1. Treatment with a single psychotropic medication (monotherapy) is the first-line treatment approach. Prescribers should ensure the dose and duration of monotherapy trials are adequate, and consistent with evidence-based guidelines.
2. Nonpharmacologic therapies, for instance cognitive behavioral therapy for insomnia, anxiety, or depression, are well-researched and effective for management of symptoms. Psychosocial interventions should be considered as an alternative strategy to polypharmacy for symptom control and improved well being.
3. Consumers who are prescribed multiple psychotropics within or across classes should be engaged by their prescribers in a conversation about the risks associated with their regimen, and the benefits of making a change. Reducing polypharmacy should be considered if clinically appropriate.
4. For consumers receiving more than one agent from the same class, periodic efforts should be made to taper off medications and to streamline the pharmacology once the consumer is doing well.
5. Gradual medication tapers are recommended when discontinuing medications. Medication changes are tolerated best by consumers when the changes proceed slowly. A common clinical practice is to change a medication by no more than 1/3 of the current dose, no more frequently than every 2-3 weeks.
6. Psychoeducation in varied formats should be available to all consumers. Brochures, scientific summaries, information sessions, and ongoing medication education groups can be helpful in providing information for consumers and promote dialogue with prescribers.
7. Consumers and families will benefit from supportive services from the clinic during periods of medication change. These services may include frequent check-in calls with the clinic nurse, increased appointment frequency with the prescriber and therapist, medication groups with other consumers, and psychoeducation about side effects or symptoms likely to be experienced. Specific interventions for management of changes in well being may be developed by the clinical staff to provide clients with tools to use during the change.
8. Rating scales filled out by the client can be very helpful during medication changes. Rating scales can educate consumers in understanding and observing symptom constellations over time; and provide clinicians with accurate longitudinal information about the effect of medication change or discontinuation on symptoms and function.
9. If, after careful review, the prescriber and consumer decide to begin or continue polypharmacy
a. Combining medication from the same class, for example antipsychotics, should only be considered after a series of failed monotherapy trials.
b. There should be a clear indication and clear target symptoms identified for each medication prescribed.
c. When adding a second medication, consider an agent with a different mechanism of action.