Psychopharmacology and Medical Collaboration
What to know
Counseling psychologists need working knowledge of major drug classes, mechanisms, and side effects: SSRIs/SNRIs (serotonin syndrome, discontinuation syndrome), bupropion (lowers seizure threshold), TCAs (anticholinergic and cardiac risk), MAOIs (tyramine and drug interactions), benzodiazepines (tolerance, dependence, falls), antipsychotics (metabolic syndrome, EPS, tardive dyskinesia, NMS), mood stabilizers (lithium toxicity and renal/thyroid monitoring; valproate hepatotoxicity and teratogenicity), and stimulants (cardiovascular effects). Know black-box warnings, especially suicidality in youth on antidepressants. Understand scope of practice: psychologists do not prescribe unless licensed to do so, and collaboration means communicating, not directing.
Traps
Questions test whether you know the difference between a side effect and a relapse, and whether a referral is warranted. Watch for lithium toxicity stems (vomiting, tremor, confusion with dehydration) and for serotonin syndrome versus NMS. Another trap is assuming you should advise a dose change-refer instead.
Rule of thumb
New or worsening physical symptoms, especially after a medication change, warrant medical referral and documentation; never advise stopping or altering a medication.
Worked example
A client on lithium returns from a stomach flu with coarse tremor and confusion. This suggests toxicity; the correct action is urgent medical referral, not reassurance or a therapy adjustment.