Medications Explained

Mental health medications are the primary treatment for many mental illnesses. Different medications are used for different illnesses. Drugs come with risks as well as benefits and they should only ever be taken under a doctor's supervision.

Depression Medications

Taking medications for depression is not a sign of personal weakness - there is good evidence that they do help. Whether antidepressant medication is the best treatment option depends on how severe the person's depression is and their history of the illness and also their age. For adults depression there is strong evidence that antidepressants are more effective than any other treatment. If depression is mild or moderate, psychotherapy alone may be sufficient, though even in this case, short-term antidepressant drug treatment can help people get to the point where they can engage in therapy.

How Antidepressants Work

Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters (such as serotonin and norepinephrine). Neurotransmitters are needed for normal brain function and are involved in the control of mood and in other responses and functions, such as eating, sleep, pain, and thinking.

Antidepressants help people with depression by making these natural chemicals more available to the brain. By restoring the brain's chemical balance, antidepressants help relieve the symptoms of depression.

Specifically, antidepressant drugs help reduce the extreme sadness, hopelessness, and lack of interest in life that are typical in people with depression. These drugs also may be used to treat other conditions, such as obsessive compulsive disorder, premenstrual syndrome, chronic pain, and eating disorders.

Typically, antidepressants are taken for 4 to 6 months. In some cases, however, patients and their doctors may decide that antidepressants are needed for a longer time.

Types of Antidepressants

  • SSRIs

Selective Serotonin Reuptake Inhibitors (SSRIs) are members of a group of antidepressants that includes drugs such as citalopram (brand name of Celexa), fluoxetine (brand name of Prozac), paroxetine (brand name of Paxil) and sertraline (brand name of Zoloft).

  • Monoamine oxidase inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs), which were some of the first antidepressants to be developed, may be helpful for people with so-called 'atypical' depression, where a person's mood may brighten up with positive events but there may be other symptoms such as oversleeping, sensitivity to rejection, and intense fatigue. The MAOIs are also used to treat so-called "major" depression.
MAOIs used in Australia are phenelzine (brand name Nardil) and tranylcypromine (brand name Parnate).

  • Other Disorders Treated by Antidepressant Medications

The SSRIs may be an effective treatment for other disorders besides depression. Some have been approved for treating various anxiety disorders including panic attacks, obsessive-compulsive disorder, Post-Traumatic Stress Disorder (PTSD) and social anxiety disorder. Some are used to treat eating disorders and chronic pain.

Antipsychotic Medications

Antipsychotic medications may reduce or eliminate symptoms of psychosis. They are not a "cure" for mental illnesses, but can be an effective part of treatment. Psychosis can be caused by any one of a number of illnesses that affect the brain and cause the person to lose contact with reality. Some examples include schizophrenia or bipolar mood disorder. During a psychotic episode, the person may experience delusions, hallucinations and thought disturbances. Antipsychotic medications work to minimise these symptoms.

Medical research has shown that symptoms of psychosis are associated with changes in brain chemistry. Antipsychotic medications help to restore the brain's natural chemical balance, thereby reducing or getting rid of the psychotic symptoms. It can take some weeks before the medication starts to work. Although antipsychotic medications cannot cure mental illnesses, they are effective in eliminating or reducing psychotic symptoms such as delusions, hallucinations and thought disorders.

Types of Antipsychotic Medications

There are two types of antipsychotic medications. These are known as:

  • Typical - this refers to the older type of medications
  • Atypical - this refers to the newer type of medications.

While both are effective, in general the newer medications have several advantages over the older ones. These advantages include:-

  • Fewer side effects such as trembling or stiffening of muscles
  • Less risk of developing "tardive dyskinesia" - movement of the mouth, tongue and sometimes other parts of the body over which the person has no control.

Some evidence suggests that the atypical medications may be effective in improving overall mood, thinking and motivation. While these newer antipsychotic medications are more commonly used than the older ones, some people find that the older medications suit them better. It is important to discuss with your doctor the different treatment options that are available and which might be the best for you.

Injections/Depot Medication

Depot medication is given by injection, which releases the drug slowly over some weeks. Some people prefer injections as they find remembering to take tablets difficult. Some people are required to take depot medication as a condition of a court community treatment order.

