Author: Bowie Han, MD, Psychiatrist and Associate Medical Director, Compass Health Center – Chicago
Frank is a 33-year-old teacher for Chicago Public Schools. Before getting on the bus, he takes his first dose of Adderall so he can focus in the classroom, along with gabapentin to minimize panic attacks during his commute. At lunchtime, he takes his second dose of Adderall. He finds the extended-release version intolerable and prefers the flexibility of an as-needed immediate-release dose, which helps him get through afternoon lessons and plan for the next day. Before leaving work, he takes a second dose of gabapentin to ease anxiety on the commute home, and a third at dinner to quiet his ruminations. Finally, at bedtime, he takes escitalopram and trazodone, which help with depression, anxiety, and insomnia, along with amlodipine for hypertension.
Medication management is one of the most common challenges clinicians hear about from patients and caregivers alike. Frank’s routine illustrates just how difficult adherence can be, especially when it involves dosing two or three times a day.
In this post, we’ll cover how to organize your medications, keep an accurate list, build a routine that sticks, know when to reach out to your provider, and explore additional support available at Compass Health Center. Consistency in these habits can make a meaningful difference for you and your loved ones.
What Is Medication Management, and Why Does It Matter?
Medication management is the process of ensuring you take your medications and supplements correctly, safely, and effectively. In psychiatry, we often call these medications psychotropics.
Studies indicate that up to 50% of individuals with depression struggle with adherence, which raises the risk of hospitalization, symptom relapse, and impaired functioning at work and in relationships (Semahegn et al., 2020).
Adherence is a challenge across all types of illness, not just mental health. Up to 13% of patients never fill their first prescription for anticoagulants after being diagnosed with atrial fibrillation, a heart condition that raises the risk of stroke-causing blood clots (Charlton et al., 2021).
As Frank’s story shows, nonadherence is an issue across the board — acute or chronic, physical or mental.
How Do You Build a Complete and Accurate Medication List?
At the doctor’s office, your provider or a member of the medical team will perform a medication reconciliation — verifying the medications you’re currently taking. An organized list, on paper or electronic, speeds up this process and, more importantly, reduces the errors that come with relying on memory alone.
A medication list should include your current medications, their timing and frequency, dose, route of administration (most often oral), and how long you’ve been taking each one.
For mental health in particular, it helps to keep a running list of past psychotropic medications you’ve tried, including how long you were on each, the dosage, and why it was prescribed. This history helps your provider identify the next step in your treatment, whether that’s a new medication or another option on your path to wellbeing.
It’s tempting to assume over-the-counter supplements and medications don’t count, but include them anyway — leaving them off your list can mean missing an important drug interaction.
Why Should You Understand What Each Medication Does?
Understanding how your medications work, and why you’re taking them, is essential. Knowing the why and how behind your psychotropics can improve your sense of control over treatment, which in turn supports adherence and outcomes (De Las Cuevas et al., 2017).
The first time you pick up a new medication, ask your pharmacist about any questions or concerns you have. An unaddressed concern can quietly grow into nonadherence and delay your improvement. It’s normal to have concerns about side effects — ask your provider what to expect in the first few minutes, hours, and days so you know what to watch for.
I once had a patient starting a stimulant medication for ADHD for the first time. We had discussed that combining caffeine with methylphenidate could be overly activating, causing jitteriness, restlessness, and racing thoughts — but on the first day, they forgot to cut back on their usual morning coffee and felt noticeably wired. A few hours later, they remembered our conversation and used coping skills to manage the anxiety, which eased once the medication wore off. The next day, they switched to black tea instead and noticed a real improvement in their focus during class. Because we had proactively discussed these anxiety-inducing effects of mixing caffeine and a stimulant, the patient avoided quitting the medication prematurely and saw rapid improvement instead.
How Do You Create a Medication Routine That Actually Sticks?
If a medication isn’t particularly activating or sedating, and doesn’t need to be taken with or without food, you have flexibility in timing — so build it around your lifestyle to maximize your chances of sticking with it. For example, take sertraline right after breakfast to help with potential GI side effects and to fold it into your morning routine. Pill organizers can help you keep track, especially with medications dosed twice a day or more, and phone alarms or reminder apps offer another layer of backup.
When a patient comes to me struggling with adherence because they keep forgetting doses, I first check whether the timing is flexible. If it is, I try to link the dose to an existing habit, which tends to significantly improve adherence going forward.
