Are medications for mental health a good idea?
Ward Halverson works with many people - particularly children and families, but also individuals and couples - who struggle with this common question. Is medication a good idea? When asked, Ward's answer, first of all, is that taking medication for a mental illness has to be your decision, and no one else's. Patients considering medication should weigh the possible benefits carefully with the possible side effects and ultimately make the most informed decision they can.
Ward's other point about taking medication is that virtually all drugs for mental illnesses treat symptoms, not the actual cause of the problem (treatment for ADHD is generally an exception - more on that topic follows). Treatment of the actual cause often involves individual therapy or some other major life change, or sometimes just time passing - it's hard to say. If the problem is causing significant emotional distress and interfering with your ability to function in life (or your child's), then it's smart to move quickly toward treatment. That move might or might not involve medications, but understanding that medications generally just treat the distressing symptoms is important.
Anyone can develop a mental illness-you, a family member, a friend, or a neighbor. Some disorders are mild; others are serious and long-lasting. These conditions can be diagnosed and treated. Most people can live better lives after treatment, and psychotherapeutic medications are an increasingly important element in the successful treatment of mental illness.
How long have these medications been around?
Medications for mental illnesses were first introduced in the early 1950s with the antipsychotic chlorpromazine. Other medications have followed, and they have often changed the lives of people with mental health disorders for the better. Interestingly, psychotherapeutic medications also may make other kinds of treatment more effective. Someone who is too depressed to talk, for instance, may have difficulty communicating during psychotherapy or counseling, but the right medication may improve symptoms so the person can respond. For many patients, a combination of psychotherapy and medication is the most effective method of treatment.
Another benefit of these medications is an increased understanding of the causes of mental illness. Scientists have learned much more about the workings of the brain as a result of their investigations into how psychotherapeutic medications relieve the symptoms of disorders such as psychosis, depression, anxiety, obsessive-compulsive disorder, and panic disorder.
So, medications really just relieve symptoms?
Just as aspirin can reduce a fever without curing the infection that causes it, psychotherapeutic medications act by controlling symptoms. These medications do not necessarily cure mental illness, but in many cases, they can help a person function despite some continuing mental pain and difficulty coping with problems. For example, drugs like chlorpromazine can turn off the "voices" heard by some people with psychosis and help them to see reality more clearly. Antidepressants can lift the dark, heavy moods of depression. Medications for Attention-deficit Hyperactivity Disorder help children focus and concentrate enough in class that they are able to learn. The degree of response - ranging from a little relief of symptoms to complete relief - depends on a variety of factors related to the individual and the disorder being treated.
How long should someone take them?
How long someone must take a psychotherapeutic medication depends on the individual and the disorder. Many depressed and anxious people may need medication for a single period - perhaps for several months - and then never need it again. People with conditions such as schizophrenia or bipolar disorder (also known as manic-depressive illness), or those whose depression or anxiety is chronic or recurrent, may choose to take medication for many years, even the rest of their lives.
Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others. Some have side effects, and others do not. Age, gender, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking are some of the factors that can influence a medication's effect.
However, most people stop taking medications once they're made significant progress in therapy. People who don't pursue therapy often take medications for years.
What are the costs and benefits of taking a medication?
That's a great question. Some people simply don't want to take any kind of medication, and that's certainly their right. Unless you're a danger to yourself or others, no one can "force" you to take a medication, and even then only under extreme circumstances. Nonetheless, when you're deeply depressed, or unable to function because of severe anxiety, or can't turn off the intrusive thoughts or voices, or just can't concentrate when you want to, there's nothing wrong with considering medication if it'll help you function. It may be a concern if you think you'll be taking that medication the rest of your life. Such long-term use is extremely rare, although some people find the symptom relief of certain antidepressants, or the increased school success that often goes along with medications for ADHD, to be a tempting permanent change. Ward cautions people against using medications for long-term symptom relief, noting, however, that plenty of people do it and have few - if any - problems.
