Pharmacologic Management of Psychiatric Comorbidity in Primary Care

Course overview

Primary care clinicians routinely manage patients whose psychiatric symptoms complicate chronic disease care, medication adherence, pain management, and overall health outcomes. This course provides a focused review of pharmacologic management for psychiatric comorbidity in the primary care setting, emphasizing antidepressant and anxiolytic selection for panic and depressive disorders, practical dosing and titration strategies, management of partial or poor response, medication adverse effects, discontinuation issues, and safe prescribing in patients with co-occurring substance use. Special attention is given to opioid use disorder treatment in primary care, including the role of buprenorphine and naltrexone, the impact of co-occurring alcohol and benzodiazepine use, methadone-related QT risk, and the importance of medication reconciliation for drug-drug interactions. The course also addresses clinical thresholds for escalation and referral, including suicidality, psychosis, acute mania, severe functional impairment, treatment resistance, unstable co-occurring psychiatric illness, and substance use complexity that exceeds the resources of primary care. Learning Objectives By the end of this course, the participant will be able to: Differentiate first-line and next-step pharmacologic options for panic disorder, depressive syndromes, and opioid use disorder commonly managed in primary care. Apply evidence-based dosing, titration, monitoring, and duration principles when initiating or adjusting antidepressants, adjunctive anxiolytics, and medications for opioid use disorder. Recognize adverse effects, discontinuation syndromes, QT prolongation risk, blood pressure effects, and clinically important drug-drug interactions that influence medication selection in primary care. Select pharmacologic strategies for patients with psychiatric symptoms complicated by current or past substance use, including when benzodiazepines should be avoided or limited. Identify when referral to psychiatry, addiction medicine, or higher-acuity specialty services is indicated based on symptom severity, diagnostic complexity, safety concerns, or inadequate response to treatment.