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When Your Patient Is on Too Many Psych Meds

Despite years of treatment and a lot of medications, Mr A continued to have significant depressive and anxiety symptoms—specifically a lot of lethargy and hypersomnolence, and then alternating with anxiety and restlessness that he found very troubling. He wasn't making progress with his psychiatrist. In fact, when Mr A showed up in my office, he was on nearly a dozen medications that included lorazepam up to 4 mg daily, amphetamine mixed salts (Adderall®) 40 mg daily, buspirone 30 mg daily, lithium 900 mg daily, topiramate 300 mg daily, escitalopram (Lexapro®) 30 mg daily, temazepam 60 mg daily at bedtime, ziprasidone (Geodon®) 80 mg a day, paliperidone (Invega®) 6 mg daily, and metformin 1000 mg daily. He actually hadn't had a lithium level checked in quite some time.