As a therapist, Ward, instead, believes in rooting out the basic causes of the illness and going after it directly, or finding other ways to reduce symptoms besides becoming dependent on medication. Most of the people who work with Ward are comfortable with this approach, which is open-ended and accommodating. There are usually a few people who come to him for help specifically to reduce their use, or dependence, on medications. Thus, the costs and benefits need to be taken into consideration: medication can become a "crutch" or a habit that makes life both easier and more difficult at the same time. Almost all medications for mental health are vastly more successful when combined with therapeutic treatment. Speak with Ward personally for more on that subject.
What mental health medications should I consider for my child?
Generally speaking, most parents considering medications for their child are concerned about ADHD, or Attention-deficit Hyperactivity Disorder The use of psychotropic medications (i.e. those for a mental illness) has grown substantially in the last twenty years, including the use of medications to help treat ADHD. Noting that there are two significantly-different forms of ADHD, both are actually treated similarly, usually from a stimulant or "non-stimulant" (but similarly-acting) group of medications that have been proven to help with both the inattentive form of ADHD and the hyperactive/impulsive type. If Ward hadn't seen these medications work quickly and effectively with children throughout his professional career, he wouldn't recommend them. A frank discussion with your pediatrician or family practitioner, followed by a course (usually a few weeks to a month, as a trial period) of the medicine will likely have tremendous effects.
However, Ward is quick to point out that ADHD is a more complicated disorder than meets the eye, for several reasons. First of all, by the time a child has begun benefiting from the behavioral changes that go with the introduction of a medication, he or she has (usually) already developed some concerning habits. These might include difficulty following the rules, disrespect for parental authority, discipline problems in school, and such. Please look over the page on "Defiance" from this web site's main page for more. Anyway, these habits need to be directly addressed, even as a medication for ADHD is added or adjusted over time. Behaviors, after all, are learned. As you child begins to improve attention skills and/or reduce distractibility or hyperactivity and impulsiveness (depending on which type of ADHD is going on), those habits have to be "unlearned" before long-term progress can be made.
A second complication with ADHD and medication has to do with school. Kids can benefit tremendously, and quickly, with some of the newer medications, but that doesn't mean their school productivity or behavior will necessarily increase without close support and direction from both parents and school personnel. Ward works with many children going through that process; he encourages a higher level of supervision and accountability for generally four or more months as the medicine is titrated (balanced) and the child's behaviors begin to recover.
Ward strongly encourages parents to learn as much as they can about the various medications for children. The remainder of this web page focuses on medicine related to different mental health disorders, any of which may or may not involve a child. This information should prove useful, as can the complete list of mental health medications approved for children at the very end.
What mental health medications should I consider, in general?
It depends on your diagnosis. If you have questions about the symptoms you may be experiencing, consult with Ward or a mental health professional, or use this web site or the Internet in general to advise you. But the following few pages should cover most major mental illnesses and the common medication approaches….
OK, what medications should I consider for depression?
Major depression, the kind of depression that will most likely benefit from treatment with medications, is more than just "the blues." It is a condition that lasts 2 weeks or more, and interferes with a person's ability to carry on daily tasks and enjoy activities that previously brought pleasure. Depression is associated with abnormal functioning of the brain. An interaction between genetic tendency and life history appears to determine a person's chance of becoming depressed. Episodes of depression may be triggered by stress, difficult life events, side effects of medications, or medication/substance withdrawal, or even viral infections that can affect the brain.
Depressed people will seem sad, or "down," or may be unable to enjoy their normal activities. They may have little appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening.
Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person's quality of life can be greatly improved.
Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not "uppers" or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed.
