Many people who take medications to treat anxiety and/or depression also take drugs to manage additional chronic conditions. So-called polypharmacy – which is generally defined as the concurrent use of five or more medications – can lead to a host of problems, including increased risk of adverse drug interactions, confusion, falls and reduced medication adherence, especially in individuals with psychiatric conditions or cognitive decline. For individuals in the long-term care setting, there are unique challenges to managing polypharmacy.
Fortunately, through proactive management and collaboration between pharmacists, prescribers, patients and caregivers, many of the risks associated with polypharmacy can be reduced, thus minimizing the negative impacts on physical and mental health and quality of life.
Depression and Anxiety Medication Usage
Depression and anxiety disorders are the most common mental health conditions, impacting millions of Americans. According to recent data from the Centers for Disease Control and Prevention’s National Center for Health Statistics, depression impacts 13.1% of adults and adolescents – an increase of about 60% in the past decade.1 Meanwhile, about 19.1% of U.S. adults suffer from an anxiety disorder, according to the Anxiety & Depression Association of America.2
About 11.4% of adults take prescription medication for depression, and adults with disabilities are nearly three times as likely to take medication for depression as those without disabilities, based on the most recent National Center for Health Statistics data.3 An earlier study reported that 16.5% of adults took medication for their mental health, including anti-anxiety and anti-depression drugs.4
Growing Need to Manage Polypharmacy
Polypharmacy is a rising phenomenon. The overall percentage of U.S. adults with polypharmacy ballooned from 8.2% in 1999-2000 to 17.1% in 2017-2018, according to a study published in the National Library of Medicine.5 Polypharmacy prevalence is considerably higher among the elderly and adults with diabetes and/or heart disease, according to the study. When appropriate, polypharmacy may effectively treat symptoms, prevent disease complications and increase life expectancy. But, the study cautioned, “The majority of research suggests that polypharmacy is associated with negative clinical consequences, including nonadherence to treatment, adverse drug events (e.g., falls, fractures, renal failure), drug-drug interactions, and hospitalizations. Polypharmacy is also linked to increased risks of disability, cognitive decline and even mortality.”5
Medications to treat anxiety and depression are an important area of focus for polypharmacy management, given the high incidence of individuals taking these medications and the fact that these medications are known to have adverse interactions with certain other drugs.
For residents of long-term care facilities, managing polypharmacy can be uniquely challenging. Long-term care residents often have multiple chronic conditions and cognitive impairments, adding nuance to medication management. Further, the involvement of various prescribers and care staff can lead to fragmented oversight of a resident’s drug regimen and medication interactions.
Your Pharmacist’s Role in Managing Polypharmacy
Pharmacists play a critical role in medication management to prevent the adverse impacts of polypharmacy in individuals with anxiety, depression and other conditions. Pharmacists are uniquely qualified and situated to monitor drug regimens for potential interactions and to collaborate closely with providers and insurance companies on finding suitable drug alternatives. Further, pharmacists can educate individuals and their caregivers about drug interactions and side effects to watch out for.
Long-term care pharmacies play an important role in supporting facilities such as group homes, assisted living centers, nursing homes and drug treatment programs. A critical part of this role is unifying the medication management process through regular communication among prescribers and conducting detailed monthly medication regimen reviews, with special attention to residents prescribed medications for anxiety and depression. Consultant pharmacists regularly evaluate potential interactions, duplications and unnecessary therapies, working closely with providers to optimize outcomes while minimizing risk. This work is increasingly supported by pharmacy software that can flag potential issues such as medication allergies, duplications and interactions.
Long-term care pharmacists must also collaborate closely with the facility’s care team to make actionable recommendations. For high-risk medications, especially central nervous system (CNS) active agents, systematic monitoring of reactions and side effects is paramount. A good pharmacy provides facility care teams with tools and checklists that staff can use to track side effects like sedation, agitation or falls. It is also critical for the pharmacists to review the care team’s incident reports and behavioral monitoring logs during monthly reviews, to identify issues that may be related to medication.
Another critical service pharmacists provide is assisting with prior authorizations and helping find clinically appropriate alternatives when insurance coverage is an issue. A good pharmacist will proactively streamline communication between prescribers and insurers to reduce delays and ensure individuals receive timely treatment.
Education should be core to every pharmacist’s services. In addition to providing training and resources for long-term care facility staff, long-term care pharmacists can and should educate residents and their families about potential drug interactions, side effects and safer alternatives.
Both in and out of the long-term care setting, pharmacists can be an invaluable source of knowledge about medication interactions and a vital partner for managing polypharmacy.
Frank Longo, RPh, is President of Precision LTC Pharmacy, which serves long-term care facilities in the New York metropolitan area. For more information, visit PrecisionLTC.com, call (516) 466-7700 or email info@precisionltc.com.
Footnotes
- National Center for Health Statistics, National Health and Nutrition Examination Survey, August 2021–August 2023. Depression Prevalence in Adolescents and Adults: United States, August 2021–August 2023. www.cdc.gov/nchs/products/databriefs/db527.htm
- Anxiety & Depression Association of America. adaa.org/understanding-anxiety/facts-statistics
- National Center for Health Statistics, National Health and Nutrition Examination Survey. www.cdc.gov/nchs/pressroom/nchs_press_releases/2025/20250416.htm
- National Center for Health Statistics, Mental Health Treatment Among Adults: United States, 2020. www.cdc.gov/nchs/products/databriefs/db419.htm#fig1
- National Library of Medicine, Prevalence and trends of polypharmacy in U.S. adults, 1999–2018. pmc.ncbi.nlm.nih.gov/articles/PMC10337167/
