Effective psychopharmacology begins with a diagnosis.
Before deciding what medication to prescribe, change, or discontinue, I take a thorough history and, most importantly, listen. I want to understand not only what symptoms a patient is experiencing, but how those symptoms developed, how they have changed over time, and how they are affecting the person's life.
I ask a lot of questions. What has been tried before? What helped? What didn't? Were there side effects? Was a medication given an adequate trial? And when a treatment failed, was it because the medication was ineffective—or because we were treating the wrong thing?
That process allows me to arrive at the most accurate diagnosis I can and to understand what previous treatment can teach us. From there, we can answer the question that matters most.......where do we go from here?
Diagnosis Comes First
Psychiatric symptoms rarely exist in neat isolation. Problems with concentration, sleep, motivation, anxiety, irritability or mood can occur in many different conditions. Treating a symptom without understanding what is causing it can lead to ineffective treatment, unnecessary medication and sometimes years of frustration.
For that reason, I view diagnosis as the foundation of good psychopharmacology. Medication decisions should follow from an understanding of the patient—not the other way around.
Learning From Previous Treatment
A history of unsuccessful medication trials is not simply a list of drugs that “didn't work.” Each trial provides information.
I review previous medications carefully: why they were prescribed, at what dose, for how long, what changed, what did not, and what side effects occurred. Sometimes a previous treatment failure tells us something important about the medication. Sometimes it tells us something important about the diagnosis.
The goal is not simply to try another medication. It is to use everything we have learned so far to make the next decision a more informed one.
Where Do We Go From Here?
Once I have a clear picture of the diagnosis and previous treatment, I formulate a plan.
That may involve starting a medication, adjusting an existing treatment, simplifying an unnecessarily complicated regimen, reconsidering a previous diagnosis, or deciding that medication is not the most important next step.
Psychopharmacology, at its best, is not about prescribing more medication. It is about making thoughtful decisions about when medication is useful, which medication makes the most sense, and how we will know whether it is working.