I have posted past medication checklists on this blog in
the link below will take you to the current version. I developed this over the
last 10 years seeing outpatients who have been treated with various psychiatric
medications over the previous 5 to 50 years. During a comprehensive evaluation
a history of past psychiatric treatment including hospitalizations, past
medications, past psychotherapy, and other biological therapies needs to be
discussed. Ideally a patient will recall ineffective therapy from the past that
can just be restarted. In my current practice setting that is relatively rare.
People with chronic mood disorders, anxiety disorders, and insomnia ever
happened men treated with multiple psychotherapies and medications. They are
typically seeing me because those past therapies have not worked. It is up to
me to come up with a newer and safe approach based on my past history.
There are varied responses to the question about what
medications have been prescribed in the past. If it has been a long time since
the last episode of treatment many people say they can’t recall the name of the
medication at all. In some cases people admit that they never really studied
the name of the medication, they just took it out of the bottle at the correct
time. There are some people who will get a month-long prescription from a
physician and never take a single pill. When people have been treated with multiple
medications the responses are more varied like “I have taken all of them”, “I
have taken all of the SSRIs”, or “I’ve taken all the SSRIs and SNRIs”. Closer
examination often shows that many people take anywhere from 3 to 5 antidepressants
over any 20-year span. There are people have taken the same antidepressant for
20 or 30 years and wanted it to be changed.
There are many other questions pertaining to best use of
medications including diagnostic clarifications. The commonest problem I see is
people misdiagnosed as having bipolar disorder and then not treated in a
standard way for bipolar disorder. There are also people who have bipolar
disorder who do not receive standard treatment. In this era of direct to
consumer advertising, many people are treated with aripiprazole or brexpiprazole
who would not have been treated with dopamine receptor blocking agents in the
past. That opens up an entire new category of potential side effects and comorbidities.
All these reasons make the history of medication use
extremely useful in a psychiatric evaluation.
Formal versions of medication history such as the Antidepressant History
Treatment Form (ATHF) have been used in research for 20 years as a standard way
to document whether or not a patient has received an adequate trial of an
antidepressant (dose x duration). This form generally requires collecting a lot
of collateral information especially with regard to the dose. Checklist
approach I am using is focused on getting the general name and class of the
medication. If I think additional information is required I will try to get the
necessary collateral information. But generally I am looking for class effects,
especially if it is apparent that the patient cannot tolerate a particular
group of medications.
Over the years I have been using it this form has been useful. It is essentially like the memory testing paradigm where you proceed from spontaneous recall to categorical recall to list prompts. This is definitely a list prompt but for much larger universe. That is often why I direct people to focus on a particular section of the list. As an example if I am seeing a young person and they have only taken one or two antidepressants and cannot recall the names, I advise them that they can probably find it in the top half of the antidepressant column. The clinical problem can be managed to subsections of the list.
A disclaimer is in order. This list is for the purpose of
discussion among clinicians and possible scientific use. It is not been
validated from a psychometric perspective. It is not commercial or for-profit like
everything else on this blog. There is no guarantee that it will cue accurate
memories of past medications. Like everything in clinical psychiatry, collateral
information-in this case from pharmacies is the gold standard. Apart from its
clinical use, this list can also function to illustrate the universe of
medications that are applied to psychiatric disorders. There can be useful for
trainees and since this list is updated, anyone who wants to take a look at
current FDA approved medications. The list is generally compiled for convenience.
I wanted all the medications to be listed on a single sheet - front and back. I
wanted the list to be easily readable even by geriatric patients. I wanted the
list to be disposable - in many cases the patient wants to take it with them in
order to do future research.
That brings me to the topic of research. Most medical
centers have been are large electronic health records for about 20 years at
this point. Those EHRs vary significantly in their research capabilities. The
obvious study of a list like this would be to see how accurate patients can
recall their medication history spontaneously and with this list or a something
similar. Optimal membership on the form can also be debated. I eliminated tiagabine
from the anticonvulsant section as a misadventure in the treatment of anxiety
from about 20 years ago. I did that in order to make room for beta-blockers and
orexin antagonists. A colleague pointed out that I don’t have the old
amitriptyline-chlordiazepoxide or amitriptyline-perphenazine combination
medications. I started practicing over 35 years ago it was extremely common to
see those medications being prescribed and thankfully that does not happen
anymore. Some of the older medications on the list are of historical interest
but also because older patients may have taken them.
The list can be downloaded from the link below. Let me know
what you think in the comments section. Please restrict those comments to the
utility of this list.
George Dawson, MD, DFAPA
References:
1: Sackeim HA. The definition and meaning of
treatment-resistant depression. J Clin Psychiatry. 2001;62 Suppl 16:10-7.
Review. PubMed PMID: 11480879. Full
Text
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