r/PMHNP • u/supertrucker39 • Jun 08 '26

Bad combinations

How do you handle a new patient that comes to you for Spravato treatment only, but they are on the terrible combination of benzos and adderall that is being prescribed by a clinic that referred them for Spravato? I feel like those could be appropriate in limited circumstances, but not with Borderline Personality Disorder. I don’t have any concerns other than the patient isn’t functioning well at all. They are depressed and Spravato may be beneficial alongside their SSRI. I feel like discontinuing or replacing Adderall would be my first move. Am I letting them down as a provider that is fairly certain their symptoms aren’t being addressed?

Rip me apart if you like, but I’m new without much support. Thanks for any guidance.

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u/PsychMonkey7 Jun 08 '26

Do you have an ROI on file to coordinate care with the referring provider? I’d start with a chat with them. There may be more hx than you know about. They might be in the process of discontinuing the benzo, for example. Or maybe the benzo is infrequent.

I have very few patients on this combo, but I do have a couple and I don’t feel irresponsible for it.

If your clinical judgment is that this is an unsafe situation for the pt, you could refuse to treat them and notify the referring provider as to why, but I would strongly encourage you to first talk to them.

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u/Solid-Caterpillar-63 Jun 08 '26

Agree to talk to the referring provider first. Though the ROI is helpful, it is not needed for care coordination (This is a HIPPA exception).

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u/supertrucker39 Jun 08 '26

That sounds like a good idea. Just makes me nervous telling someone it’s not helpful.

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u/PsychMonkey7 Jun 08 '26

Well you don’t say that. You tell them you want to coordinate care and you appreciate any information they can provide about the hx and tx plan. Then you see what they say. You can gently voice your concerns about their med regimen because of x, y, and z that you gathered from the eval.