⚖️

Post 5 in the Series: Safer Psychiatry
By Dr. Srinivas Rajkumar T, Consultant Psychiatrist

🧭 The Central Dilemma

In modern psychiatry, we often face this question:

“What’s the most effective treatment for this condition?”

But equally important is:

“What’s the safest effective treatment for this person?”

This post is a call for balanced prescribing—especially in long-term psychiatric care. Whether you’re a psychiatrist, primary care doctor, or a thoughtful caregiver, this post will help you reflect on how to choose psychiatric medications that heal without harm.

🔍 Why Balance Matters

Psychiatric medications have transformed lives—but powerful medications can become problematic when:

• Used without regular review

• Continued beyond the point of necessity

• Prescribed to individuals vulnerable to misuse

• Prioritised over non-drug approaches

As psychiatrists, we must weigh:

• Efficacy (Will it work?)

• Safety (What are the risks?)

• Sustainability (Can this be continued long-term?)

• Suitability (Is this right for this patient’s life, culture, and preferences?)

✅ The Medication Safety Scorecard

Here’s a tool I use during every review:

🔎 A “red flag” score in two or more domains = time to reassess the plan.

💊 Schedule X Medications: High Power, High Responsibility

Stimulants, benzodiazepines, and sedative-hypnotics should never be prescribed as “forever medications.” Their use should always include:

• A clear reason and exit plan

• Education for the patient and family

• Written documentation of risks

• Regular deprescribing discussions

👩‍⚕️ Case Reflection

Mrs. L, age 45, was on clonazepam for 3 years for “tension headaches.” Her primary care doctor kept renewing the script. She had developed:

• Poor sleep without the tablet

• Daytime drowsiness

• Emotional blunting

After careful tapering and starting escitalopram + sleep hygiene therapy, she:

• Regained better clarity

• Reduced fatigue

• Slept naturally again in 8 weeks

✅ Moral: Don’t just prescribe what works now—prescribe what keeps working safely.

💬 What Patients Can Ask Their Doctor

• “How long do I need this medicine?”

• “Can we review the plan every 3 months?”

• “What are the long-term side effects?”

• “What are the non-drug options?”

• “When can I stop or reduce this?”

These are not disrespectful questions—they show informed collaboration.

👨‍⚕️ My Approach to Responsible Psychiatry

As a Consultant Psychiatrist in Chennai (Apollo Clinics – Velachery & Tambaram), I focus on:

• Deprescribing where appropriate

• Introducing non-Schedule X alternatives

• Creating holistic treatment plans involving sleep, diet, therapy, and family support

• Educating patients so they understand and own their recovery

📞 Call 8595155808 for consults
🌐 Online and offline sessions available

🧾 Final Thoughts

Responsible psychiatry means choosing not just what works—but what is wise, sustainable, and patient-friendly. It’s time we measure success not just in symptom reduction, but in long-term wellbeing.

🧠 Next in the Series:
“How to Talk to Your Psychiatrist About Medication Concerns” — Empowering Patients and Families