Side Effects

Medication side effects can be worrying. Any side effects should be discussed immediately with your treating doctor. Maintenance doses of an antipsychotic medication are important to minimise the risk of further psychotic episodes. If a person suddenly stops taking antipsychotic medication against their doctor's advice, it can lead to a return of psychotic symptoms. 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 immediately and he or she may prescribe a different medication, change the dosage or schedule, or prescribe an additional medication to control the side effects.

Things To Remember:

  • While antipsychotic medications don't cure mental illnesses, they can reduce or even eliminate symptoms.
  • The new generation of antipsychotic medications have fewer side effects.

Several other atypical antipsychotics have been developed since clozapine was introduced. The first was risperidone (Risperdal), followed by olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). Each has a unique side effect profile, but in general, these medications cause fewer and milder side effects than the earlier drugs. 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.

Antipsychotic medications can produce unwanted effects when taken with other medications. Be sure that your doctor knows about all other medications that you are taking, including any herbal medications such as St. John's Wort. If you are prescribed any mental health medication, be sure to read the patient information that accompanies your medication. It will describe the medication, how it should be taken, and side effects to look for.

Anxiety Medications

A number of medications are used to treat the symptoms of anxiety disorders. These symptoms include

  • Irritability
  • Uneasiness
  • Jumpiness
  • Feelings of apprehension
  • Rapid or irregular heartbeat
  • Stomach ache or nausea
  • Faintness
  • Breathing problems.

If you have an anxiety disorder, this sometimes helpful emotion can keep you from coping and can disrupt your daily life. Anxiety disorders are more than just a case of "nerves." They are illnesses, often related to the biological makeup and life experiences of the individual, and they frequently run in families. There are a number of anxiety disorders, each with its own distinct features. on anxiety disorders, including generalized anxiety disorder (GAD),panic disorder, phobias, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

A high level of anxiety or a prolonged state of anxiety can make the activities of daily life difficult or impossible. Both antidepressants and antianxiety medications are used to treat anxiety disorders. Many antidepressants are effective in anxiety disorders as well as depression. The first medication approved to treat 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.

The most important group of antianxiety medications are the benzodiazepines. This class includes clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines can generally 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.

Different people respond differently to benzodiazepines. Some people may need to take them two or three times a day, and others only once a day, or on an "as-needed" basis. Dose is generally started at a low level and gradually raised until symptoms are diminished or removed. The dose will vary a great deal depending on the symptoms and your body chemistry.

You should abstain from alcohol when taking benzodiazepines, because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. Be sure to tell your doctor about other medications you are taking.

Benzodiazepines are usually prescribed for short periods of time -days or weeks, They are sometimes given on an "as needed" basis just for stressful situations or anxiety attacks. If you take these medications for weeks or months you may develop tolerance or dependence. Tolerance means that you need to take more of the medication in order for it to work. Dependence means that you develop withdrawal symptoms if you stop taking the medication. Some people abuse these medications in order to get high. Some patients with severe anxiety may need long term treatment. Longer acting medications such as clonazepam (Klonopin) or diazepam (Valium) may produce milder withdrawal symptoms than short acting medications such as alprazolam (Xanax) and lorazepam (Ativan).

Be sure to talk with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is stopped abruptly. Withdrawal symptoms may include

  • Anxiety
  • Shakiness
  • Headache
  • Dizziness
  • Sleeplessness
  • Loss of appetite
  • Seizures

Ironically many of these symptoms are similar to the anxiety symptoms that you may have sought treatment for. To avoid these symptoms your doctor will probably taper your medication dose gradually. Buspirone (BuSpar) is a medication specifically for anxiety disorders other than the benzodiazepines. It differs from the benzodiazepines in that it must be taken consistently for at least 2 in order to work. You can't take buspirone on an "as needed" basis.

Beta blockers such as propranolol (Inderal, Inderide) are sometimes used to control "stage fright" or other forms of performance anxiety. These medications are more commonly used to treat heart conditions and high blood pressure.

