, to assess whether there are any adherence concerns. “That’s a really big role for pharmacists, I think,” she said.

Psychotropic medications are also known to have a lot of side effects, which need to be monitored closely by pharmacists and other members of the care team.

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“Because I recognize the side effects, I am usually the key person who will let the physician know I think there’s an adverse effect. Maybe we could lower the dose or maybe we should try something different,” Jackson said.

If pharmacists suspect a patient is misusing a medication, they should always report any concerns to the prescribing physician, Jackson added. Red flags to watch out for include referring to a medication by its street name, requesting early refills, paying in cash, filling the prescription a long way from home, or filling a prescription for a medication that would typically be outside the prescriber’s specialty area, she said.

“I think community pharmacists are on that front line of patient care and can use their professional judgment if they think medications are being taken incorrectly or being ... misused,” she said.