Prescription medications when properly prescribed can improve many patient’s quality of life and act as a safeguard to lowering the long-term effects of common diseases or more severe mental health illnesses: such as heart disease, diabetes, strokes, major depression, bipolar disorder, and panic attacks however, if individuals take multiple medications for various reasons at once it may lead to greater side effects. Prescription medications can be a stop-gap measure for many ailments. On the other hand, some of them may not be the best long-term solutions. This is one of the reasons why integrative therapies that include lifestyle modifications, nutrition, mindfulness, complementary alternative medicine therapies, and functional medicine approaches for root-cause problems may lower the need for more prescription medications or support tapering them off.
Polypharmacy is considered the use of 5 or more medications at a time. Safety concerns arise at this point because of the multi-interaction of drugs, which may lead to unexpected or more difficult-to-predict side effects. 1 in 5 individuals, in the U.S., between the ages of 40-59 take 5 or more prescription medications. Per a 2022 meta-analysis, there was a 37% prevalence of polypharmacy in all medication classes.
Psychiatric medications can be essential for individuals who are struggling with serious mental illness that impedes their ability to carry on daily activities or maintain healthy relationships with others. Medications often prescribed to support common mood disorders (anxiety, depression, insomnia) include: sertraline, fluoxetine, citalopram, quetiapine, trazodone, etc.
In regards to psychiatric medications, about 15.8% of Americans in 2019 were taking prescription medications for their mental health and 9.5% were receiving mental health counseling.
What are some concerns when there are too many prescription medications or supplements in your medicine cabinet or pill box?
The Science behind Drug Metabolism:
CYP enzymes are located mainly in the liver and play a large role in the metabolism and sometimes activation of prescription medications. The liver has two main phases of metabolism called Phase 1 and Phase 2. CYP enzymes mainly support the Phase 1 enzymatic breakdown of drugs. The intermediate compound created by CYP enzymes is then sent to other enzyme pathways in Phase 2 to be eventually “neutralized” and packaged so our body can excrete and remove the byproducts from our body.
CYP enzymes can be overwhelmed if more than one type of drug competes for its breakdown. This leads to higher levels of certain medications in the body than expected. Also, some drugs or foods may either inhibit or induce (increase) CYP function which leads to higher or lower-than-expected amounts of medications.
There are over 50+ recognized CYP enzymes. Their function may also be affected by different genetic variants (alleles). CYP2D6 is a well-known gene that metabolizes many commonly prescribed drugs. However, CYP2D6 in some individuals may have different alleles that can influence its function. Thus, leading to normal activity, reduced activity, or no activity.
Clinical Side Effects of Polypharmacy:
The cumulative effects of medications AND supplements are the reason why it’s important to keep your physician or integrative medicine clinician up to date on how you are taking your medications. The higher the number of medications being used and their frequency, the more important it is to explore side effects or again their unpredictable cumulative effects on the body.
In an ideal world, medications would be assessed for their necessity and attempt at tapering if other lifestyle modifications or changes in health are occurring that lower their need.
Examples of side effects:
- Brain Fog
- Fatigue
- Sedation
- Depression or anxiety (worsening of mood)
- Gastrointestinal symptoms (diarrhea, constipation, reflux)
- Headaches
- Joint Pains
- Rash
- Lowered Libido
Severe outcomes may include:
- Hypotension
- Disorientation
- Increased Fall Risk
- Arrhythmias (dangerous heart rhythms)
- Serotonin syndrome (hypertension, palpitations, sweating)
Genetic Testing Options:
Besides working with a pharmacist and physician to determine if there are any known interactions between your medications and supplements; working with a functional medicine provider can also provide an ability to do further genetic testing. CYP allele testing for individuals helps determine if there are any genetic variations or CYP polymorphisms, that may affect their ability to metabolize common medications. This may also provide a more educated approach to deciding what medications to avoid or try as a first or second-line choice.
Uplift Health MD provides access to multiple genetic testing centers, some are covered by health insurance. Please reach out for more information about specific genetic testing options.
How to Explore Options:
Making the decision about how to assess whether you can improve your health without getting another pill prescribed is both an art and a science. The process is unique to the individual and their circumstances. Integrative medicine is a route to develop a whole-picture approach for a patient and particularly focuses on holistic methods that respect both conventional and complementary alternative therapies.
References:
Hales, C. M. (2019, August 8). Prescription Drug Use Among Adults Aged 40–79 in the United States and Canada. CDC: National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db347.htm
Terlizzi, E. P. (2021, December 7). Mental Health Treatment Among Adults: United States, 2020. CDC: National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db419.htm
Delara M, Murray L, Jafari B, Bahji A, Goodarzi Z, Kirkham J, Chowdhury M, Seitz DP. Prevalence and factors associated with polypharmacy: a systematic review and Meta-analysis. BMC Geriatr. 2022 Jul 19;22(1):601. doi: 10.1186/s12877-022-03279-x. Erratum in: BMC Geriatr. 2022 Sep 12;22(1):742. doi: 10.1186/s12877-022-03388-7. PMID: 35854209; PMCID: PMC9297624.
Gilani B, Cassagnol M. Biochemistry, Cytochrome P450. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557698/
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