How medications help treat behavioral health and severe mental illness

Hossam Mahmoud, MD MPH, Regional Chief Medical Officer, Carelon 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 psychotherapy 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 . As medications to treat behavioral health conditions become more targeted, their effectiveness continues to improve.

“Treating behavioral health conditions with psychotropic medications can be a complex process,” says Hossam Mahmoud, MD MPH, Regional Chief Medical Officer, Carelon 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 mental, emotional and – at times - physical symptoms of depression helping to improve the patient’s overall mood, though medications do not change the underlying factors that led to the patient’s depression. However, when medications improve these symptoms, the individual is more cognitively able to work on their recovery. An individual can more actively participate in psychotherapy, reframe their thoughts about 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 certain approaches to managing mental illness with medications. Dr. Mahmoud shares an example. “Overreliance on medications in treating kids with attention deficit hyperactivity disorder (ADHD), without looking at the core issues or factors that may be contributing to the symptoms, may produce suboptimal outcomes. For example, 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. Prescribing medications, without addressing psychosocial stressors or maladaptive skills, 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 . “Individuals with psychotic conditions struggle with reality testing. They might be hearing things that are not present, misinterpreting things in their environment, or struggling to organize their thoughts or behaviors. Medications help address these symptoms and organize their thoughts in a way that counseling cannot, helping individuals have a better sense of reality. Some psychiatric symptoms are only treatable with medications,” says Dr. Mahmoud.

Dr. Mahmoud cites bipolar disorder as another example. “Individuals with bipolar disorder suffer from episodes of 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 utilized and effective treatment for SMI, delivering patients consistent levels of antipsychotic medications lasting for extended periods of time. LAI treatment helps patients  achieve treatment continuity, prevent relapses, and reduce functional impairment.
 

LAI helps patients maintain treatment

LAI helps address additional issues that providers face when treating patients experiencing SMI. “Individuals experiencing SMI are often averse to taking medications. Their reasons include the stigma associated with psychotropic medications, previous adverse reactions to medications, or not wanting to feel controlled,” explains Dr. Mahmoud.

Dr. Mahmoud emphasizes how LAI can help SMI patients who struggle to adhere to their treatment plans. “A major focus in treatment is encouraging patient adherence, because that is necessary to achieve treatment goals, such as symptoms and functional improvement. This improvement itself is usually accompanied by improved insight, where patients recognize how helpful medications can be in their road to recovery and to live their best lives.”
 

LAI helps prevent patient relapse

LAI treatment has shown a significant decrease in patient relapse  rates. Dr. Mahmoud believes this is due to the ease of LAI medication regimens. “Long acting injectables allow the provider to prescribe a form of the medication that will remain active for weeks at a time. There is also an ease for the patient. For the patient to maintain their medication regimen they only need to see their provider anytime from every month to every six months depending on the LAI, rather than self-administering a pill daily or even more than once a day. This makes LAI the easier option for patients in terms of adherence. And, when patients better adhere to their medications, the treatment can help prevent patient relapse and unnecessary repeat admissions.”
 

Future trends in LAI for SMI

Prioritizing patient whole health

Dr. Mahmoud highlights the importance of treating the patient’s whole health. “Carelon Behavioral Health’s SMI program focuses on all aspects of the health and wellbeing of the SMI population. This includes behavioral health, physical health, pharmacy and health related social needs (HRSN). We center our care around who the patient is, their health needs, their housing needs, food insecurity, clothing, and transportation needs. We attend to the whole person, and we engage them in discussions on their recovery, including all the factors that are conducive to this recovery, from engaging in physical and mental health treatment to accessing resources that address their HRSN.”
 

Improved methods in delivering fast-acting medication

New fast-acting sublingual and oral options are emerging , which are less invasive in the patient. “Within these new options we are seeing more targeted windows of activity, and the safety profile of the medications is improving,” says Dr. Mahmoud.
 

The use of genomics in treating SMI

The future of treating SMI will likely include the use of precision medicine, according to Dr. Mahmoud. Part of that precision approach will be the use of genomics , 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. “Eventually, we will see treatment that is specific to an individual’s genomic profile.”

Overall, Dr. Mahmoud 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 from the typical ‘trial-and-error approach’ to psychotropic medications to a more customized treatment based on the patient’s individualized profile that incorporates genomics and a range of other data points and factors influencing symptomatology and recovery. That is the future.”