Polypharmacy, love it or hate it.

Whichever side of the line you stand on, these are the medications you don't want to combine.

Welcome to the Coralite Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief and the author of the Depression and Bipolar Workbook.

And I'm Kelly Newsom, a P. and a dedicated reader of every issue.

The green reed which bends in the wind is stronger than the mighty oak that breaks in the storm, said the Chinese philosopher Confucius

some 2,500 years ago. And it's also good advice for the budding psychopharmacologist.

Study the practice guidelines, learn the evidence base, but your patients will come in with very different ideas about where their

treatment should go. And you need to meet them where they're at. To bend with the wind.

Unless they're asking you to break one of the ten psychopharm commandments.

Granted, does not bend with the wind, but it lays a firm foundation that will

keep your patients safe. Today, we're on commandment number eight. Avoid unwise combinations

of meds. But first, Kelly, can you read out the previous seven?

One, do not worsen mental illness with psych meds.

We're talking about benzodiazepines and opioid use disorders,

psychostimulants and psychosis, and antidepressants during mania.

2. Avoid stopping meds abruptly,

particularly benzodiazepines, serotonergic antidepressants, and lithium.

3. Stop Lomotrogen if any rash develops in the first three months of treatment with it.

4. Watch out for lithium toxicity by staying on top of drug interactions, dehydration, and your patient's age and renal function.

Five, do not give benzodiazepines to patients who have an elevated risk of opioid overdose deaths.

Benzos increase the overdose risk fourfold.

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