Your family practitioner chooses an antidepressant based on the individual's symptoms. Some people notice improvement in the first couple of weeks, but usually the medication must be taken regularly for at least 6 weeks and, in some cases, as many as 8 weeks before the full therapeutic effect occurs. If there is little or no change in symptoms after 6 or 8 weeks, the doctor may prescribe a different medication or add a second medication such as lithium, to augment the action of the original antidepressant. Because there is no way of knowing beforehand which medication will be effective, the doctor may have to prescribe first one and then another. To give a medication time to be effective and to prevent a relapse of the depression once the patient is responding to an antidepressant, the medication should be continued for 6 to 12 months, or in some cases longer, carefully following the doctor's instructions. When a patient and the doctor feel that medication can be discontinued, withdrawal should be discussed as to how best to taper off the medication gradually. Never discontinue medication without talking to the doctor about it. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing more episodes.
Dosage of antidepressants varies, depending on the type of drug and the person's body chemistry, age, and, sometimes, body weight. Traditionally, antidepressant dosages are started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects. Newer antidepressants may be started at or near therapeutic doses.
From the 1960s through the 1980s, tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin. Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment. Other antidepressants introduced during this period were monoamine oxidase inhibitors (MAOIs). MAOIs are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. This has deterred many clinicians and patients from using these effective medications, which are in fact quite safe when used as directed.
The past decade has seen the introduction of many new antidepressants that work as well as the older ones but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).
The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include venlafaxine (Effexor) and nefazadone (Serzone).
Other newer medications chemically unrelated to the other antidepressants are the sedating mirtazepine (Remeron) and the more activating bupropion (Wellbutrin). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.
Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants.
Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows:
- Dry mouth-it is helpful to drink sips of water; chew sugarless gum; brush teeth daily.
- Constipation-bran cereals, prunes, fruit, and vegetables should be in the diet.
- Bladder problems-emptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain.
- Sexual problems-sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor.
- Blurred vision-this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor.
- Dizziness-rising from the bed or chair slowly is helpful.
- Drowsiness as a daytime problem-this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness.
- Increased heart rate-pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.
The newer antidepressants, including SSRIs, have different types of side effects, as follows:
- Sexual problems-fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome.
- Headache-this will usually go away after a short time.
- Nausea-may occur after a dose, but it will disappear quickly.
- Nervousness and insomnia (trouble falling asleep or waking often during the night)-these may occur during the first few weeks; dosage reductions or time will usually resolve them.
- Agitation (feeling jittery)-if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified.
- Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.
The small number of people for whom MAOIs are the best treatment need to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the individual should carry at all times. Other forms of antidepressants require no food restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to the risk of serotonin syndrome.
What about anxiety? What medications should I consider then?
Everyone experiences anxiety at one time or another-"butterflies in the stomach" before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomachache, nausea, faintness, and breathing problems.
Anxiety is often manageable and mild, but sometimes it can present serious problems. A high level or prolonged state of anxiety can make the activities of daily life difficult or impossible. People may have generalized anxiety disorder (GAD) or more specific anxiety disorders such as panic, phobias, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD).
Both antidepressants and antianxiety medications are used to treat anxiety disorders. The broad-spectrum activity of most antidepressants provides effectiveness in anxiety disorders as well as depression. The first medication specifically approved for use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil). The SSRIs, fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) have now been approved for use with OCD. Paroxetine has also been approved for social anxiety disorder (social phobia), GAD, and panic disorder; and sertraline is approved for panic disorder and PTSD. Venlafaxine (Effexor) has been approved for GAD.
Antianxiety medications include the benzodiazepines, which can relieve symptoms within a short time. They have relatively few side effects: drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous for people taking benzodiazepines to drive or operate some machinery. Other side effects are rare.
Benzodiazepines vary in duration of action in different people; they may be taken two or three times a day, sometimes only once a day, or just on an "as-needed" basis. Dosage is generally started at a low level and gradually raised until symptoms are diminished or removed. The dosage will vary a great deal depending on the symptoms and the individual's body chemistry.
It is wise to abstain from alcohol when taking benzodiazepines, because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. It is also important to tell the doctor about other medications being taken.
People taking benzodiazepines for weeks or months may develop tolerance for and dependence on these drugs. Abuse and withdrawal reactions are also possible. For these reasons, the medications are generally prescribed for brief periods of time-days or weeks-and sometimes just for stressful situations or anxiety attacks. However, some patients may need long-term treatment.
