The Use of Medication in Mental Health Problems: What you can expect from them
In the last three decades, with the advent of newer, more powerful and more tolerable psychoactive medications, the use of medications (psychopharmacotherapy/ medication management) has skyrocketed. Medication management is carried out by prescribers: Psychiatrists, General Practitioners, and in some areas of the US, Nurse Practitioners.
A summary history on the use of medications for mental health problems
Psychiatric medications were originally developed in the 1950s. They became commonly used in the sixties and seventies; and their use became widespread in the late 1980s. In the last three decades since that time, medication use for mental health disorders in the United States has increased with every decade that passed and it has become the main form of treatment intervention for the majority of people.
Psychoactive medications became popular in the sixties after the development of the Benzodiazepines, which led to the sixties and seventies to be called “the Valium decades.” With the development of the Selective Serotonin Reuptake Inhibitors (SSRIS) in the late 1980s, Benzodiazepine use remained strong, but other more modern agents were used in the treatment of anxiety.
Prozac was the first medication in this new medication family group. This antidepressant, then considered “miraculous drug,” came out in 1988 and it made the cover of Time magazine. That event marked the advent of the “Listening to Prozac” era in psychiatric care; this meaning an era in which psychiatrist became more frequently prescribers in detriment of the practice of psychotherapy that was largely left in the hands of non medical professionals. And since that time, the SSRIs (Zoloft, Paxil, Celexa and others) have been the most popularly used medications in psychiatry and in primary care in the US.
The SSRIs as the most used drugs in current practice
The reason for this popularity is that this class of drugs are safe and effective in treating depression and anxiety. They are tolerable, have a favorable side effect profile, and are not addictive. For these reasons, the SSRIS have become the “go to” medications for people suffering from depression, anxiety, OCD, PTSD and social anxiety.
At present there are more than 6 drugs available in this medication class. The two most commonly used in the present are Sertraline (Zoloft) and Escitalopram (Lexapro). The reason for this choice is their best side effect profile and their 24 hours half-life. This characteristics make them safe drugs in overdose. These two drugs are ideal for treatment because they have very few interactions with other medications and they are out of the body in 24 hours.
The use of Benzodiazepine anxiolytics (antianxiety medications)
Current drugs in the Benzodiazepines family used in Psychiatry today are Clonazepam (Klonopin) and Alprazolam (Xanax). The first one is used for prevention of panic attacks and the latter for treatment of breakthrough panic episodes. These drugs are also used in the treatment of other anxiety disorders with great success.
These medications are oftentimes used together with the SSRIs to achieve better effects on some conditions, especially in treatment resistant panic disorder. As a group, the Benzodiazepines have some potential for addiction, but this potential is not severe and should not preclude its judicious use. Even though “dependence” on these medications is common, addiction tends to happen in people with history of addictions, alcohol problems, and/or personality disorders.
Benzodiazepines are classified by the Drug Enforcement Administration (DEA) as Scheduled IV (4) drugs. This means they have low potential to addiction compared to Schedule II (2) drugs such as Adderall or Oxycodone which are commonly used for treating ADHD and pain with much higher risk. The least addictive of the Benzodiazepines is Clonazepam (Klonopin)
What are psychiatric medications useful for?
Medications are successfully used in the treatment of:
- Major depression
- Bipolar Disorder
- Mania
- Schizophrenia
- Psychotic disorders
- Dementias (like Alzheimer’s Disease)
- Anxiety disorders such as panic disorder, generalized anxiety, social anxiety
- Post-traumatic stress disorder
- Attention deficit disorders
- Insomnia and sleep disorders
- Many other less common mental health disorders
The main groups of psychiatric medications
- Antidepressants (help with depression and anxiety)
- Mood stabilizers (stabilize mood in bipolar disorders)
- Antimanic agents (bring the person down from the heights of mania)
- Antipsychotics (decrease hallucinations and delusions)
- Cognition enhancers (improve memory)
- Anti-panic medications (control panic attacks)
- Psychostimulants (improve energy, attention, and concentration)
- Hypnotics (improve sleep)
- Miscellaneous (do a number of different things in different conditions)
What can you expect from psychiatric medications
In general, psychoactive medications are not curative but palliative treatments. This means that they do not resolve the problem permanently, but rather that they improve the symptoms as long as people continue to take them. Note that sometimes, people can be cured after a course of medication, but that is not the rule.
In order for psychiatric medications to work, they must be taken regularly and as prescribed by the prescriber. Taking these medications erratically–or not at the indicated dose–is the cause of most treatment failures. Taken as prescribed they are effective in 80 percent of cases. In general, except for the group of the benzodiazepines, these drugs are effective long-term, but they take a long time (weeks) to work and are not addictive. They can be taken for years without complications.
Asa rule of thumb, the more biological the condition (meaning, the more the condition is caused by an inherited chemical imbalance in the brain) the better the medications work.
Paradoxically, medications can work more efficiently in more severe mental conditions such as Bipolar Disorder than on a less severe personality or anxiety problem caused by reactions to environmental circumstances.
The use of psychiatric medication in personality disorders
The effects of medications on psychological conditions, such as the personality disorders, is less robust. For example, people with Borderline Personality Disorder may benefit from the same medications used in Bipolar Disorder, but their effect on the former condition is more marginal than in the latter.
Whereas a person with Bipolar Disorder may be treated exclusively in medication management without psychotherapy, intensive psychotherapy (both individual and group interventions) is necessary to treat borderline personality. So, in this personality disorder, the patient will still benefit from medication management, but the total improvement effect is about 30 percent of the entire therapeutic intervention. In schizophrenia or in bipolar disorder, in contrast, medication management represents 70 percent of the total therapeutic effect.
Overall, most studies have shown that a combination of psychotherapy and medications works best in all mental health disorders.
In future posts, I will continue to explain more in detail the utility of psychiatric medications in the treatment of different mental health disorders. I will explain further their mechanisms of action, the effects of different families of medications, and other details of interest.
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Dr T