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Introduction

This guide is designed to help you understand some of the medications that are prescribed by psychiatrists. It is by no means a complete compendium of all medications. It briefly touches upon the categories of medication used for treating common psychological disorders, describing the indications for medication, an overview of how the medications work, and the potential for addiction and adverse effects.

It is also important to remember the following points:

1. Medication is frequently given for a period of time rather than indefinitely. This will depend upon the psychological disorder and the medication.

2. When considering whether to take medication or while taking medication, it is important to ask questions of your doctor and to carefully monitor symptoms.

3. Medication is most often taken in conjunction with counseling in order to receive comprehensive assistance.

Anxiety

Anxiety is generally defined as an overwhelming sense of uneasiness or discomfort. It may be related to a precipitating condition or situation (i.e. an upcoming examination) though at times the cause may not be readily discernible.

There are many medications that can be used to treat anxiety disorders. Benzodiazepines are one of the more common classes of medication used. Benzodiazepine medications have been around for a long time and have many uses; among them muscle relaxation, induction of sleep, and rapid relief against common forms of anxiety. Medications in the class include Valium, Librium, Xanax, Klonopin, Ativan, and Serax. Benzodiazepines act by increasing GABA, an inhibitory neurotransmitter in the brain. While the clinical effects for all benzodiazepines are similar, they differ in the way in which the body may metabolize them. Some medications are more long acting and are more useful in treating anxiety that tends to be fairly consistent, prevalent and interferes with sleep as opposed to a brief episode of anxiety (i.e. anxiety that might be experienced prior to test situations) which might do better with a short-acting drug. All the benzodiazepines have a potential for abuse and one may develop tolerance to them; however under the supervision of a psychiatrist, this is unlikely to occur. Another medication, Buspar, is a non-benzodiazepine antianxiety drug. It does not cause sedation and has no potential for abuse; however it may take as long as four weeks to act.

Sedation is the most common adverse effect of the benzodiazepines. It may be more severe in the elderly and increase the risk of falls. Anterograde amnesia, inability to remember a period of hours after taking the drug, has occurred in some patients. Overdoses of benzodiazepines are rarely lethal, but they can be dangerous if taken with alcohol, barbiturates, opiates, or other drugs that depress the central nervous system. For this reason, patients on benzodiazepines are usually encouraged to avoid alcohol. Physical dependence may develop with chronic use. Withdrawal symptoms including insomnia, nausea, vomiting, twitching, sweating, and muscle cramping can develop when these drugs are abruptly discontinued, especially after prolonged or excessive use. Gradual tapering of dosage, sometimes over weeks or months, is recommended in order to avoid this potential side effect. With some benzodiazepines that have longer half-lives (i.e. those that last longer in your body) withdrawal symptoms and rebound anxiety may be less frequent and milder. Benzodiazepines are usually, although not always, used for short-term treatment of anxiety (potentially for a few days to weeks).

Mania

Mania is a sense of euphoria often associated with a decreased need for sleep, increased appetite, increased energy, and a sense of overwhelming well being, almost grandiosity. Some self-destructive behaviors including increased spending, sexual promiscuity, and substance abuse may also occur. Mania occurs as part of bipolar disorder also known as manic-depression that includes periods of highs and lows in cycles. The common drugs used to treat mania include lithium, and some newer medications including Valproate, Tegretol, Neurontin and Lamictal. Lithium, the most common treatment, may take two to four weeks to have a full therapeutic effect. Lithium requires laboratory studies to check baseline functions of red and white blood cells, as well as thyroid and kidney capacity. Lithium can be given safely if serum concentrations are monitored.

Nausea and fatigue may occur in the first weeks of treatment with Lithium even when the serum concentrations are in the recommended range. Tremors, thirst, increased urination, fluid retention and weight gain can persist for the duration of treatment. Lithium induced tremor, which is a very minor trembling generally of the upper extremities can be treated by lowering the dose or by adding Inderal, which is a form of an antihypertensive or high blood pressure medication.

