Addressing Patient Concerns About Atypical Antipsychotic Augmentation for MDD

While augmenting antidepressant treatment with an atypical antipsychotic is an evidence-based strategy, many patients may feel apprehensive about incorporating an antipsychotic medication into their treatment plan. 

In this discussion, Erin Crown, MHS, PA-C, CAQ-Psychiatry, Co-Chair, Psych Congress PA Institute, shares several communication strategies to effectively address these patient concerns when considering augmentation for major depressive disorder (MDD). Crown emphasizes the importance of correcting misconceptions about the role of atypical antipsychotics in MDD. She also highlights the value of equipping patients with accurate information to reduce stigma and support shared decision-making about their treatment plan.

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• Clinicians can proactively address stigma by explaining that the medication class name does not mean the patient has psychosis and clarifying the rationale for its use.
• Atypical antipsychotics should be described as medications that have been studied in the patient's illness and shown to provide therapeutic benefit from an evidence-based perspective.
• Discussions should set expectations by reviewing potential benefits, safety, and risk profiles to help patients understand the treatment option and support informed decision-making.
   

Erin Crown, MHS, PA-C, CAQ-Psychiatry: Hello, my name is Erin Crown, and I'm a psychiatric PA in State College, Pennsylvania, where I own my practice with my supervising physician. We provide outpatient medication management and psychotherapy. I've been leading a first-episode psychosis program since 2018. We have primary care, obesity medicine, aesthetics, and recently I've had opportunities to practice as a principal investigator in clinical trial work.

Psych Congress NP Institute: How do you approach conversations with patients about adding an atypical antipsychotic, especially those who may be apprehensive about antipsychotic medications due to stigma or concerns about adverse effects?

Crown: The first thing that I do is I say, “Now don't freak out. It's not my fault that it's classed this way, but the medication I'm going to talk to you about is technically called an atypical antipsychotic. That doesn't mean you're crazy.” 

I find that if I just meet it with a little bit of humor and a little bit of sarcasm, it kind of helps to relax the patient because if I don't do that, they're going to go home and they're going to get on Dr Google or whatever platform they're using and they're going to say, “She must think I'm crazy. I'm not crazy. I don't have psychosis. Why is she giving me an antipsychotic?” and they're going to misunderstand why I'm prescribing that medication. 

Then I follow it up explaining that [antipsychotics are] used in other illnesses that can include symptoms of psychosis, but it's also been studied in their illness, in their brain illness, and shown to have therapeutic benefit from an evidence-based perspective. 

Then I just begin to talk to them about what they might experience or expect, balancing the safety and the benefit risk profiles. So, just really setting those expectations, helping them to understand why I'm talking to them about giving them an antipsychotic medication and helping them to feel more relaxed and hopefully hopeful about the treatment option.

Erin Crown, MHS, PA-C, CAQ-Psychiatry, is a Board Certified Physician Assistant with a Certificate of Added Qualifications in Psychiatry, and the Managing Member of Oasis LifeCare in State College, PA. She practices psychiatry in the outpatient setting and also leads a first episode psychosis program.. She is the owner of Future Options Research and is the Principal Investigator for multiple clinical trials. Erin is the past Chair of the NCCPA Health Foundation and is also working with AAPA and the PA Foundation to bring trauma informed education to school districts across the country.

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