Posted: Tue Aug 08, 2006 3:10 am Post subject: Alot Of Info about Medication
Special Message On Medication
This information is provided to help people understand how and why drugs can be used as part of the treatment of mental health problems. It is important for persons who use mental health services to be well informed about medications for mental illnesses, but this file is not a "do-it-yourself" manual. Self-medication can be dangerous. Interpretation of both signs and symptoms of the illness and side effects are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician working closely with the patient and sometimes the patient's family or other mental health professionals. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications.
Oftentimes an individual is taking more than one medication and at different times of the day. It is essential to take the correct dosage of each medication. An easy way to ensure this is to use a 7-day pill box, available at the prescription counter in any pharmacy, and to fill the box with the proper medications at the beginning of each week.
Introduction
Anyone can develop a mental illness, you, a family member, a friend, or the fellow down the block. Some disorders are mild, while others are serious and long-lasting. These conditions can be helped. One way an important way is with psychotherapeutic medications. Compared to other types of treatment, these medications are relative newcomers in the fight against mental illness. It was only 41 years ago that the first one, chlorpromazine, was introduced. But considering the short time they've been around, psychotherapeutic medications have made dramatic changes in the treatment of mental disorders. People who, years ago, might have spent many years in mental hospitals because of crippling mental illness may now only go in for brief treatment, or might receive all their treatment at an outpatient clinic.
Psychotherapeutic medications also may make other kinds of treatment more effective. Someone who is too depressed to talk, for instance, can't get much benefit from psychotherapy or counseling; but often, the right medication will improve symptoms so that the person can respond better.
Another benefit from these medications is an increased understanding of the causes of mental illness. Scientists have learned a great deal more about the workings of the brain as a result of their investigations into how psycho- therapeutic medications relieve disorders such as psychosis, depression, anxiety, obsessive compulsive disorder, and panic disorder.
Symptom Relief, Not Cure
Just as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure mental illness, but they do lessen its burden. In many cases, these medications can help a person get on with life 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 schizophrenia and help them to perceive reality more accurately. And antidepressants can lift the dark, heavy moods of depression. The degree of response ranging from little relief of symptoms to complete remission depends on a variety of factors related to the individual and the particular disorder being treated.
How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. For some conditions, such as schizophrenia or manic-depressive illness, medication may have to be take indefinitely or, perhaps, intermittently.
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 do. Some experience annoying side effects, while others do not. Age, sex, 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.
Questions for Your Doctor
To increase the likelihood that a medication will work well, patients and their families must actively participate with the doctor prescribing it. They must tell the doctor about the patient's past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, the patient or family member should ask the following questions recommended by the U.S. Food and Drug Administration (FDA) and professional organizations:
What is the name of the medication, and what is it supposed to do?
How and when do I take it, and when do I stop taking it?
What foods, drinks, other medications, or activities should I avoid while taking the prescribed medication?
What are the side effects, and what should I do if they occur?
Is there any written information available about the medication?
In this file, medications are described by their generic (chemical) names and in italics by their trade names (brand names used by drug companies). They are divided into four large categories based on the symptoms for which they are primarily used antipsychotic, antimanic, antidepressant, and antianxiety medications. In addition, stimulants used for attention- deficit/ hyperactivity disorder are listed.
An index at the end gives the trade name, and the generic name, of the most commonly prescribed medications and notes the section that contains information about each type.
Treatment evaluation studies have established the efficacy of the medications described here; however, much remains to be learned about these medications. The National Institute of Mental Health, other Federal agencies, and private research groups are sponsoring studies of these medications. Scientists are hoping to improve their understanding of how and why these medications work, how to control or eliminate unwanted side effects, and how to make the medications more effective.
Medications For Special Groups
Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.
In general, the information throughout this booklet applies to these groups, but the following are a few special points to keep in mind.
CHILDREN
The 1999 MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 21 percent of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder that caused at least some impairment. When diagnostic criteria were limited to significant functional impairment, the estimate dropped to 11 percent, for a total of 4 million children who suffer from a psychiatric disorder that limits their ability to function.6
It is easy to overlook the seriousness of childhood mental disorders. In children, these disorders may present symptoms that are different from or less clear-cut than the same disorders in adults. Younger children, especially, and sometimes older children as well, may not talk about what is bothering them. For this reason, it is important to have a doctor, another mental health professional, or a psychiatric team examine the child.
