In terms of antipsychotics and antidepressants there should be a huge bias in favor of prescribing the antipsychotics and antidepressants that patients are willing to take. Perhaps a new antipyschotic is heralded as the best thing ever but the patient hates the new antipsychotic. The new antipsychotic could produce restlessness which the patient just can not stand and the patient is unwilling to take an anticholineric. The best antipsychotic for a patient has to be amongst those antipsychotics that the patient is willing to take so the new antipsychotic, which is the best thing ever, can not be the best antipsychotic for the patient.
Patients must be safe for themselves and others but once that is achieved dosages of antipsychotics and antidepressants should be decided by the patient though if a patient wants to take physically unsafe dosages that can not be allowed. A patient is much more likely to take an antipsychotic or antidepressant if he or she decides the dosage.
Psychotropic medications do not cure so the search for a cure via medications is worse than useless. Safe for themselves and and others though strange can count as a victory with psychotic disorders. Intutions of prescribers at the clinical level who have solved the mysteries of how prescribed psychotropic medications really work can result in disasters for patients via rococco med regimes.
Simpler med regimes are ceteris paribus better than complex med regimes though frequently medications from different psychotropic classes have to be taken. Taking a second drug from the same pysychotropic class is to be avoided. Drugs in a class are basically differentiated due to side-effects so taking a second drug in the same drug class will only add more side-effects not improve basic efficacy of med regimes. Side-effects are a huge deal with psychotropic medications and unacceptable side-effects are completly legitimate grounds for switching antipsychotics and antidepressants. There is wide variety among patients as to what side-effects are acceptable which can result in switching drugs frequently until a drug with the right side-effect profile is found.
Getting patients on board with taking medications is very important so patient decisions within limits as to antipsychotics and antidepressants taken and at what dosages count for a lot. Personal skills and willingness to work with patients on meds are as important for prescribers as a knowedege of the pharmacology of antipsychotics and antidepressants.