Medication Related Information

Getting the right medicine, medication side effects, fear of being dependent on a medication, medications that stop working mysteriously... psychiatric medications evoke in us as many reactions as do psychiatric disorders... and psychiatrists.

What we propose to do on this page is to try to collect and organize information that we have found helpful in thinking about psychiatric medications. As with other parts of this website, this will most definitely be a "work in progress" as there is an endless supply of information on this topic.

We should begin with some of our beliefs about psychiatric medications. In general, we find them to be quite a bit less mysterious and magical than most people do. This is good and bad. They don't have the ability to change who we are... as we sometimes fear they might, and sometimes desire they would. By and large, psychiatric medications are not "magic bullets" that take away problems so that we don't have to think about them again. Adverse effects are pretty common, but in ten years of practice, we have not (thank goodness) had any catastrophic outcomes... no one has had a reaction that didn't resolve after the medications was stopped... although those things do happen with psychiatric medications as they do with any other medicine (including Tylenol and aspirin).

Medication "versus" Psychotherapy

One of the questions that we find we don't know how to answer is the common question, "Is this a biological depression?" which often means, "should I take medication for this depression or is psychotherapy the answer." The problem is that all depressions are both biological and psychological. Psychotherapy and medications both affect biology, they appear to do it by somewhat different routes. A recent article in the Archives of General Psychiatry demonstrated this with some dramatic brain scans. The implication is that they may be synergistic, working on the common problem of depression in different ways.

The important question is what is effective treatment. And, in general, comparing the two treatments, outcomes tend to be about the same. Medications tend to work a bit faster and is a little bit less expensive in the short run, psychotherapy tends to be a bit slower and more expensive in the short run, but results from psychotherapy may be more enduring. Two recent articles in the Archives confirmed this finding.

We find that usually medication and therapy compliment each other (although the story is not as clear for anxiety disorders as it is for mood disorders). Medications are generally necessary for conditions that are more severe, but they are not restricted to use in severe disorders. On the one hand, medications tend not to be associated with the kind of enduring changes that can occur with psychotherapy. Severe depression has a profound effect on the ability of the brain to learn and therefore may block the effects of psychotherapy.

Adverse Effects from Medications

Many patients ask us about the long-term effects of treatment with antidepressants and mood stabilizers. Over the years, we have grown increasingly comfortable saying that there do not appear to be any major or significant adverse effects of long-term antidepressant treatment. More recently, very good quality studies have begun to show that this is only part of the total picture in terms of brain effects.

A large number of studies now find that patients with chronic mood disorders have measurable cell loss and atrophy in certain areas of the brain associated with memory. These changes are similar to changes seeing in laboratory animals who have very high cortisol or cortisol releasing factor (CRF) levels (indicating high levels of stress). New studies find that individuals with depression have much lower levels of an important chemical called brain-derived neurotrophic factor (BDF). It seems that neurons need to be exposed to this "fertilizer" in order to grow in a healthy way and that depression, perhaps because of increased stress hormone levels, or perhaps for other reasons, is associated with reductions in this factor.

The two most recent findings are that the effects of mood stabilizers and antidepressants are to counteract both the increase in stress hormones as well as the decrease in BDF. The most exciting study shows that antidepressants, in order to be effective in treating depression, have to result in stimulation of brain cell function in a way that is similar to normal brains. In other words, depression is associated with brain toxicity, and the best evidence is that antidepressants reverse this brain toxicity.

However, there certainly are adverse effects from psychiatric medications, just as with any kind of medication. Here are some resources that may be helpful if you are having a potential adverse effect.

Rashes
Sexual Side Effects
Nausea
Medical Symptoms and Recommendations

This is a very useful general reference that talks about common medical symptoms and helps you to gather information that your doctor may want to know, and that also will allow you to determine when a problem is an emergency, and when getting help is less urgent.

Specific Medications and Classes of Medications

Medications can generally be divided (somewhat loosely) into "classes" and "types" of medications based on a mixture of their principle use and their mechanism of action. Note that the designations of "antidepressant", "mood stabilizer", "antipsychotic", although used here, are really not accurate since mood stabilizers may be used to treat depression, antipsychotics may be mood stabilizers, etcetera.

Antidepressants

Serotonin reuptake inhibitors (SRI's)

Serotonin and Norepinephrine reuptake inhibitors (SNRI's)

Serotonin2 Receptor Blockers (SRB's)

Others

Mood Stabilizers

Lithium

Mood Stabilizing Anticonvulsants

Antipsychotics

Typical Antipsychotics

Atypical Antipsychotics

Anti-Anxiety Medications

Benzodiazepines

Other GABA agents

Others