Many treatments are available to help these children. The treatments include both medications and psychotherapy--behavioral therapy, treatment of impaired social skills, parental and family therapy, and group therapy. The therapy used is based on the child's diagnosis and individual needs.
When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, and others who have charge of the child) is essential. Children should be watched and questioned for side effects because many children, especially younger ones, do not volunteer information. They should also be monitored to see that they are actually taking the medication and taking the proper dosage on the correct schedule.
Childhood-onset depression and anxiety are increasingly recognized and treated. However, the best-known and most-treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD). Children with ADHD exhibit symptoms such as short attention span, excessive motor activity, and impulsivity which interfere with their ability to function especially at school. The medications most commonly prescribed for ADHD are called stimulants. These include methylphenidate (Ritalin, Metadate, Concerta), amphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), and pemoline (Cylert). Because of its potential for serious side effects on the liver, pemoline is not ordinarily used as a first-line therapy for ADHD. Some antidepressants such as bupropion (Wellbutrin) are often used as alternative medications for ADHD for children who do not respond to or tolerate stimulants.
Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called "off-label." Most medications prescribed for childhood mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that "safety and efficacy have not been established in pediatric patients." The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.
The use of the other medications described in this booklet is more limited with children than with adults. Therefore, a special list of medications for children, with the ages approved for their use, appears immediately after the general list of medications. Also listed are NIMH publications with more information on the treatment of both children and adults with mental disorders.
THE ELDERLY
Persons over the age of 65 make up almost 13 percent of the population of the United States, but they receive 30 percent of prescriptions filled. The elderly generally have more medical problems, and many of them are taking medications for more than one of these conditions. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.
The elderly are also more likely to take too much of a medication accidentally because they forget that they have taken a dose and take another one. The use of a 7-day pill-box, as described earlier in this brochure, can be especially helpful for an elderly person.
The elderly and those close to them--friends, relatives, caretakers--need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications--not only those prescribed but also over-the-counter preparations and home, folk, or herbal remedies--the possibility of adverse drug interactions is high.
WOMAN DURING THE CHILDBEARING YEARS
Because there is a risk of birth defects with some psychotropic medications during early pregnancy, a woman who is taking such medication and wishes to become pregnant should discuss her plans with her doctor. In general, it is desirable to minimize or avoid the use of medication during early pregnancy. If a woman on medication discovers that she is pregnant, she should contact her doctor immediately. She and the doctor can decide how best to handle her therapy during and following the pregnancy. Some precautions that should be taken are:
If possible, lithium should be discontinued during the first trimester (first 3 months of pregnancy) because of an increased risk of birth defects.
If the patient has been taking an anticonvulsant such as carbamazepine (Tegretol) or valproic acid (Depakote)--both of which have a somewhat higher risk than lithium--an alternate treatment should be used if at all possible. The risks of two other anticonvulsants, lamotrigine (Lamictal) and gabapentin (Neurontin) are unknown. An alternative medication for any of the anticonvulsants might be a conventional antipsychotic or an antidepressant, usually an SSRI. If essential to the patient's health, an anticonvulsant should be given at the lowest dose possible. It is especially important when taking an anticonvulsant to take a recommended dosage of folic acid during the first trimester.
Benzodiazepines are not recommended during the first trimester.
The decision to use a psychotropic medication should be made only after a careful discussion between the woman, her partner, and her doctor about the risks and benefits to her and the baby. If, after discussion, they agree it best to continue medication, the lowest effective dosage should be used, or the medication can be changed. For a woman with an anxiety disorder, a change from a benzodiazepine to an antidepressant might be considered. Cognitive-behavioral therapy may be beneficial in helping an anxious or depressed person to lower medication requirements. For women with severe mood disorders, a course of electroconvulsive therapy (ECT) is sometimes recommended during pregnancy as a means of minimizing exposure to riskier treatments.
After the baby is born, there are other considerations. Women with bipolar disorder are at particularly high risk for a postpartum episode. If they have stopped medication during pregnancy, they may want to resume their medication just prior to delivery or shortly thereafter. They will also need to be especially careful to maintain their normal sleep-wake cycle. Women who have histories of depression should be checked for recurrent depression or postpartum depression during the months after the birth of a child.
