What is a psychopharmacologist?

Sometimes potential patients ask whether I am a psychopharmacologist.  Often they are not sure what the word means, but have been advised to seek one by a doctor, family member, or friend.

A psychopharmacologist is a psychiatrist who specializes in medication management.  It is a self-applied label, as there is no special credential or license for this.  All psychiatrists are qualified to prescribe medication.  Some make this a primary practice focus, and develop expertise with complicated medication issues.  Others virtually never prescribe medication, focusing instead on psychotherapy or some other aspect of practice.  Most psychiatrists, at least here in the Bay Area, are somewhere in between.

I am not a psychopharmacologist.  My practice leans toward psychotherapy.  Nonetheless, like most psychiatrists, I have prescribed plenty of medication over the years.  I weigh a variety of treatment options, and try to avoid a “one size fits all” approach.  Rarely, a situation of great medical complexity or mystery arises in which I believe a patient would be better served by a true specialist in psychiatric medication — a psychopharmacologist.  To be honest, it doesn’t happen very often.

7 comments to What is a psychopharmacologist?

  • Anonymous

    Hi,

    I’ve been in therapy and taking medication for 22 years. I take 6 medications. Three were added in 2009 when I was an out-patient at a mental faciality. I’ve moved to DC and I’m not in sync with my psychatrist. My psychotheraptist wants me to see a psychophramacologist because my depression hasn’t lifted and my hands shake because of lithium. Do you have any opinion on my opitions.

    • Hi and thanks for writing. There are unusual conditions that really do require six medications, so I can’t proclaim from here that it’s a mistake that you personally are taking so many. However, in my experience, it often is a mistake. The usual 6-med regimen looks something like this: (1) antidepressant, (2) mood stabilizer like lithium, (3) anti-anxiety med, (4) sleep aid, (5) neuroleptic, and (6) a second med in one of the preceding categories, such as Buspar in addition to a benzodiazepine for anxiety, or a 2nd antidepressant or neuroleptic. Or it could be a stimulant, such as Ritalin or Adderall, or a beta-blocker like propranolol to treat hand shaking. I’ve even seen the rare patient on 7 or 8 meds.

      There are several problems with such complex combinations. The main one is that drug interactions multiply, such that often the medications end up treating each other’s side-effects. Instead of removing a drug that is causing side-effects, another is added to “treat” the side-effect. The risks of adverse drug reactions is high, and non-specific effects such as dull thinking, low daytime energy, and weight gain are very common. There is no systematic research on patients taking so many different medications at once, so your prescriber is essentially shooting in the dark. At a more general level, polypharmacy (the technical term for prescribing many meds at once) is often a piecemeal approach of treating symptoms one-by-one, instead of treating the underlying problem. It therefore can reflect lazy thinking by the prescriber.

      Again, I’m not in a position to comment on your specific situation. But your options are limited: You need to see a psychiatrist to manage these medications. I hope you find a thoughtful psychopharmacologist who appreciates the drawbacks of polypharmacy, and who is able to taper you off of one or more of these medications. I’ve simplified the medications of a number of patients in your situation, but it can be tricky, and you are best off seeing a specialist with plenty of experience.

  • Doctor,

    You did a great job at defining what a psychophramacologist is. I was searching online for various definitions for the purposes of completing an article on the benefits of Ginger. My research led me to another doctor by the name of Daniel Mowrey PhD., who is a proponent of herbal therapy. One of my first thoughts were, “what in the world is that,” but thanks to this website I learned a very important term. I have always admired physicians who are not so quick to prescribe a “cure all” pill. You seem to be that type.

    I have visited your primary website and I plan to bookmark your information because it could be useful. At the age of 14 I was diagnosed with clinical depression, and currently I have a couple of family members that struggle with depression overall. I understand that most ailments can be prevented/cured by natural resources, just as many ailments actually DO require something man-made. I am just glad to have stumbled upon a doctor that will carefully consider all options of treatment. If you are interested in the nature of the article I published simply click on my name to see it. Thanks and have a great day.

    Kevin Timothy, Tampa Bay, FL

  • Rena Kurdziolek

    I am looking to locate a psychopharmacologist in the upstate New York vicinity of Rochester, Syracuse, Utica, Albany, or even New York City’

  • Rick

    Need a psychopharmacologist in the Boston area. If anyone knows of one please e-mail me. Thanks.

  • Rena and Rick,
    No one can email you, as you didn’t leave your email in the body of your comment. I don’t advise this in any case, it’s an open invitation to spam. Posting to a little-commented blog entry from 2008 probably won’t be fruitful in any case. What I advise patients seeking a specialist in an unfamiliar (to me) city: Call the psychiatry department at a nearby teaching hospital, i.e., one with medical students and/or residents, or large medical center. Ask if anyone, in this case a psychopharmacologist, on their faculty or staff is accepting new patients. Any names given will have been vetted through that institution, giving you some evidence of quality or reputation. Good luck.

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