It is essential to talk with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is stopped abruptly. Symptoms may include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, or in extreme cases, seizures. A withdrawal reaction may be mistaken for a return of the anxiety because many of the symptoms are similar. After a person has taken benzodiazepines for an extended period, the dosage is gradually reduced before it is stopped completely. Commonly used benzodiazepines include clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
The only medication specifically for anxiety disorders other than the benzodiazepines is buspirone (BuSpar). Unlike the benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an antianxiety effect and therefore cannot be used on an "as-needed" basis.
Beta blockers, medications often used to treat heart conditions and high blood pressure, are sometimes used to control "performance anxiety" when the individual must face a specific stressful situation-a speech, a presentation in class, or an important meeting. Propranolol (Inderal, Inderide) is a commonly used beta blocker.
What medications should I consider for a child with ADHD?
Scroll up - your answer is covered above.
What medications should I consider for Bipolar Disorder?
Bipolar disorder - which used to be called Manic Depression - is characterized by cycling mood changes: severe highs (mania) and lows (depression). Episodes may be predominantly manic or depressive, with normal mood between episodes. Mood swings may follow each other very closely, within days (rapid cycling), or may be separated by months to years. The "highs" and "lows" may vary in intensity and severity and can co-exist in "mixed" episodes.
When people are in a manic "high," they may be overactive, overly talkative, have a great deal of energy, and have much less need for sleep than normal. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. Their attention span is often short, and they can be easily distracted. Sometimes people who are "high" are irritable or angry and have false or inflated ideas about their position or importance in the world. They may be very elated, and full of grand schemes that might range from business deals to romantic sprees. Often, they show poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state - this is quite serious.
In a depressive cycle the person may have a "low" mood with difficulty concentrating; lack of energy, with slowed thinking and movements; changes in eating and sleeping patterns (usually increases of both in bipolar depression); feelings of hopelessness, helplessness, sadness, worthlessness, guilt; and, sometimes, thoughts of suicide.
The medication used most often to treat bipolar disorder is lithium. Lithium evens out mood swings in both directions-from mania to depression, and depression to mania-so it is used not just for manic attacks or flare-ups of the illness but also as an ongoing maintenance treatment for bipolar disorder.
Although lithium will reduce severe manic symptoms in about 5 to 14 days, it may be weeks to several months before the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder. If given in the absence of lithium or another mood stabilizer, antidepressants may provoke a switch into mania in people struggling with bipolar disorder.
A person may have one episode of bipolar disorder and never have another, or be free of illness for several years. But for those who have more than one manic episode, doctors usually give serious consideration to maintenance (continuing) treatment with lithium.
Some people respond well to maintenance treatment and have no further episodes. Others may have moderate mood swings that lessen as treatment continues, or have less frequent or less severe episodes. Unfortunately, some people with bipolar disorder may not be helped at all by lithium. Response to treatment with lithium varies, and it cannot be determined beforehand who will or will not respond to treatment.
Regular blood tests are an important part of treatment with lithium. If too little is taken, lithium will not be effective. If too much is taken, a variety of side effects may occur. The range between an effective dose and a toxic one is small. Blood lithium levels are checked at the beginning of treatment to determine the best lithium dosage. Once a person is stable and on a maintenance dosage, the lithium level should be checked every few months. How much lithium people need to take may vary over time, depending on how ill they are, their body chemistry, and their physical condition.
When people first take lithium, they may experience side effects such as drowsiness, weakness, nausea, fatigue, hand tremor, or increased thirst and urination. Some may disappear or decrease quickly, although hand tremor may persist. Weight gain may also occur. Dieting will help, but crash diets should be avoided because they may raise or lower the lithium level. Drinking low-calorie or no-calorie beverages, especially water, will help keep weight down. Kidney changes-increased urination and, in children, enuresis (bed wetting)-may develop during treatment. These changes are generally manageable and are reduced by lowering the dosage. Because lithium may cause the thyroid gland to become underactive (hypothyroidism) or sometimes enlarged (goiter), thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone may be given along with lithium.