Women who are planning to breastfeed should be aware that small amounts of medication pass into the breast milk. In some cases, steps can be taken to reduce the exposure of the nursing infant to the mother's medication, for instance, by timing doses to post-feeding sleep periods. The potential benefits and risks of breastfeeding by a woman taking psychotropic medication should be discussed and carefully weighed by the patient and her physician.
A woman who is taking birth control pills should be sure that her doctor knows this. The estrogen in these pills may affect the breakdown of medications by the body--for example, increasing side effects of some antianxiety medications or reducing their ability to relieve symptoms of anxiety. Also, some medications, including carbamazepine and some antibiotics, and an herbal supplement, St. John's wort, can cause an oral contraceptive to be ineffective.
Source: National Institute of Mental Health
NIH Publication No. 02-3929
Revised April 2002
Last edited by Sluagh on Tue Aug 08, 2006 7:07 pm; edited 1 time in total
Stimulant Medications
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---------- dexmenthylphenidate------------------------ 6 and older
Metadate ER----- methylphenidate(extended release)------ 6 and older
Ritalin------------ methylphenidate--------------------------- 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)
FOR BEDWETTING?!
Wellbutrin------------- bupropion--------------------- 18 and older
Zoloft (SSRI)---------- sertraline--------------------- 6 and older (for OCD)
Antipsychotic Medications
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
Orap------------------------ pimozide---------------------- 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)
Source: National Institute of Mental Health
NIH Publication No. 02-3929
Revised April 2002
Commonly Prescribed Psychotropic Medications
Listed below are two tables of commonly prescribed psychotropic mediations. The first table is a listing of medications based on their psychiatric use. This table includes brand names and their generic form in parentheses. The second table provides a cross-reference by generic name.
As with all questions about medication, be sure to consult with your prescribing physician or pharmacist for any specific questions you may have about dosage, drug interactions, or side effects.
Reviewed by Rex Cowdry, M.D.,
NAMI medical director, March 2001
Anxiety disorders
Ativan (lorazepam)
BuSpar (buspirone)
Centrax (prazepam))
*Inderal (propranolol)
*Klonopin (clonazepam)
Librium (chlordiazepoxide)
Serax (oxazepam)
*Tenormin (atenolol)
Tranxene (clorazepate)
Valium (diazepam)
Xanax (alprazolam)
*Antidepressants, especially SSRIs, are also used in the treatment of
anxiety.
Anti-panic Agents
Klonopin (clonazepam)
Paxil (paroxetine)
Xanax (alprazolam)
Zoloft (sertraline)
*Antidepressants are also used in the treatment of panic disorder.
Stimulants (used in the treatment of ADD/ADHD)
Adderall (amphetamine and dextroamphetamine)
Cylert (pemoline)
Dexedrine (dextroamphetamine)
Ritalin (methylphenidate)
*Antidepressants with stimulant properties, such as Norpramin and Wellbutrin, are also used in the treatment of ADHD.
*Although this medication has been approved by the FDA for the treatment of other disorders, it has not been approved for this particular use. Some evidence of this medication's efficacy for such use does exist however. This type of medication use is referred to as "off label."
Compared to the glut of new medications developed in recent years for the treatment of such serious mental illnesses as schizophrenia and depression, the lack of advances in new drug options for those with bipolar disorder (manic depression) has proven increasingly frustrating and disappointing. Currently, the mood stabilizers available for those with manic depression are limited to the old standby lithium (Eskalith, Cibalith-S, Lithobid) and the newer divalproex sodium (Depakote). While these medications have proven helpful for many, there is a substantial group of those with bipolar disorder who have either not benefited from these options or experience problematic side effects. Furthermore, some feel that lithium and Depakote are better at treating mania than depression, and using antidepressants with these drugs has been known to trigger mania or rapid cycling-conventional antidepressants may not be as effective in treating depressive episodes related to bipolar disorder as they are for treating such episodes in those with unipolar depression. For such reasons, many clinicians have begun to experiment with drugs that are indicated for the treatment of other illnesses, but have proven effective in the treatment of those with bipolar disorder in some studies. This type of medication usage is known as "off label."