Medications for Bipolar Disorder

Bipolar Disorder (previously known as Manic Depression) is a mental health disorder characterised by mood swings. Persons with this disorder experience severe highs (mania) and lows (depression). Some people experience mostly highs, others mostly lows. If the mood swings follow each other closely - within days - the person is said to suffer from "rapid cycling" bipolar disorder. Other people primarily experience mood swings that are separated by months or years. Some people experienced "mixed" episodes consisting of both sets of symptoms at the same time.

When people are in the "manic stage" they may be energetic, talkative, and need little sleep. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. This stage often feels good to the person, and they often report feeling "on top of the world." Other people feel irritable and are easy to anger during this stage. Judgment is often impaired, and they may go on shopping sprees, buying things that they can't afford. They may have grand schemes that are unrealistic, and a severe manic episode can include psychotic thinking similar to schizophrenia.

The depressed stage of bipolar disorder is similar to major depression. The person will have a little energy and a low mood, slowed thinking and movements, difficulty concentrating, changes in eating and sleeping patterns, feelings of hopelessness and helplessness, and often suicidal thinking.

Lithium

Lithium is the medication used most often to treat bipolar disorder. This medication evens out mood swings in both directions. It is used not just for manic attacks or flare-ups of the illness but also as an ongoing maintenance treatment for bipolar disorder. Lithium will usually reduce severe manic symptoms in one to two weeks. It may take 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 lithium begins to take effect. Some of the newer antipsychotic medications are also approved for longer term use in bipolar disorder. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder. Care must be taken, because given in the absence of lithium or another mood stabilizer, antidepressants may provoke a switch into mania in people with bipolar disorder.

Some people have a single episode of mania that is not repeated. Most have more episodes, and continue treatment with lithium or another mood stabilizer to keep moods stable. Some people respond on lithium and have no further episodes. Others may have milder mood swings, or less frequent mood swings. Some people with bipolar disorder may not be helped by lithium.

People taking Lithium must have regular blood tests. Lithium needs to be maintained within a certain level (therapeutic level) in the bloodstream to be effective. If too much is taken, severe side effects may occur, if too little is taken, lithium may have little or no effect. Blood lithium levels are checked frequently at the beginning of treatment. Once a person is stable on a maintenance dosage, the lithium level is usually then 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.

Lithium is a safe and effective drug for most people who take it. With regular monitoring, people who otherwise would suffer from severe mood swing can lead normal lives.

Anticonvulsants

Many drugs that are used to treat seizures can also be used to stabilize mood. These anticonvulsants are often used for people with bipolar disorder who do not benefit from lithium.

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 may be superior to lithium in rapid-cycling bipolar disorder. Valproic acid can cause gastrointestinal side effects in a few people. Some people also report headache, double vision, dizziness, anxiety, or confusion. Valproic acid has rarely caused liver problems, so liver function tests should be performed before therapy and at frequent intervals afterward, particularly during the first 6 months of therapy. Other anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). These medications are used more frequently for short-term mania than for long-term maintenance of bipolar disorder. Lamotrigine may be particular effective in bipolar depression.

Many people who have bipolar disorder take more than one medication. Along with the lithium and/or an anticonvulsant they may take a medication for accompanying agitation, anxiety, insomnia, or depression. It is important to keep taking the mood stabilizer when taking an antidepressant because treatment with an antidepressant alone increases the risk that the patient will switch to mania.

Atypical Antipsychotic Medications

Atypical Antipsychotic Medications are sometimes prescribed for bipolar disorder. They may be used early in treatment to manage mania, or they may be used longer-term.

Whatever treatment is prescribed, it is important to keep taking medications even when the symptoms subside. Patients with bipolar sometimes stop taking their medications because the manic phase of the disorder (the high) feels good. Staying on prescribed medications is the best way to manage the symptoms of bipolar disorder.

Questions for Your Doctor

To increase the likelihood that a medication will work well for you, you and your family must actively participate with the doctor prescribing it. Make sure you tell the doctor about your past medical history, other medications you are taking and anticipated life changes such as planning to have a baby. After some experience with the medication you should also tell the doctor if you think it is causing side effects.

Here are some questions to ask:-

  • What is the medication supposed to do?
  • How and when do I take it? Also when do I stop taking it?
  • What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
  • What are possible side effects and what should I do if they occur?
  • Is there any written information available about the medication?

Further information can be obtained at:

http://www.nps.org.au/medicines