Because of possible complications, doctors either may not recommend lithium or may prescribe it with caution when a person has thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies. Special caution should be taken during the first three months of pregnancy.
Anything that lowers the level of sodium in the body-reduced intake of table salt, a switch to a low-salt diet, heavy sweating from an unusual amount of exercise or a very hot climate, fever, vomiting, or diarrhea-may cause a lithium buildup and lead to toxicity. It is important to be aware of conditions that lower sodium or cause dehydration and to tell the doctor if any of these conditions are present so the dose can be changed.
Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics-substances that remove water from the body-increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat, and, ultimately, seizures. A lithium overdose can be life-threatening. People who are taking lithium should tell every doctor who is treating them, including dentists, about all medications they are taking.
With regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives.
Some people with symptoms of mania who do not benefit from, or would prefer to avoid, lithium have been found to respond to anticonvulsant medications commonly prescribed to treat seizures. The anticonvulsant valproic acid (Depakote, divalproex sodium) is the main alternative therapy for bipolar disorder. It is as effective in non-rapid-cycling bipolar disorder as lithium and appears to be superior to lithium in rapid-cycling bipolar disorder. Although valproic acid can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases valproic acid has caused liver dysfunction, liver function tests should be performed before therapy and at frequent intervals thereafter, particularly during the first six months of therapy.
Other anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder. Some studies suggest particular efficacy (effectiveness) of lamotrigine in bipolar depression. At present, the lack of formal FDA approval of anticonvulsants other than valproic acid for bipolar disorder may limit insurance coverage for these medications.
Most people who have bipolar disorder take more than one medication. Along with the mood stabilizer-lithium and/or an anticonvulsant-they may take a medication for accompanying agitation, anxiety, insomnia, or depression. It is important to continue taking the mood stabilizer when taking an antidepressant because research has shown that treatment with an antidepressant alone increases the risk that the patient will switch to mania or hypomania, or develop rapid cycling. Sometimes, when a patient with bipolar disorder is not responsive to other medications, an atypical antipsychotic medication is prescribed. Finding the best possible medication, or combination of medications, is of utmost importance to the patient and requires close monitoring by a doctor and strict adherence to the recommended treatment regimen.
What medications should I consider for hallucinations and delusions?
A person who is psychotic is out of touch with reality. People with psychosis may hear "voices" or have strange and illogical ideas (for example, thinking that others can hear their thoughts, or are trying to harm them, or that they are the President of the United States or some other famous person). They may get excited or angry for no apparent reason, or spend a lot of time by themselves, or in bed, sleeping during the day and staying awake at night. The person may neglect their appearance, not bathing or changing clothes, and may be hard to talk to-barely talking or saying things that make no sense. They often are initially unaware that their condition is an illness.
These kinds of behaviors are symptoms of a psychotic illness such as schizophrenia.
Antipsychotic medications act against these symptoms. These medications cannot "cure" the illness, but they can take away many of the symptoms, or make them milder. In some cases, they can shorten the course of an episode of the illness as well.
There are a number of antipsychotic (neuroleptic) medications available. These medications affect neurotransmitters that allow communication between nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to schizophrenia symptoms. All these medications have been shown to be effective for schizophrenia. The main differences are in the potency-that is, the dosage (amount) prescribed to produce therapeutic effects-and the side effects. Some people might think that the higher the dose of medication prescribed, the more serious the illness, but this is not always true.
The first antipsychotic medications were introduced in the 1950s. Antipsychotic medications have helped many patients with psychosis lead a more normal and fulfilling life by alleviating such symptoms as hallucinations, both visual and auditory, and paranoid thoughts. However, the early antipsychotic medications often had unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements, leading researchers to continue their search for better drugs.