Note: It is important to recognize that "off label" usage is generally considered an option only after all traditional treatment methods have failed. Like all medications, these new drugs work differently for different people and each has its own unique side effects. Although the discovery of the effectiveness of these medications in some cases points to a future filled with newer and better options for those with bipolar disorder, many more controlled studies need to be conducted. These drugs have not been approved by the Food and Drug Administration (FDA) for the treatment of bipolar disorder.
The type of medication used most often for bipolar disorder in an "off label" capacity is the group known as anticonvulsants. Used primarily for the treatment of epilepsy, several of these drugs have recently shown promise in treating those with manic depression, particularly in helping stabilize mood.
Tegretol (carbamazepine)
: Due to its apparent effectiveness as a mood stabilizer, Tegretol has become a first-line treatment option even though it has never received FDA approval for the treatment of bipolar disorder. The most common side effects seen with Tegretol include dry mouth and throat, constipation, impaired urination, decreased sense of taste, dizziness, drowsiness, unsteadiness, loss of appetite, nausea, vomiting, indigestion, and diarrhea. Some individuals may also experience clumsiness, double vision, edema (excess of fluid in tissue or body cavity), skin rash, and cardiovascular complications. Additionally, there is the possibility of such life-threatening adverse effects as suppression of blood cells that fight infection or prevent bleeding. The drug can also have negative interactions with Prozac, Luvox, and lithium. Furthermore, it should not be taken with monoamine oxidase inhibitors (MAOIs) and should not be used by those pregnant or nursing. Lastly, regular blood count monitoring and periodic liver function tests are mandatory-due to the induction of enzymes in the liver by carbamazepine, several adverse interactions can occur when it is combined with other drugs.
Lamictal (lamotrigine): Several studies (including a randomized, double-blind, placebo-controlled trial presented at the 1998 American Psychiatric Association's annual meeting) indicate that Lamictal may also help stabilize mood in those with bipolar disorder. The drug has been reported as being a more potent antidepressant than Tegretol or Depakote, and it appears to have a low incidence of such side effects as weight gain and hair loss. Although it seems that Lamictal can be taken with MAOIs, taking the drug concurrently with Tegretol may increase the chance of adverse side effects. The most commonly reported side effects are dizziness, headache, double vision, unsteadiness, nausea, blurred vision, sleepiness, rash, and vomiting. Special attention should be paid to skin rashes, which in some extreme cases have developed into the severe disorder known as Stevens-Johnson syndrome or caused death. Any noticed rash should be reported immediately to a doctor. The concurrent use of Depakote increases the risk of developing a rash.
Neurontin (gabapentin): Also proven effective as a mood stabilizer for those with bipolar disorder, Neurontin is chemically unrelated to any other anticonvulsant. The drug has been the subject of several studies as well, two of which were presented at this year's APA meeting. Like Lamictal, Neurontin has exhibited a lower incidence of side effects (weight gain, hair loss) than lithium and Depakote. As opposed to Lamictal, Neurontin appears to work more in alleviating mania than depression. It also seems to be a more potent antianxiety agent than both Depakote and Tegretol. Additionally, there have been no reports of Neurontin interacting negatively with MAOIs, lithium, Depakote, or Tegretol. Side effects most often noted include sleepiness, dizziness, unsteadiness, nystagmus (rapid, involuntary fluctuation of the eyeballs), tremor, and double vision. A distinct disadvantage to the drug is that it needs to be taken up to four times a day, compared to twice a day for other anticonvulsants.
Topamax (topiramate): Yet another anticonvulsant that seems to help regulate mood in those with manic depression, Topamax has been the subject of a few open-label studies. The apparent advantage of this anticonvulsant over the others is that it does not seem to cause weight gain; it may actually help individuals lose weight. On the other hand, Topamax appears to cause more cognitive side effects than the other new drugs. Other commonly reported side effects include sleepiness, dizziness, vision problems, unsteadiness, speech problems, psychomotor slowing, "pins and needles," nervousness, nausea, memory problems, tremor, and confusion. Topamax does not seem to interact negatively with MAOIs, lithium, Lamictal, or Neurontin, but a combination of the drug with Depakote or Tegretol can lower plasma levels of Topamax.
