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Psychopharmacology awareness for psychotherapists
Your scope (RPs do not prescribe or advise on medication), the common classes and what to notice and pass on, the signs that need urgent care, and how to work with prescribers.
Study aid, not legal advice.Last verified against the official sources linked below on .
Your scope
- Prescribing a drug is a controlled act (RHPA s. 27 (2), para. 8) that RPs are not authorized to perform.
- CRPO: "RPs are not authorized to prescribe medication, give advice about medication, or communicate a diagnosis" (Standards 1.4 and 3.3).
- In a CRPO scenario, an RP texted a client articles on a medication's side effects; CRPO cautioned that providing information about medication is outside the scope of psychotherapy and could cause harm.
- Your part: listen to the client's concerns, notice changes, and encourage them to talk to their prescriber or pharmacist.
When it is urgent
- Signs of serotonin syndrome or lithium toxicity, a sudden change in consciousness or behaviour: 911 or the nearest emergency department.
- New or worsening suicidal thoughts: assess and plan as for any risk, tell the prescriber with consent, and give 9-8-8.
Common classes: what to notice and pass on
| Class | Notice and pass on | Source |
|---|---|---|
| Antidepressants (SSRIs, SNRIs and others) | New or worse suicidal thoughts early on, above all under 25. Stopping suddenly can bring withdrawal, which can be severe and mistaken for relapse. | Stone et al., 2009, BMJ 339:b2880; Horowitz and Taylor, 2019, Lancet Psychiatry 6(6):538-546 |
| Serotonergic combinations | Agitation or confusion, a racing heart, sweating, tremor or muscle jerks: possible serotonin syndrome, urgent. | Boyer and Shannon, 2005, N Engl J Med 352(11):1112-1120 |
| Lithium | A narrow margin: worsening tremor, weakness, unsteadiness, diarrhea, then vomiting, slurred speech or confusion: urgent. Dehydration, fever and new medications raise the risk. | Gitlin, 2016, Int J Bipolar Disord 4(1):27 |
| Antipsychotics | Side effects differ more than benefits between drugs: weight change, restlessness, stiffness, drowsiness. | Huhn et al., 2019, Lancet 394(10202):939-951 |
| Benzodiazepines | Drowsiness, memory and coordination effects; dependence. Benefit is established for 2 to 4 weeks, not beyond. | Lader, 2011, Addiction 106(12):2086-2109 |
| ADHD medications (stimulants and others) | Effective in the short term; effects the client reports, and any misuse. | Cortese et al., 2018, Lancet Psychiatry 5(9):727-738 |
Working with prescribers
- Make reasonable attempts to communicate with the client's other providers, unless the client refuses, it would be counter-therapeutic, or it is unnecessary (3.3.1).
- Within the circle of care, implied consent can be assumed for the client's care unless they have said no (PHIPA s. 20 (2)); ask anyway.
- Share what you observed and what the client reports: sleep, mood, side effects, missed doses, substance use. Not a diagnosis, not a medication suggestion.
- Document what was shared, with whom, when and with what consent, and what you advised (Standard 5.1).
Notice, listen and pass it on: the prescriber decides about medication.