For patients who cannot tolerate Lithium or with a specific form of mania, Valproate, Tegretol, Neurontin or Lamictal may be reasonable alternatives. Other agents may include Gabitril or Topamex. Some recent research has also suggested that fish oil or flax oil may benefit some patients as well.

Depression

Depression is a medical illness like any other medical illness. Common symptoms of depression include problems with sleep and appetite, loss of concentration and memory, lack of interest, low energy and a low mood. There also may be tearfulness, indecisiveness, and a sense of helplessness, hopelessness, and guilt. These symptoms, of a pervasive nature, affect mood, thinking, and behavior for a period of ten days to two weeks or more. Major depression often requires treatment with drugs. Anxiety, insomnia, substance abuse, or multiple somatic or physical complaints that frequently accompany depression may obscure the diagnosis. Many drugs including oral contraceptives, high blood pressure medication, long-term benzodiazepine use, and illegal substances such as cocaine can also cause depression. Moreover, a very common substance, alcohol may (with long-term use) cause depression or worsen a depression already in existence.

It has been estimated that approximately one of five people in this country is depressed at any given time. The good news, however, is that depression is very treatable. Many antidepressants are available to treat this common disorder. At least 80% of people will recover on the first antidepressant that they try. The remainder usually recovers with different antidepressants or a combination of medications.

The older antidepressants are called tricyclics because of their chemical structure, which includes a three-ring component. They are very effective and much research has been done with these substances. Better-known compounds in this class include Elavil (amitriptyline), Tofranil (imipramine), Pamelor (nortriptyline), and Norpamin (desipramine). They have gone somewhat out of favor because of their broad side effect profile, which may include sedation, weight gain, dry mouth, blurred vision, and constipation. MAO inhibitors have also been used to treat depression. However, these have gone somewhat out of favor as well because of their restrictions on dietary intake and over-the-counter medications.

Wellbutrin (bupropion) is another medication that is effectively used. It requires two daily doses. It may also be helpful with attention deficit disorder.

The newer antidepressants are called selective serotonin re-uptake inhibitors (SSRIs) because of their specific action on a neurochemical called serotonin. In this class of medication are Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), and Lexapro (escitalopram). They seem to be very well tolerated because of their low side effect profile and low lethality. These medications take three to six weeks to work as they cause a subtle re-regulation of neurotransmitter systems.

Effexor, also known as Venlafaxine, is another antidepressant alternative that may be effective for some patients. Trazadone, another antidepressant, is helpful as a second drug for patients with sleep disturbance. Some antidepressants, particularly the serotonin re-uptake inhibitors may be energizing and worsen a sleep disorder. Low doses of trazadone in addition to these can improve sleep. Serzone, a medication similar to trazadone, is particularly helpful in treating depression that is accompanied by anxiety. It does not cause weight gain but may cause sleepiness. Remeron, another antidepressant alternative, may help with sleep but can cause weight gain.

The most common side effects with serotonin re-uptake inhibitors include nausea, headache, nervousness and insomnia. However, they do not usually cause the weight gain that is more common with tricyclic antidepressants. Agitation and increased anxiety may occur in the first weeks of treatment and subside later. All serotonin re-uptake inhibitors may cause some incidences of delayed orgasm or inorgasmia in men and women. This is a totally reversible side effect that may be improved by decreasing the dose. Wellbutrin may cause agitation and rarely seizures but fewer of the other side effects of tricyclic antidepressants. Effexor is generally similar to the serotonin re-uptake inhibitors in its adverse effects, but it has been associated in a small number of people with a sustained increase in blood pressure. Therefore, blood pressure monitoring is essential.

Attention Deficit/Hyperactivity Disorder

Attention Deficit/hyperactivity disorder is a condition characterized by difficulties in inattention and/or hyperactivity-impulsivity. These difficulties must first be present in childhood, although they may not have been recognized then. Approximately one third of children diagnosed with attention deficit disorder in childhood will have residual symptoms as adults. Medications more commonly used to treat this condition include stimulants such as Ritalin, Dexedrine, Adderall and Pemoline as well as many of the antidepressants previously mentioned in the discussion on depression. Extended release forms of the medications have recently become available.