ABS-103: This drug is currently in preclinical studies evaluating its treatment potential for epilepsy, migraine headaches, and mania. Evidence suggests it may be as effective as Depakote and not cause as many side effects. In fact, ABS-103 might prove safe for women of childbearing age.
The new generation of drugs used to treat schizophrenia, known as atypical antipsychotics, have also been explored in some studies as potential treatment options for individuals with bipolar disorder.
Zyprexa (olanzapine): Although recently turned down by the FDA to be marketed for the treatment of bipolar disorder, Zyprexa has shown antimanic effectiveness in some trials when used in conjunction with other medication. One adverse effect, excessive weight gain, can be problematic in some patients and may lead to nonadherence.
Seroquel (quetiapine fumarate): Another atypical antipsychotic currently being investigated for use in those with bipolar disorder.
Substance P-blockers are one other type of newly developed medication that also shows potential promise in helping regulate mood. This class of drugs derives its name from how it works; unlike SSRIs, which work by blocking the brain chemical serotonin, these medications block a brain chemical known as substance P. Substance P was discovered in 1931, and medications designed to work against the chemical have often been used experimentally, but never successfully, in attempts to treat such conditions as chronic pain, migraine headaches, anxiety, and asthma. A recent study of a substance P-blocker called MK-869 found the drug to work as effectively as and cause less of certain sexual side effects than the SSRI Paxil.
Please remember: While all of the medications mentioned above have proven effective in certain studies, there is still quite a way to go in getting approval by the FDA for their use in the treatment of bipolar disorder. We will keep you notified about any changes in status.
Reviewed by David J. Kupfer, M.D., Thomas Detre professor and chair for the Department of Psychiatry and director of research at Western Psychiatric Institute and Clinic
Psychosocial treatments
What are psychosocial treatments?
Psychosocial treatments--including certain forms of psychotherapy (often called talk therapy) and social and vocational training--are helpful in providing support, education, and guidance to people with mental illnesses and their families. Studies tell us that psychosocial treatments for mental illnesses can help consumers keep their moods more stable, stay out of the hospital, and generally function better. A licensed psychiatrist (a doctor, who can prescribe medications), psychologist, social worker, or counselor typically provides these psychosocial therapies. The therapist and a psychiatrist may work together as the psychiatrist prescribes medications and the therapist monitors the consumer's progress. The number, frequency, and type of psychotherapy sessions a consumer has should be based on his or her individual treatment needs. As with medication, it is important to follow the treatment plan for psychosocial treatments to gain the greatest benefit.
Individual Psychotherapy
Individual psychotherapy involves regularly scheduled sessions between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker, or psychiatric nurse. The goal of this treatment is to help consumers understand why they are acting and thinking in ways that are troubling or dangerous to themselves or others so they have more control over their behaviors and can correct them.
Talk-therapy sessions may focus on a consumer's current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained, knowledgeable, and understanding person--by talking about the consumer's world with someone outside it--people with mental illnesses may gradually understand more about themselves and their problems.
Individual psychotherapy is used successfully to treat emotional, behavioral, and social problems in people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, depression, eating disorders, and anxiety disorders.
Psychoeducation
Psychoeducation involves teaching people about their illness, how to treat it, and how to recognize signs of relapse so that they can get necessary treatment before their illness worsens or occurs again. Family psychoeducation includes teaching coping strategies and problem-solving skills to families (and friends) of people with mental illnesses to help them deal more effectively with their ill relative. Family psychoeducation reduces distress, confusion, and anxieties within the family, which may help the consumer recover.
Pscyhoeducation in combination with medication has been used successfully to treat people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and depression as well as to help their loved ones.
Self-help and Support Groups
Self-help and support groups for people and families dealing with mental illnesses are becoming increasingly common. Although not led by a professional therapist, these groups may be therapeutic because members give each other ongoing support. These groups also are comforting because ill people learn that others have problems similar to theirs.
Members of support groups share frustrations and successes, referrals to qualified specialists and community resources, and information about what works best when trying to recover. They also share friendship and hope for themselves, their loved ones, and others in the group.
Groups may also help families work together to advocate for needed research and treatments and for better hospital and community programs. And when consumers act as a group rather than individually, they are often more effective in the fight against stigma and more successful at drawing public attention to abuses such as discrimination.
What are examples of specific psychotherapies?
