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A 58-year-old male with treatment-resistant depression and generalized anxiety disorder has been maintained on a regimen of fluoxetine 60 mg daily, bupropion SR 200 mg twice daily, buspirone 15 mg twice daily, trazodone 150 mg at bedtime, and low-dose aripiprazole 2 mg daily for the past three years. His depression has been in partial remission with a PHQ-9 score of 8. The PMHNP initiated a polypharmacy reduction plan six months ago, successfully tapering and discontinuing buspirone and reducing trazodone to 50 mg. His current PHQ-9 score is 7, GAD-7 is 6, and he reports improved daytime alertness and no worsening of sleep. However, he reports new-onset mild restlessness and increased caffeine consumption over the past month. Which evaluation finding most accurately reflects the outcome of the polypharmacy reduction?
Explanation
Polypharmacy reduction can unmask adverse effects of remaining medications that were previously counteracted by discontinued agents. In this case, reduction of sedating and anxiolytic medications has exposed aripiprazole-induced akathisia that was previously buffered. Evaluation should include formal akathisia assessment to guide further optimization of the remaining regimen.
Key Takeaway
When evaluating polypharmacy reduction outcomes, new symptoms must be assessed for medication-related causes in the remaining regimen, as discontinued agents may have been masking adverse effects of medications that are being continued.