Monday, July 8, 2013

Psychiatric Drugs for Mood Disorder Patients? A Bipolar Patient's Point-Of-View

When positive-thinking and self-help books seem not to help anymore and individual or group therapy are no longer fruitful, it is likely time to head for a psychiatrist's office to seek drug therapy for anxiety, depression, mania, psychosis, SAD, PTSD, ADHD, OCD and whatever else may challenge the English alphabet. Okay, let us begin with the obligatory generalities.

The term "Pharmaceutical" comes from the Greek "pharmakon" or "medicinal drug." Most drugs are controlled by law and prescribed by physicians among civilized populations. They are prescribed for patients when over-the-counter (OTC) remedies are no longer effective in treating or offering relief from a person's illness or medical condition. Pharmaceutical companies develop prescription drugs for various maladies and diseases for a princely sum to offset development costs and to make a healthy profit for shareholders until the drug patent expires and less-costly generic equivalents are produced by competing manufacturers.

A medicine is almost always prescribed for its intended use; however, it sometimes is prescribed for a side-effect that will most benefit the patient. Every known medicine has side-effects, some good and some worse for a given patient. A single type of side-effect may affect either many patients or very few. The likelihood of a side effect affecting a patient according to double-blind testing required by the U.S. Food & Drug Administration (FDA) is expressed in terms of a percentage of drug side-effects to a percentage of equivalent placebo side-effects among a test population.

Medicines often do not get along with other medicines and the interference between them requires health care professionals to be wary and responsible for which combinations of them are either ineffective or dangerous. This is especially true of psychiatric (psychotropic) medicines prescribed for patients having behavioral disorders. Many of these potions carry potent side-effects and require extra-careful scrutiny when being prescribed by a psychiatrist or primary care physician.

There are five (5) main classes of psychiatric medications:

  1. Antidepressants

  2. Antiepileptics (Anticonvulsants)

  3. Antipsychotics (you sure don't want any of us running around)

  4. Anxiolytics (if reading this makes you anxious)

  5. Mood Stabilizers

There are over 100 of these medicines in use today and many others that have fallen out of favor. This number of medications gives the doctor several ways to attack each disorder's multiple conditions and symptoms, and more importantly, to prescribe an effective medicine with the least amount of side-effects for each patient.

One antidepressant was prescribed for my clinical depression shortly after its introduction in 1985. There was much media hoopla for the miracle drug that could make people "happy." But the real breakthrough was intended only to raise the moods of folks who were suicidal, vegetative or otherwise crippled with incessant clinical depression by allowing the needed amount of the neurotransmitter serotonin to increase in the brains of patients. It worked wonderfully for me. Taking it permitted me to function almost normally (or whatever that was for me) again.

Once a psychiatric medication is prescribed, time-pressured physicians and pharmacists typically skim over the list of side-effects with the patient, placing the onus of discovery on that patient. The most prevalent cautions are usually relayed to the patient by his or her doctor or pharmacist. Regardless, the psychiatric patient needs to know them all, for many of these side-effects are debilitating or life-threatening and must be reported to a doctor quickly when discovered.

The patient or his or her domestic caregiver must have all of the drug information available for each prescription taken. I have found Wikipedia drug articles to be the most comprehensive, understandable, rich in detail and peppered with many related hotlinks. The best way to secure this information is to visit Wikipedia and type the drug name into its search window. Here is what you will find in each pharmaceutical article at [] Select "English" if you can read this.

  • General Description

  • Medical Uses

  • Adverse Effects (including contraindications with other drugs)

  • Pharmacokinetics (how the drug works)

  • Mechanism of Action (if you're studying to become a doctor or pharmacist!)

  • History (not for the faint-of-heart)

  • Other Brand Names (domestic and worldwide)

  • In Popular Culture (books, movies, parades, etc.)

  • Online References

  • External Web Links

One article for a popular antidepressant has 95 online references upon which it is based. This ubiquitous medicine is FDA-approved for treatment of clinical (major) depression, obsessive-compulsive (OCD), bulimia, panic and premenstrual dysphoric disorder. Adverse (side-)effect test result percentages are referenced to those of placebo test results and include discontinuation syndrome (going cold-turkey), suicidality in persons younger than age 25, nausea, insomnia, sleepiness, anxiety, tremors and sexual dysfunction.Then it lists warnings when taking it along with certain other medicines. One's pharmacist usually includes a data sheet with the medication; it will contain the most important information and cautions, but many patients do not take the time to read them.

Initially, I received two prescriptions for my bipolar disorder. They worked great, except for the fact, like a disproportionate number of pyschiatric drugs, one of them produced dramatic weight gain. The current and complex drug "cocktail" for my bipolar I disorder consists of 5 psychotropic medicines. I presently take 1 anticonvulsant, 1 mood stabilizer, 2 antipsychotics and 2 antidepressants. One of these was prescribed for me only for its side effect of weight loss in order to counter the weight-gain side-effects of three of my other medications. Whew! And so it goes. Who ever said psychiatry was a simple thing?

One common antidepressant is now available as a generic, making it a wonderful choice for needy patients. It is a good treatment choice for a clinically depressed patient since 90% of all suicides result from clinical depression. I am sure there are better choices today, but I have a long experience with it so I use it here as an example. It carries a 2% chance of suicide as a side effect-a regular sword of Damocles, right? How ironic. So how do we square this anomaly? The way I see it, a 98% survival rate beats the living daylights out of a 10% survival rate! Additionally, watchful patients and others around them can often observe the patient and obtain medical intervention well before the act of suicide is committed.

In practice, after a patient's initial dosing of a psychiatric medication, it requires 2-3 weeks to approach therapeutic levels. The patient often must be hospitalized for at least this critical period for his or her safety's sake. This characteristic is typical for psychotropic drugs. They require a lengthy ramp-up time to achieve efficacy and then a long weaning-off period if they are to be eliminated or tapered off as another medicine is simultaneously introduced and ramped-up to replace it.

Psychiatric drugs are numerous, complex, slow to take effect, fraught with ungodly side-effects, pretty darned expensive-since those most often prescribed are usually not generics-and often not covered by drug insurance plans. The ramifications of improper patient medication relate not only to the health of the patient, but to his or her relationships with family, friends and others. One caveat remains, however. A mental patient often fails to take his or her medication(s), including specified doses at the right times when raging, manic, disoriented, or distracted. The depressed patient simply forgets to take his or her medicines. Ideally, someone living with the patient must keep refills current with the pharmacy and then fill a weekly pill carrier to provide proper doses of each medication to administer at the right times of day. Then the patient must be reminded to take them or have the pills handed to him or her with a beverage with which to drink them down. My spouse lovingly either reminds me to take them or brings my meds to me, depending on the moment. But many times I do remember to take them! This ideal and idyllic thought I shall leave with you.

No comments:

Post a Comment