Therapists offer several different types of psychotherapy. In general no one type of therapy is necessarily "better" than another type. When deciding which therapy (or therapies) will likely be the most successful treatment option for an individual consumer, a psychotherapist considers the nature of the problem to be treated and the consumer's personality, cultural and family background, and personal experiences. Note that a psychiatrist or psychotherapist (or both) may offer each of the following therapies to an individual, family, couple, or group.
Interpersonal Therapy
Interpersonal therapy focuses on the relationships a consumer has with others. The goal of interpersonal therapy is, of course, to improve interpersonal skills. The therapist actively teaches consumers to evaluate their interactions with others and to become aware of self-isolation and difficulties getting along with, relating to, or understanding others. He or she also offers advice and helps consumers make decisions about the best way to deal with other people.
Interpersonal therapy is a relatively new psychosocial treatment used most frequently to help people with bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), depression, eating disorders, and generalized anxiety disorder.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) helps people learn to change inappropriate or negative thought patterns and behaviors associated with their illness. The goal is to recognize negative thoughts or mind-sets (mental processes such as perceiving, remembering, reasoning, decision making, and problem solving) and replace them with positive thoughts, which will lead to more appropriate and beneficial behavior. For instance, cognitive behavioral therapy tries to replace thoughts that lead to low self-esteem ("I can't do anything right") with positive expectations ("I can do this correctly"). Combined with effective medication, CBT can successfully treat people with schizophrenia, bipolar disorder, ADHD, depression, eating disorders, generalized anxiety disorder, and panic disorder.
Exposure Therapy
A type of behavioral therapy known as exposure therapy or exposure and response prevention is very useful for treating obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). During exposure therapy, a consumer is deliberately exposed to whatever triggers the obsessive thoughts or reaction to a previous traumatic experience under controlled conditions. The consumer is then taught techniques to avoid performing the compulsive rituals or to work through the trauma.
Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) was developed to treat chronically suicidal individuals, but it has evolved into a treatment for multi-disordered consumers with borderline personality disorder (BPD) as one of their diagnosis. DBT has also been adapted for behavioral disorders involving emotion dysfunction (such as substance dependence in individuals with BPD and binge eating) and for treating people with severe depression and suicidal thoughts. DBT combines the basic strategies of behavior therapy with a philosophy that focuses on the idea that opposites may really not be opposite when looked at differently.
As a comprehensive treatment, DBT:
improves destructive behaviors,
improves motivation to change (by modifying inhibitions and providing positive reinforcement,
ensures that new capabilities generalize to the natural environment
provides a treatment environment that emphasizes what consumers and therapist are best at when working together
enhances the therapist's motivation and ability to treat consumers effectively.
In standard DBT, different types of psychosocial therapy--including individual psychotherapy, group skills training, and even phone consultations--are used to help consumers.
Reviewed by Rex Cowdry, M.D. Medical Director, NAMI (April 2001)
Permission is granted for this fact sheet to be reproduced in its entirety, but it must include the NAMI name and contact information
Posted: Tue Aug 08, 2006 5:56 pm Post subject: What Are Antipsychotic Medications?
What Are Antipsychotic Medications?
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 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 have 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 patients.
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.
Dosages and side effects. 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.
Multiple medications. 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.
Other effects. 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."1 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.
List of Antipsychotic Medications
GENERIC NAME----------------------------------------- TRADE NAME
Source: National Institute of Mental Health
NIH Publication No. 02-3929
Revised April 2002
What Are Antidepressant Medications?
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 no 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.
The doctor 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.
Early antidepressants. 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).
Cases of life-threatening hepatic failure have been reported in patients treated with nefazodone (Serzone). Patients should call the doctor if the following symptoms of liver dysfunction occur - yellowing of the skin or white of eyes, unusually dark urine, loss of appetite that lasts for several days, nausea, or abdominal pain.
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.
Side effects of antidepressant medications.
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.
Medications of any kind -- prescribed, over-the-counter, or herbal supplements -- should never be mixed without consulting the 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.
Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor and/or the pharmacist
List of Antidepressant Medications
GENERIC NAM--------------------------------- TRADE NAME
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.
List of Antipsychotic Medications
GENERIC NAME------------------------------------------ TRADE NAME
Bipolar disorder 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.
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.
Lithium. 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 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.
