What psychiatric medication management is
Psychiatric medication management is the ongoing, individualized oversight of medications used for mental health: choosing whether a medication is appropriate, starting it at the right dose, monitoring how it works and what side effects it causes, adjusting it, and, when the time is right, simplifying or tapering it. Good medication management is not a ten-minute refill. It is a series of careful decisions made with you, based on your history, goals and biology.
At Sphosh Health, medication management always sits inside a broader plan that also considers therapy, sleep, nutrition, physical health and life context. Medication can be an important tool; it works best when the rest of the foundation is also being addressed.
When medication management can help
- Starting medication for depression, anxiety, insomnia or other concerns, after a thorough assessment of whether it is the right step.
- A medication that is not working well enough, where the question is whether to adjust the dose, switch, add something, or look for an underlying factor that is limiting the response.
- Side effects such as weight changes, fatigue, emotional blunting, sexual side effects or sleep problems that make a medication hard to continue.
- Too many medications, where several prescribers have added treatments over time and no one has reviewed the whole list.
- Wanting to reduce or stop a medication, which needs a careful, supervised plan.
- A second opinion on your current regimen.
Our approach
A complete review, not just a refill
We start by understanding your full history: what you have tried, at what doses and for how long, what helped and what did not, side effects, and how your symptoms have changed over time. We also review supplements, over-the-counter medicines, caffeine, alcohol and cannabis, because these interact with psychiatric medications and with mood and sleep.
Looking for what limits the response
When a medication only partly works, it is worth asking why. Untreated insomnia, low iron or vitamin B12, thyroid problems, ongoing stress, alcohol use and inflammation can all limit improvement. Addressing these is often as important as changing the medication. See functional psychiatry and root causes and lab testing for mental health.
Measured, shared decisions
We explain the options, expected benefits, common side effects and alternatives, and make decisions together. Changes are made one at a time where possible, so we can tell what is helping. Progress is tracked with standardized symptom scales and your own goals.
Integration with therapy and lifestyle care
Research consistently shows that psychotherapy combined with medication works better than either alone for many conditions. We coordinate both, along with sleep, nutrition and stress care. See integrative psychiatry and holistic mental health care.
Tapering and deprescribing, done safely
Many people want to know whether they can take fewer medications. Sometimes that is possible, and sometimes staying on a medication is the right choice. When reducing a medication is clinically appropriate, it should be done gradually and with supervision. Stopping antidepressants, sleep medications or other psychiatric drugs abruptly can cause discontinuation symptoms such as dizziness, irritability, flu-like feelings, insomnia or a return of the original symptoms. A good taper:
- is planned in advance, at a stable time in your life rather than during a crisis;
- reduces the dose in small steps, adjusted to how you respond;
- strengthens sleep, stress skills and other supports before and during the process;
- includes a clear plan for what to do if symptoms return.
Please do not stop or change a prescribed medication on your own. Talk with your prescriber first. See medication tapering and deprescribing.
Our prescribing scope, explained plainly
Our providers are licensed naturopathic physicians in Washington, led by Dr. Koichi Tanji, ND, LMHC. Under Washington law, naturopathic physicians may prescribe legend (prescription) drugs consistent with naturopathic practice, but controlled substances are limited to a small group of products. In practice this means:
- We can manage many commonly used non-controlled medications, alongside nutrition, sleep and lifestyle care.
- Controlled substances, including ADHD stimulants and benzodiazepines, are outside our prescribing scope. If one of these is part of the right plan for you, we coordinate with your primary care physician, psychiatrist or psychiatric nurse practitioner so your care stays connected.
- For complex situations, such as bipolar disorder, psychosis or severe treatment-resistant depression, we work alongside psychiatrists and other specialists rather than in place of them.
If you are unsure whether we can manage a specific medication, call us before booking and we will tell you honestly.
Supplements and medications: checking for interactions
Many people add supplements on their own while taking psychiatric medication. Some combinations are harmless; others are not. St. Johnโs wort, for example, can interact with many prescription drugs, including some antidepressants and hormonal contraceptives, and combining several serotonin-affecting products can raise the risk of serotonin toxicity. Other supplements can affect sleep, blood pressure or how medications are metabolized. Part of medication management is reviewing everything you take, including teas, powders and over-the-counter products, and making sure the overall regimen is safe and makes sense.
Life stages that call for a medication review
- Planning a pregnancy, pregnancy and breastfeeding, when the balance of risks and benefits of each medication should be reviewed carefully with your prescribers and obstetric team. See perinatal and postpartum mental health.
- Perimenopause, when sleep, mood and anxiety can shift and a regimen that worked for years may need revisiting.
- New medical diagnoses or medications, which can change how psychiatric medications are tolerated.
- Older age, when the body processes medications differently and simplifying a regimen is often worthwhile.
What visits look like
Your first visit is a comprehensive assessment, usually through our Biopsych Assessment. Early follow-ups are more frequent, often every few weeks, while a regimen is being started or adjusted. Once you are stable, visits are spaced out. Visits are available in person in Bellevue and by secure telehealth across Washington.
Conditions we commonly support
Depression and low mood, anxiety and panic, insomnia, stress and burnout, mood dysregulation, perinatal and postpartum mood changes, and ADHD (in coordination with a stimulant prescriber where needed).
Getting started
We are in-network with Premera, Regence, BlueCross BlueShield, Aetna, Cigna and Kaiser PPO. Book online or call (425) 278-6166. Please bring a list of your current and past medications, doses and dates if you have them.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