The 1990s saw the development of several new drugs for schizophrenia, called "atypical antipsychotics." Because they have fewer side effects than the older drugs, today they are often used as a first-line treatment. The first atypical antipsychotic, clozapine (Clozaril), was introduced in the United States in 1990. In clinical trials, this medication was found to be more effective than conventional or "typical" antipsychotic medications in individuals with treatment-resistant schizophrenia (schizophrenia that has not responded to other drugs), and the risk of tardive dyskinesia (a movement disorder) was lower. However, because of the potential side effect of a serious blood disorder-agranulocytosis (loss of the white blood cells that fight infection)-patients who are on clozapine must have a blood test every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance on clozapine difficult for many people. Clozapine, however, continues to be the drug of choice for treatment-resistant schizophrenia.
Several other atypical antipsychotics have been developed since clozapine was introduced. The first was risperidone (Risperdal), followed by olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs.
All these medications have their place in the treatment of schizophrenia, and doctors will choose among them. They will consider the person's symptoms, age, weight, and personal and family medication history.
Some drugs are very potent and the doctor may prescribe a low dose. Other drugs are not as potent and a higher dose may be prescribed. Unlike some prescription drugs, which must be taken several times during the day, some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in "depot" forms that can be injected once or twice a month.
Most side effects of antipsychotic medications are mild. Many common ones lessen or disappear after the first few weeks of treatment. These include drowsiness, rapid heartbeat, and dizziness when changing position. Some people gain weight while taking medications and need to pay extra attention to diet and exercise to control their weight. Other side effects may include a decrease in sexual ability or interest, problems with menstrual periods, sunburn, or skin rashes. If a side effect occurs, the doctor should be told. He or she may prescribe a different medication, change the dosage or schedule, or prescribe an additional medication to control the side effects.
Just as people vary in their responses to antipsychotic medications, they also vary in how quickly they improve. Some symptoms may diminish in days; others take weeks or months. Many people see substantial improvement by the sixth week of treatment. If there is no improvement, the doctor may try a different type of medication. The doctor cannot tell beforehand which medication will work for a person. Sometimes a person must try several medications before finding one that works.
If a person is feeling better or even completely well, the medication should not be stopped without talking to the doctor. It may be necessary to stay on the medication to continue feeling well. If, after consultation with the doctor, the decision is made to discontinue the medication, it is important to continue to see the doctor while tapering off medication. Many people with bipolar disorder, for instance, require antipsychotic medication only for a limited time during a manic episode until mood-stabilizing medication takes effect. On the other hand, some people may need to take antipsychotic medication for an extended period of time. These people usually have chronic (long-term, continuous) schizophrenic disorders, or have a history of repeated schizophrenic episodes, and are likely to become ill again. Also, in some cases, a person who has experienced one or two severe episodes may need medication indefinitely. In these cases, medication may be continued in as low a dosage as possible to maintain control of symptoms. This approach, called maintenance treatment, prevents relapse in many people and removes or reduces symptoms for others.
Antipsychotic medications can produce unwanted effects when taken with other medications. Therefore, the doctor should be told about all medicines being taken, including over-the-counter medications and vitamin, mineral, and herbal supplements, and the extent of alcohol use. Some antipsychotic medications interfere with antihypertensive medications (taken for high blood pressure), anticonvulsants (taken for epilepsy), and medications used for Parkinson's disease. Other antipsychotics add to the effect of alcohol and other central nervous system depressants such as antihistamines, antidepressants, barbiturates, some sleeping and pain medications, and narcotics.
Long-term treatment of schizophrenia with one of the older, or "conventional," antipsychotics may cause a person to develop tardive dyskinesia (TD). Tardive dyskinesia is a condition characterized by involuntary movements, most often around the mouth. It may range from mild to severe. In some people, it cannot be reversed, while others recover partially or completely. Tardive dyskinesia is sometimes seen in people with schizophrenia who have never been treated with an antipsychotic medication; this is called "spontaneous dyskinesia." However, it is most often seen after long-term treatment with older antipsychotic medications. The risk has been reduced with the newer "atypical" medications. There is a higher incidence in women, and the risk rises with age. The possible risks of long-term treatment with an antipsychotic medication must be weighed against the benefits in each case. The risk for TD is 5 percent per year with older medications; it is less with the newer medications.