Some psychotropics carry a higher risk of withdrawal or discontinuation symptoms. Taking these at the same time each day can help minimize that risk.
Why Is It Important to Talk to Your Provider About Medication Concerns?
There are many reasons someone might avoid telling their provider that they’ve stopped taking a medication — fear of disappointment, shame, and guilt are all commonly reported. But we can only work with what we know, so being open and honest helps with treatment planning and with tailoring further options, whether medications or other avenues like neuromodulation. Cost is another important factor, especially for brand-name or off-label medications. By sharing your concerns, you and your provider can build a more tailored plan that reduces the risk of nonadherence and maximizes effectiveness.
In my own practice, I always start by asking, “How do you feel about medications?” I’ve found that question invaluable for managing expectations and figuring out where to begin the conversation. I’ve had patients spend two to three months in our program and choose not to take any psychotropic medication at all — and yes, they still improved, without me raising the subject at every visit. At Compass, we strive to build connection and patient-centered care into everything we do. I find this kind of shared decision-making essential — it builds rapport, gives patients a sense of agency, and ultimately leads to better outcomes.
How Can Caregivers Help Manage a Loved One’s Medications?
Some of you may be managing medications for a loved one — a spouse, parent, or child. It might be a temporary measure due to safety concerns, or something more longstanding related to cognitive difficulties or age. As your loved one’s primary support, keeping an updated medication log, attending appointments, and having a point of contact at the provider’s office are all key if questions about adherence, tolerability, or effectiveness come up. Our dedicated nursing team at Compass is available by phone and email during business hours to answer your questions about your loved one’s medications.
When Should You Ask Your Provider for a Medication Review?
Medications are usually reviewed at the end of each visit with your mental health provider, but that doesn’t guarantee every one gets discussed. If you’re dealing with intolerable side effects, questioning a medication’s effectiveness, or unsure why you’re taking something, bring it up with your provider. It can be hard to tell the difference between a medication side effect, a lack of benefit, and the natural, waxing-and-waning course of an illness. By raising concerns proactively, your psychiatry team member can help pinpoint which symptoms to watch and identify what’s driving the change.
What Additional Medication Support Does Compass Offer?
Prior Authorizations (PAs): What They Are and How Compass Handles Them
Compass Nursing completes prior authorizations for medications not initially covered by a patient’s insurance. Our nurses submit PAs by fax (via CoverMyMeds) or phone with the insurance company, working with the Compass psychiatrist or nurse practitioner to document previous medication trials and the clinical case for the prescription. This is especially important for patients at the PHP and/or IOP level of care who have already tried several medications and may benefit from newer options or dose exceptions. Support through this process, and access to the medication itself, aids recovery and symptom management, and reduces the risk of needing a higher level of care.
Long-Acting Injectables (LAIs) at Compass
Compass Nursing currently administers Vivitrol onsite, including managing the PA process for insurance approval and delivery. This service especially benefits patients in the MHSU program, lowering barriers to access and strengthening treatment adherence. By Q3 2026, Nursing will also roll out a standardized process to prepare, train for, and launch administration of psychotropic Long-Acting Injectables (LAIs), further supporting symptom management for higher-acuity patients and strengthening continuity of care and overall wellbeing.
Key Takeaways on Medication Management
Medication management is an ongoing process, and it can be a bumpy ride at times — especially in the first few months, as you adjust to how you feel, whether that means welcome symptom relief or a distressing side effect. Being on any medication, let alone several, can feel daunting. But you’re not walking this path alone. At Compass Health Center, your treatment team — primary therapist, family therapist, group therapists, nursing team, and psychiatry team member — is here to support you every step of the way, helping you get back to your life.
Sources
De Las Cuevas, C., de Leon, J., Peñate, W., & Betancort, M. (2017). Factors influencing adherence to psychopharmacological medications in psychiatric patients: a structural equation modeling approach. Patient Preference and Adherence, 11, 681–690. https://doi.org/10.2147/PPA.S133513
Charlton, A., Vidal, X., Sabaté, M., Bailarín, E., Martínez, L. M. L., & Ibáñez, L. (2021). Factors associated with primary nonadherence to newly initiated direct oral anticoagulants in patients with nonvalvular atrial fibrillation. Journal of Managed Care & Specialty Pharmacy, 27(9), 1210–1220. https://doi.org/10.18553/jmcp.2021.27.9.1210
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews, 9, 17. https://pmc.ncbi.nlm.nih.gov/articles/PMC6966860/
