Medication Management

Psychiatric Medication Review: When You’re Taking Several Medications

By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC · Updated October 12, 2026

If you take three, four, or more psychiatric medications, you may not remember why some of them were started. That is common. Medications get added over years, often by different clinicians, and a combination that made sense once may not today. A structured medication review looks at the whole regimen together: what each drug is for, how the drugs interact, and whether the same benefit could come with less. This guide explains how regimens grow, what a careful review checks, and how to prepare for one.

How regimens accumulate

Polypharmacy, the use of many medications at once, rarely comes from one bad decision. It usually builds from a series of reasonable ones:

• Partial response. An antidepressant helps somewhat, so something is added instead of switching. Sometimes that’s the right call. See how augmentation decisions are made.
• Treating each symptom separately. One medication for sleep, another for anxiety, a third for focus, each added on its own and never looked at together.
• Several prescribers. A psychiatric clinician, a primary care doctor, a sleep specialist, and an urgent-care visit may each add something, and none of them sees the whole list.
• Never revisiting. A medication started during a crisis can keep going for years after the crisis passes, simply because nobody asked whether it was still needed.
• Side effects treated as new problems. This last pattern has a name.

The prescribing cascade

Geriatric researchers Paula Rochon and Jerry Gurwitz described the prescribing cascade in 1997. It happens when a side effect of one drug is mistaken for a new medical condition, and a second drug is prescribed to treat it. The second drug can cause side effects of its own, and the chain can keep going.

Psychiatry has its own examples. Some antipsychotics can cause stiffness or tremor that looks like Parkinson’s disease. A published study of prescribing cascades used exactly this pattern: an antipsychotic followed by an antiparkinsonian medication. Other examples you may recognize: insomnia from an activating medication, treated with a sleep aid; or daytime grogginess from a sedating medication, treated with something to help focus.

Sometimes adding the second drug really is the right answer. But a review always asks the question in this order: is this new symptom caused by something already on the list? If it is, changing the cause may be better than treating the effect.

Interactions a review checks

Two medications can be perfectly safe alone and cause problems together. A thorough review looks for several kinds of interaction:

Too much serotonin

Taking two or more medicines that raise serotonin can cause serotonin syndrome. MedlinePlus gives the example of migraine triptans combined with SSRI or SNRI antidepressants. The risk is highest when a medication is started or its dose goes up. Symptoms include agitation, tremor or muscle twitching, a fast heartbeat, sweating, fever, and diarrhea, and they need prompt medical attention.

Too many sedating medications

The American Geriatrics Society’s 2023 Beers Criteria advise older adults to avoid taking three or more central-nervous-system-active drugs at once. That list includes antidepressants, antipsychotics, benzodiazepines, “Z-drug” sleep medications, antiseizure drugs including gabapentinoids, opioids, and muscle relaxants. The reason is a higher risk of falls and fractures. The criteria were written for adults 65 and older, but the reasoning that sedation adds up applies at any age.

How the body processes each drug

Some medications speed up or slow down the liver enzymes that clear other drugs. That can quietly raise or lower another medication’s level. Your genes affect these enzymes too, which is one reason pharmacogenomic testing is sometimes useful. See what genetics can and can’t tell you about medication.

Supplements and over-the-counter products

Herbal products, sleep aids, and allergy pills count. A review that leaves them out is incomplete. Our guide to supplement and medication interactions covers the common ones.

Anticholinergic burden: effects that add up

Many medications block acetylcholine, a chemical messenger involved in memory, attention, bowel and bladder function, and saliva. One such drug may cause little trouble. Several together can add up to what clinicians call anticholinergic burden: dry mouth, constipation, blurred vision, trouble urinating, confusion, and memory problems.

These drugs aren’t only psychiatric. Older tricyclic antidepressants, some antipsychotics, first-generation antihistamines (found in many over-the-counter allergy and “PM” sleep products), and bladder-control medications are common examples. The Beers Criteria advise older adults to avoid combining more than one anticholinergic drug, citing risks of cognitive decline, delirium, and falls.

Long-term research raises a further question. A 2015 study followed 3,434 adults aged 65 and older and found that higher cumulative use of strongly anticholinergic medications was associated with a higher risk of dementia. It was an observational study, so it can’t prove the drugs caused the dementia. Still, it’s a reason to count anticholinergic effects across the whole medication list, not drug by drug. For more on later life, see psychiatric medication for older adults.

How a structured review works

A careful review is a conversation built around your goals, not a checklist run on you. It usually follows these steps:

1. Build one complete list. Every prescription from every prescriber, plus supplements and over-the-counter products, checked against the bottles.
2. Match each drug to a reason. Which symptom or diagnosis was it for? Is that still a problem?
3. Look at benefit and burden. What is each medication doing for you, and what side effects or risks come with it?
4. Check for overlaps and cascades. Two drugs doing the same job, or one drug treating another’s side effect.
5. Pick a priority. If change makes sense, choose the one with the clearest benefit and the lowest risk to change first.
6. Change one thing at a time, slowly. That way, if something shifts, you know what caused it. Stopping a medication usually means a gradual taper, not a sudden stop.
7. Watch what happens. Track symptoms and side effects after each change before taking the next step. Our guide on measuring whether a medication is working explains how.

Reducing a medication, sometimes called deprescribing, is an active treatment decision, not giving up. Sometimes the review ends with no changes, and that’s a good outcome too: you now know why each medication is there.

What to bring

• All your bottles, or clear photos of every label, including supplements and over-the-counter products.
• A rough timeline: when each medication started, any dose changes, and what was happening in your life then.
• A list of side effects you’ve noticed, even ones you’ve assumed were “just you,” such as constipation, dry mouth, memory lapses, or falls.
• Recent lab results and the names of every clinician who prescribes for you.
• Your own goals: fewer pills, a specific side effect gone, clearer thinking, or simply understanding the plan.

How Willow & Stone approaches a crowded regimen

Willow & Stone doesn’t sell a separate “medication review” product. Reviewing the whole regimen is part of how care works here. The 90-minute integrative evaluation covers every medication and supplement you take, why each one was started, and how you’re actually doing, along with sleep, nutrition, and labs where they help explain symptoms. The work continues at follow-up visits, with any changes made slowly and only when you agree.

The guiding idea is the minimal effective dose: the least medication that gives you real benefit. Sometimes that means fewer drugs. Sometimes it means keeping a combination that is clearly working. Medication is treated as a bridge alongside therapy and lifestyle support, not as the whole plan. You can read more about integrative medication management, or book through the consultation page if you’re in Texas, New Mexico, Florida, Alaska, Arizona, or Colorado.

Common Questions

Sources & Further Reading

• 2023 American Geriatrics Society Beers Criteria (J Am Geriatr Soc, PMC)
• Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997 (PMC)
• Antidopaminergic–antiparkinsonian medication prescribing cascade in persons with Alzheimer’s disease. J Am Geriatr Soc 2021 (PMC)
• Gray SL et al. Cumulative use of strong anticholinergics and incident dementia. JAMA Intern Med 2015 (PMC)
• MedlinePlus — Serotonin syndrome

This article is general education, not advice for your situation. Do not start, stop, or change a medication or supplement without talking to the clinician who prescribes it.