Medications

According to a 2004 poll sponsored in part by Psychology Today magazine, almost fifty-nine million adults in the United States sought treatment for a mental health problem between 2002 and 2004, and more than 80 percent of them took some kind of medication as a part of their treatment.¹ However, for most people medication is a confusing subject. “To take or not to take?” that is the question. So what should a person do?

For the treatment of mental health problems, psychotropic medications can be used alone or in combination with therapy. In fact, using a combination of medication and therapy may be the best treatment for some problems. This is especially true if the person is struggling with specific problems like bipolar disorder or schizophrenia. In these cases, medication is the most important form of treatment. But using a combination of medication and therapy is also important if the person is struggling with a problem such as moderate to severe depression, especially if he or she is having suicidal thoughts. In this case, the person might need the help of a medication to get out of bed, get activated in life, and, perhaps, get into a therapist’s office. However, for other problems that are caused by distressing situations in life, such as a difficult relationship, medication might be less important than therapy.

When people are having trouble making a decision about whether or not to take medication, they should discuss the issue with any medical or mental health care professionals with whom they are already working, such as a primary care provider or psychotherapist. In addition, people can do their own research by reading medication reports and treatment recommendations issued by reputable sources. Click here for more information about psychotropic medications.

However, even with all of this information available, the decision about whether to use medication might still be confusing. A person is bound to get different recommendations from different people. To make more educated decisions about medication, there are three important things people should keep in mind.

Remember, no one should never stop taking medications without first consulting a medical professional. Stopping the use of medications without medical advice canbe extremely dangerous.

Second, most medications have side effects. People often worry about the potential side effects of psychotropic medications. For some medications, such as antipsychotics, the side effects can be serious and long-term. For others, such as some antianxiety and antidepressant medications, the side effects are less severe and often disappear over time. It’s understandable that people are worried about these side effects; however, for some problems medications are a necessity, and the side effects are often less troublesome than the problems medications are meant to treat. Anyone taking medication should always discuss side effects with whoever prescribed the medication because often there are simple solutions to these issues.

Third, medications sometimes have to be adjusted. If the side effects of a medication are difficult to tolerate or the medication doesn’t seem to be working, the person should talk to his or her medical provider about adjusting the dosage or trying a different medication. Getting the dosage right is often as much an art as it is a science, and there may be a similar medication the person can try if he or she reacts poorly to the first one. Also, it’s important to note that anyone who is prescribed medications might be prescribed more than one medication at a time, in order to provide the most effective treatment possible.

Ultimately, it’s up to the individual to make the final decision about whether or not to use medication. However, it’s strongly suggested that people listen to the advice of medical and mental health care professionals and consider the benefits of using medication, if it’s recommended. Of course, people are bound to hear stories about others for whom medications didn’t work, but there are also millions of people around the world for whom they do work—every day. And remember, for some problems, medication is the only treatment; for others, a combination of medications and therapy is recommended.

Although it’s clearly beyond the scope of this short section to provide in-depth information on psychotropic medications, the following is a brief summary of some of the medications a person might encounter. (Click here for more information about psychotropic medications .

ANTIANXIETY MEDICATIONS

Three commonly used groups of medications are used to treat anxiety: benzodiazepines, buspirone (BuSpar), and antidepressants.

Benzodiazepines are minor tranquilizers that induce sleep and relax muscles. Among the more common benzodiazepines are the following: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), temazepam (Restoril), and triazolam (Halcion).

Buspirone (BuSpar) is an atypical antianxiety medication. This means that it decreases a person’s anxiety level without inducing sleep and muscle relaxation, as the benzodiazepines do.

Some of the most common medications used in the treatment of anxiety problems are the selective serotonin reuptake inhibitors (SSRIs), which are discussed below.

ANTIDEPRESSANT MEDICATIONS

There are four groups of medications used to treat depression: selective serotonin reuptake inhibitors, atypical antidepressants, tricyclic antidepressants, and monoamine oxidase inhibitors.

