Welcome to part three of our series on antidepressants!

In this article, I will be discussing what psychotropic polypharmacy is and how it can put you at risk for a hormonal imbalance.

If you are interested in reading the first two parts of this series, you can find the links here and here.

What is polypharmacy?

Polypharmacy is the term for when a patient is on multiple medications at the same time. (In Greek ‘poly‘ means multiple, or many). Definitions and dangers can vary depending on age group, illness, and medication type. For this article, we’re going to be looking at psychotropic polypharmacy. It’s not as intimidating as you may be thinking. Another term for mental health disorders is psychiatric disorders. Therefore, when you are on treatment for depression for example, you are on medication for a psychiatric disorder. So, when we talk about psychotropic polypharmacy, it simply means taking multiple medications targeted to help a psychiatric disorder. The most common types of psychiatric medications are antidepressants, tranquillisers, sleeping pills, and antipsychotics.

I can hear you asking, “ok, but what does this have to do with me?”

Well, because mental health difficulties, or psychiatric disorders, rarely ever occur on their own. A comorbidity is when more than one disorder occurs at the same time. For example, depression and anxiety occur together often, as do eating disorders and depression, bipolar affective disorder and ADHD, and more.

When we’re being treated for one disorder and then another one crops up, a way to address the distress is through medication. Antidepressants (such as SSRIs) and tranquillisers (such as benzodiazepines) are a common pairing. Another common pairing are antipsychotics and tranquillisers.

Why can it be risky?

Taking more than one type of psychiatric medication can happen for many reasons. Sometimes it can be because of co-occurring disorders, as mentioned above. Other times it can be because the treatment isn’t working as it should. When this is the case, an antipsychotic (also referred to as a mood stabiliser) can sometimes be given in combination with an SSRI. This can help with depression or anxiety that doesn’t seem to be going away. It can also work for folks who experience psychosis but also feel anxious or depressed. Studies show this specific type of combination can be risky because of the side effects. Some of these side effects can include:

• lack of menstruation
• low libido (sex drive)
• increased levels of prolactin
• weight gain
• trouble with concentration and memory

Hormonal relationships

A study tested the effects of psychotropic polypharmacy on individuals with Bipolar Affective Disorder. The following hormones were found to be impacted:

• thyroid hormone levels and functioning
• cortisol related functioning (ACTH hormone)
• growth hormone (GH)

Put these together with the other hormones shown to be impacted above, and we have a potential for almost all our hormones to be influenced. Don’t get me wrong, as I’ve already written about, I’m on antidepressants as we speak to help me monitor my anxiety. I’ve also been on the terrifying train ride of being on multiple psychotropic medications that lead to a confusing hormonal imbalance. You probably know the story all too well by now; including the misdiagnoses, having to go to a very high number of doctors to be met with a very high number of tests to get done.

Solution focused

My solution focused approach includes a few key factors. This is what worked for me, and is by no means a conclusive guide. Also, as always, consult a doctor or other health professional first.

First off, record all of your symptoms, no matter how insignificant you may think they seem. Secondly, book an appointment with a GP or your physician. It may be worthwhile to ask for blood tests including a general test, and whatever else your doctor may find relevant. It may also be worthwhile to test levels of cortisol, prolactin, and thyroid producing hormones. Next you should consider how you feel about the medication you’re on. Speak to your doctor about the prescriptions you’re being given to try to determine if they are still working, or if you’re willing to experience the side effects. As pointed out here, you can ask the following:

• Is what you are taking needed and still working?
• is it causing side effects and if so, are they distressing?
• are you on the right dose? Will it still be therapeutic if you lower it?
• Can a certain medication be replaced by another to avoid interactions?
• are there any other tests that should be done to ensure the medications aren’t creating other issues?
• do you want to continue taking it?

For promotion of overall health, it is also important to drink enough water, get enough sleep, and eat vitamin rich foods.

Overall, psychotropic polypharmacy can work for some folks, but as we have already covered in the previous segments of the series, each individual is unique and that includes our reactions to different medications!

For anyone curious in learning more about Polypharmacy in psychiatry, an interesting article written by S. Kukreja and colleagues in 2013 can be found here.

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