Side effects of lithium. 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 3 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.
Anticonvulsants. 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.2 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 6 months of therapy.
Studies conducted in Finland in patients with epilepsy have shown that valproic acid may increase testosterone levels in teenage girls and produce polycystic ovary syndrome (POS)in women who began taking the medication before age 20.3,4 POS can cause obesity, hirsutism (body hair), and amenorrhea. Therefore, young female patients should be monitored carefully by a doctor.
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 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.5 Sometimes, when a bipolar patient 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.
List of Anti-manic Medications
GENERIC NAME--------------------------------------- TRADE NAME
Posted: Tue Aug 08, 2006 6:12 pm Post subject: What are SSRIs?
What are SSRIs?
Selective Serotonin Re-uptake Inhibitors act as antidepressants by inhibiting CNS (central nervous system) neuronal uptake of serotonin and blocking uptake of serotonin. The increased level of serotonin at neuroreceptors is believed to act as a stimulant and, therefore, counteracts depression. SSRIs are generally used to treat depression and obsessive-compulsive disorder.
INFO ABOUT
What is Abilify?
Abilify (generic name aripiprazole) was approved for the treatment of schizophrenia on November 15, 2002 by the U.S. Food and Drug Administration. It represents a departure from the usual mechanism of action of antipsychotic drugs.
How is Abilify different from other antipsychotic medications?
All of the currently available medications for schizophrenia block the ability of the neurotransmitter dopamine to bind to a particular receptor in the brain called the D2 receptor. The new, so-called atypical antipsychotic drugs like Zyprexa and Risperdal are weaker D2 receptor blockers than the older drugs like Haldol and Thorazine. By contrast, Abilify actually has the ability, under certain circumstances, to stimulate the D2 receptor and is technically called a "partial D2 agonist." Animal studies suggest that when levels of dopamine in the brain are low, Abilify may enhance the dopamine effect by stimulating the D2 receptor. On the other hand, these animal studies suggest that when dopamine levels in the brain are too high, Abilify may actually switch its role and block the ability of too much dopamine to get to the receptor. Because it is now believed that some of the negative and cognitive symptoms of schizophrenia may be due to too little dopamine while the positive symptoms like hallucinations and delusions are due to too much dopamine, a drug that could regulate dopamine activity in this way would be beneficial. However, it is very important to remember that we do not know if Abilify actually works in this way in the human brain.
Like the atypical antipsychotic drugs, Abilify also has effects on some of the serotonin receptors. Again, it is not yet clear if this is important in terms of how these drugs work in treating schizophrenia.
Abilify was studied in 1,238 patients with an acute relapse of schizophrenia before the FDA approved it. In these studies, Abilify proved to be superior to placebo for treating positive and negative symptoms.
What are the side effects of Abilify?
Abilify showed a relatively low rate of adverse side effects in the clinical trials. The most common side effects were headache, anxiety, and insomnia. Some patients also experience a reduction in blood pressure when they get up from lying or sitting, a phenomenon called "orthostatic hypotension." This can cause dizziness and lightheadedness. In the short term trials lasting four to six weeks the incidence of extrapyramidal side effects (EPS) from Abilify was low and there was no weight gain. However, longer-term experience is needed before it can be certain that these will not be problems with Abilify as they are with many other antipsychotic drugs.
What is the standard dosage of Abilify?
Abilify can be given once daily, at any time of day. It comes in 10, 15, 20 and 30 mg doses. The usual starting dose is 10 mg and most patients so far have been treated at between 10 and 15 mg daily. There are a few interactions between Abilify and other drugs, such as fluoxetine (Prozac) and paroxetine (Paxil), so it is important to tell your doctor about all the other drugs you are taking before starting Abilify.
What is Ambien?
Ambien (zolpidem tartrate), is one of the most prescribed sleep medication in the United States for people suffering from insomnia.
It is highly effective for the treatment of insomnia on a short-term basis. In case you are having sleepless night Ambien helps in getting a good night's sleep.
How Ambien Works?
Ambien works in combination with the natural brain chemical Gaba. Gaba is a neurotransmitter and is one of the 18 major brain chemicals that control communication among neighboring brain cells.
