Red Flags When to Reevaluate

As noted in earlier chapters, a positive medication response is rarely immediate. Most psychotropic medications require a number of days or weeks to reach adequate blood levels and produce physiologic changes that yield symptomatic improvement. Also, there exists tremendous variability from patient to patient regarding absorption and metabolism of medications, which affects the ultimate response time. Initial 

In addition to patients failure to respond, therapists commonly encounter situations in which the patient has shown a positive response, but the symptomatic improvement is only partial. Many patients who show partial response can experience enhanced improvement when doses are increased or medications are augmented. In such cases of partial response, a re-referral is warranted. 

Sometimes a patient who has responded well to psychotropic medication treatment, will at some point experience emergence of symptoms—even when medications are continued. When this occurs, the clinician should consider the following common reasons  

Tolerance to the drug can develop. This is uncommon however, there is increasing evidence that some medications work well in early stages of some biologically based mental illnesses but are not as successful in later phases of the illness. For example, lithium is very effective in early episodes of bipolar disorder but is less effective after a number of episodes. This probably does not represent true tolerance but rather a change in the underlying pathophysiology or neurochemical substrate. 

All psychotropic medications have side effects to a greater or lesser degree. Some side effects are minor, benign, and transient. Others are quite rmpleasant and at times dangerous. Summarized in figure 18-A are the most common side effects associated with the various classes of psychotropic medications. These are classified into three groups  

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