How medications help treat behavioral health and severe mental illness

James Polo, MD, Chief Medical Officer, Carelon Behavioral Health, discusses best practices and future trends in treating behavioral health and severe mental illness with medications.

 

Medications are effective in accelerating behavioral health therapy

The combination of therapy and psychotropic medications, which are medications that affect the brain and how it works, has long been a standard and effective treatment in behavioral health. While medications alone do not cure mental illness, they can improve symptoms and make therapy more effective.¹ As medications to treat behavioral health conditions become more targeted, their efficacy continues to improve.

“The use of psychotropic medications to treat behavioral health conditions is very complex,” says James Polo, MD, Chief Medical Officer, Carelon Behavioral Health. “While medications play an important role in the treatment of psychiatric illnesses, they do not change the way an individual thinks or the circumstances of their life. Medications that treat depression, for example, help alleviate the physical symptoms of depression helping to improve the patient’s overall mood, but medications do not change the underlying cause that led to the patient’s depression. However, when medications improve the symptoms, the individual is more cognitively able to work on their illness. An individual can participate in more intensive psychotherapy, reframe their circumstances, and develop better coping skills to move forward with life.”

At the same time, providers need to be aware of the risk of overmedicating patients. Dr. Polo shares an example. “A classic overmedicating situation is medicating kids for attention deficit hyperactivity disorder (ADHD), without looking at the core issues. A child might have trouble focusing on a school subject they dislike but have no trouble playing a complex video game for hours at a time. In that case, the child needs to learn coping skills that will help them focus and concentrate on the required school subject they dislike, because medication is not going to make that subject more enjoyable. So, providers need to carefully assess the presenting complaint before jumping to the use of medication. Overmedicating patients can lead to a loss in their coping skill development.”
 

Medications are necessary to treat severe mental illness (SMI)

Psychotropic medications play a necessary role in helping to treat individuals that are living with SMI. The medications offer substantial relief to individuals experiencing debilitating symptoms like hallucinations and cognitive distortions.² “Individuals might be hearing and misinterpreting things, such as their TV talking to them. Medications help organize the mind in a way that counseling cannot, helping individuals have a better sense of reality. Some psychiatric symptoms are only treatable with medications,” says Dr. Polo.

Dr. Polo cites bipolar disorder as another example. “Individuals with bipolar disorder suffer from severe mood instability because of complex neurochemical imbalances. By targeting these neurotransmitter systems, medications help stabilize mood in a way that counseling and therapy cannot. When the individual’s moods become more leveled, they are better able to understand mood management and why treatment compliance is so important, including therapy and medication regimens.”
 

The success of long-acting injectables in the treatment of SMI

Long-acting injectables (LAI) are an increasingly effective treatment for SMI, delivering patients consistent psychotropic medication lasting for extended periods of time. LAI treatment helps patients achieve treatment continuity, prevent relapses, and reduce functional impairment.³
 

LAI helps patients maintain treatment

LAI helps address additional issues that providers face when treating patients experiencing SMI. “Individuals experiencing SMI are almost always averse to taking medications. Their reasons include fear of the unknown, previous adverse reactions, or not wanting to feel controlled,” explains Dr. Polo.

Dr. Polo emphasizes how LAI can help SMI patients who struggle to stay on their treatment plans. “A major goal in treatment is encouraging patient compliance. When patients achieve that goal, they recognize how helpful medications can be in helping them live their best lives, especially if they have experienced acute episodes requiring hospital admission for stabilization.”
 

LAI helps prevent patient relapse

LAI treatment has shown a significant decrease in patient relapse rates.⁴ Dr. Polo believes this is due to the ease of LAI medication regimens. “Long-acting injectables allow the provider to prescribe a medication that will remain active in the patient for weeks at a time. So, for the patient to maintain their medication regimen they only need to see their provider once a month rather than self-administering medication two or three times daily. Also, LAI treatment often has fewer side effects than oral medications. All these factors make LAI the easier option for patients in terms of compliance. And, when patients comply with LAIs, the treatment can help prevent patient decompensation and unnecessary repeat admissions.”
 

The success of paliperidone palmitate

Long-acting injectables such as paliperidone palmitate have shown positive results in patients experiencing schizophrenia who are either nonadherent or resistant to treatment. Patients receive paliperidone palmitate treatment monthly. The treatment is effective in preventing relapse and hospitalization in patients with schizophrenia.⁵
 

Future trends in LAI for SMI

Prioritizing patient whole health

Dr. Polo highlights the importance of treating the patient’s whole health. “Carelon Behavioral Health’s SMI program focuses on all the social needs of the SMI population. We center our care around who the patient is, their housing needs, food insecurity, clothing, and transportation to doctor. We attend to the patient’s whole health, which will ensure they stay engaged in both their physical and mental health over the long term.”

Improved methods in delivering long-acting medication

New long-acting medication delivery methods provide patients with a steadier release of medication. Fast-acting sublingual and oral options are emerging, which are less invasive in the patient.⁶ “Within these new options we are seeing more specific, better windows of activity, and the safety profile of the medications is improving. Patients cannot overdose on them,” says Dr. Polo.

The use of genomics in treating SMI

The future of treating SMI will likely include the use of precision medicine, according to Dr. Polo. Part of that precision approach will be the use of genomics,⁷ which is the study of an individual’s genes, including how those genes interact with each other and influence an individual’s behavior within their environment.⁸ “Eventually, we will see treatment that is specific to an individual’s genomic profile.”

Overall, Dr. Polo believes that the medical community still needs more research to fully understand how to improve and to better target treatment options. “Precision medicine will help us move beyond the typical ‘trial-and-error approach’ to use of medication. That is the future.”