Once this chemical is discharged from a brain cell, it is hypothesized that GABA dampens the electrical activity of neighboring brain cells. Laboratory studies have shown that Ambien works with Gaba to further reduce the possibility of certain brain cells becoming electrically active. Unlike older sleep drugs, Ambien targets a specific area of the brain cell.
Safety information
It is always advised not to use sleep inducing medication for more than 7 to 10 days, and re-evaluation is recommended if they are taken for more than 2 to 3 weeks. The most commonly observed side effects in controlled clinical trials were drowsiness (2%), dizziness (1%), and diarrhea (1%). The Consumption of alcohol should be avoided while taking Ambien.
What are the benefits of Ambien?
We know natural sleep is best, however the benefits of AMBIEN for one who cannot sleep immediately are:
Helps to fall asleep. AMBIEN help individuals to fall asleep within 15 to 30 minutes. Therefore, it is to be taken only when you are completely ready to go to sleep.
Helps you to stay asleep. It is disturbing to wake up during the night without being able to sleep gain. After taking Ambien insomnia patients report significantly fewer awakenings, compared with placebo.
Helps you to avoid waking up early. It provides a full night's sleep, and has been proven to increase total sleep time.
Here are few commonly asked queries that would help one to understand Ambien better.
Does AMBIEN really work?
The answer is, it does and fast as well.
Do I feel drowsy the next day?
A study conducted among Ambien users, only 2% of reported daytime sleepiness. In order to minimize the possibility of next day drowsiness take AMBIEN as directed by the physician. A small but statistically significant decrease in performance of Ambien was observed in a test of dexterity when compared with placebo in a study conducted on elderly subjects with no insomnia.
If Ambien can be taken along with other medications?
There are certain drugs, that can either interfere with or increase the effect of AMBIEN. Hence before taking any other drug, ask your doctor or pharmacist about possible interactions with AMBIEN.
What I must tell to the doctor before AMBIEN is prescribed for me?
In order to avoid unnecessary complications you must tell the Doctor
If you drink alcohol
Have a history of alcohol or drug dependency
Are pregnant or breast-feeding
Have any breathing difficulties, such as asthma, bronchitis, emphysema
Have a history of heavy snoring
Are depressed
Have kidney or liver disease
Can Ambien be administered if pregnant?
Use of AMBIEN during pregnancy is not recommended and should be considered only if your physician determines it is needed. Sleep medicines may cause sedation of the unborn baby when used during the last weeks of pregnancy.
What are the most common Side Effects
Some of the common side effects that you encounter are
Dizziness
Daytime drowsiness
Difficulty with coordination
Lightheadedness
You may feel sleepy during daytime if you are using such sleep medicines How drowsy you feel depends on
How your body reacts to the medicine,
Which sleep medicine you're taking and
How large a dose your doctor has prescribed.
What is Ativan?
Ativan (lorazepam) is a sedative medication that is most generally used to treat anxiety. Other accepted uses include treating insomnia, symptoms of severe alcohol withdrawal, relieving serial seizures in children (sublingual form), as a muscle relaxant, and reducing the suffering of chemotherapy patients who experience vomiting during treatment. Ativan is not generally recommended for long-term use, over 4 months duration, as this may increase the likelihood of physical withdrawal symptoms.
Ativan works by increasing the activity of a neurotransmitter called GABA (gamma-aminobutyric acid), which inhibits the nervous system, reducing states of mental and physical overexcitement. Lorazepam is a member of the benzodiazepine group of drugs, a class of antidepressants, anti-panic agents, sleep medications, and muscle relaxants.
Ativan is only available by prescription.
Ativan Side Effects
Ativan (lorazepam) is generally considered to be a safe medication with a low risk of adverse side effects. If side effects do occur, they are likely to happen at the beginning of treatment, and are typically reduced with continued treatment or lower dosages. If any side effect should persist, become bothersome, or if an allergic or paradoxical reaction should develop, contact your doctor.
Expected Ativan Side Effects: Drowsiness and mild nervous system depression during the day following use at bedtime are normal and expected side effects of this medication. Normal use may cause mild central nervous system depression, but dosage should be managed to minimize this. Do not drive or perform any other potentially hazardous activities until you are familiar with your reaction to this medication and know how long it takes to clear from your body.
FAQ
Search
Memberlist
Usergroups
Register
Profile
Log in to check your private messages
Log in