Selective serotonin reuptake inhibitors (SSRIs) are considered to be the first-line treatment for depression. As their name suggests, SSRIs increase levels of the neurotransmitter serotonin. Among the more common SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft).

Atypical antidepressants are newer medications that work in unique ways. Venlafaxine (Effexor), duloxetine (Cymbalta), and mirtazapine (Remeron) increase levels of the neurotransmitters serotonin and norepinephrine. Bupropion (Wellbutrin), another atypical antidepressant, is thought to increase levels of the neurotransmitters norepinephrine and dopamine.

Tricyclic antidepressants (TCAs), developed in the 1950s, are often used after multiple attempts to use SSRIs and atypical antidepressants have failed. Like the SSRIs, the TCAs are a family of related antidepressants; the name refers to their chemical structure. TCAs increase levels of serotonin and/or norepinephrine, but they aren’t used as a first-line treatment for depression because they can also create a number of serious side effects. Some of the common TCAs include amitriptyline (Elavil), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), and nortriptyline (Pamelor).

Finally, the last group of antidepressants is the oldest group, monoamine oxidase inhibitors (MAOIs). MAOIs were developed in the 1950s, and they too help increase levels of serotonin, norepinephrine, and dopamine. Although they can be effective at treating some types of difficult depression, the potential side effects of MAOIs, coupled with necessary dietary restrictions, often outweigh the benefits of their use. Among the more commonly prescribed MAOIs are isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).

ANTIMANIA MEDICATIONS

Antimania medications are often called mood stabilizers. The most common is lithium (Eskalith, Lithobid), a naturally occurring substance. It’s not exactly clear how it reduces mood swings, but lithium generally begins to lessen symptoms of mania within one to three weeks, although it may take longer to fully control a person’s mania. It’s reported to be effective in as many as 60 to 80 percent of the patients treated. Valproic acid (Depakote) is a medication used to treat seizures that is also approved by the FDA to treat mania. Valproic acid is often used to treat patients when lithium has proven ineffective. Carbamazepine (Tegretol) is another antiseizure medication that has proven effective for the treatment of mania.

ANTIPSYCHOTIC MEDICATIONS

Antipsychotic medications are also known as neuroleptics or major tranquilizers because they have a very calming effect. The medications often cause sleepiness, emotional soothing, and a lessening of agitation. These medications, used to treat schizophrenia and other psychoses, can be divided into two groups: traditional and atypical medications. Both groups of medication reduce the level of the neurotransmitter dopamine, and some atypicals also reduce the level of serotonin.

Both traditional and atypical medications lessen the severity of hallucinations, diminish delusions, and calm disturbed thinking. The newer atypical medications may also improve symptoms such as low energy, lack of emotion, lack of expressiveness, and lack of interest.

Among the more commonly prescribed traditional antipsychotic medications are chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thioridazine (Mellaril), and trifluoperazine (Stelazine).

Among the more commonly prescribed atypical antipsychotic medications are aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).

Remember that the information in this section is very limited in scope. So anyone taking medication or considering the use of medication should ask a medical professional about how and when to take it and about any common or expected side effects. (Click here for more information about psychotropic medications)

Here are some helpful questions to ask a medical professional about the use of psychotropic medications:

What are some of the common side effects?
Are there rare or serious side effects too?
When should I expect it to begin working?
Do I need any lab tests or special monitoring while I’m taking it?
What if I skip or miss a dose?
What happens if I suddenly stop taking it?
Does it interact with my other medications, herbs, or supplements?
Is it possible to overdose on it?
Is it covered by my insurance?

For more information, visit these websites:

National Alliance on Mental Illness: http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Medications/Default798.htm

National Institute of Mental Health: http://www.nimh.nih.gov/publicat/medicate.cfm

Food and Drug Administration: http://www.fda.gov

REFERENCES FOR MEDICATIONS

Psychology Today, and PacifiCare Behavioral Health. 2004.> Therapy in America 2004. www.psychologytoday.com/pto/press_release_050404.html. Accessed June 14, 2004.