First Do No Harm: Psychotropic Prescribing Principles and Guidelines for Older Adults

The drive to prescribe to alleviate symptoms and ease suffering is prevalent in health care. In psychiatry, it is no different. Although monotherapy remains the preferred approach to treating psychiatric disorders, especially when combined with nonpharmacological approaches, in practice, a focus on remission of symptoms over patient preferences and quality of life can result in higher doses than necessary and polypharmacy from the addition of drugs for augmentation or treatment of adverse effects. This is especially concerning for older adults who are likely to have comorbid medical disorders, eventually leading to prescribing cascades as different providers address different symptoms. Whereas we generally look to best practice guidelines to treat identified disorders, the approach to treating older adults with multimorbidities requires collaboration among the patient, the family (if appropriate), and the provider to re-evaluate goals based on the patient's priorities, and to examine tradeoffs, reduce medication overload, and simplify care. Fortunately, many resources are available to help the clinician in this process. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 12-16.].