Any particular warnings I should consider?
Medications of any kind-prescribed, over-the-counter, or herbal supplements-should never be mixed without consulting your doctor; nor should medications ever be borrowed from another person. Other health professionals who may prescribe a drug-such as a dentist or other medical specialist-should be told that the person is taking a specific antidepressant and the dosage. Some drugs, although safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Alcohol (wine, beer, and hard liquor) or street drugs, may reduce the effectiveness of antidepressants and their use should be minimized or, preferably, avoided by anyone taking antidepressants. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants. The potency of alcohol may be increased by medications since both are metabolized by the liver; one drink may feel like two.
Can you provide a complete list of medications for mental illness?
There are many, so let's break them down, in each instance with both the medication's trade name and generic name, sorted by common diagnoses:
|TRADE NAME||GENERIC NAME|
Combination Antipsychotic and Antidepressant Medication
fluoxetine & olanzapine Symbyax (Prozac & Zyprexa)
|Orap (for Tourette's syndrome)||pimozide|
|Antimanic (Bipolar Disorder)||Medications|
|Depakote||valproic acid, divalproex sodium|
(All of these antianxiety medications except BuSpar are benzodiazepines)
|Librax, Libritabs, Librium||chlordiazepoxide|
Could you provide a list of medications used specifically with children?
Of course - as Ward Halverson is primarily a family therapist, this is a common question. The following provides the trade name, generic name, and (very importantly) approved age for each medication. Note the special attention to stimulant medications, those that help children who are struggling with Attention-deficit Hyperactivity Disorder (or ADHD) focus and get through the class day.
|TRADE NAME||GENERIC NAME||APPROVED AGE|
|Adderall||amphetamine||3 and older|
|Adderall XR||amphetamine (extended release)||6 and older|
|Concerta||methylphenidate(long acting)||6 and older|
|Cylert*||pemoline||6 and older|
|Dexedrine||dextroamphetamine||3 and older|
|Dextrostat||dextroamphetamine||3 and older|
|Focalin||dexmethylphenidate||6 and older|
|Metadate ER||methylphenidate (extended release)||6 and older|
|Ritalin||methylphenidate||6 and older|
Non-stimulant for ADHD
|Strattera||atomoxetine||6 and older|
*Because of its potential for serious side effects affecting the liver, Cylert should
not ordinarily be considered as first-line drug therapy for ADHD.
Antidepressant and Antianxiety Medications
|Anafranil||clomipramine||10 and older (for OCD)|
|BuSpar||buspirone||18 and older|
|Effexor||venlafaxine||18 and older|
|Luvox (SSRI)||fluvoxamine||8 and older (for OCD)|
|Paxil (SSRI)||paroxetine||18 and older|
|Prozac (SSRI)||fluoxetine||18 and older|
|Serzone (SSRI)||nefazodone||18 and older|
|Sinequan||doxepin||12 and older|
|Tofranil||imipramine||6 and older (for bedwetting)|
|Wellbutrin||bupropion||18 and older|
|Zoloft (SSRI)||sertraline||6 and older (for OCD)|
|Clozaril (atypical)||clozapine||18 and older|
|Haldol||haloperidol||3 and older|
|Risperdal (atypical)||risperidone||18 and older|
|Seroquel (atypical)||quetiapine||18 and older|
|Mellaril||thioridazine||2 and older|
|Zyprexa (atypical)||olanzapine||18 and older|
12 and older
(for Tourette's syndrome-Data for age 2
and older indicate similar safety profile)
Mood Stabilizing Medications
|Cibalith-S||lithium citrate||12 and older|
|Depakote||valproic acid||2 and older (for seizures)|
|Eskalith||lithium carbonate||12 and older|
|Lithobid||lithium carbonate||12 and older|
|Tegretol||carbamazepine||any age (for seizures)|