Presentation on theme: "Medication and Treatment Challenges for the Young Adult"— Presentation transcript:
1Medication and Treatment Challenges for the Young Adult Karen Moeller, PharmD, BCPP Clinical Associate ProfessorThe University of KansasSchool of PharmacyHeidi Wehring, PharmD, BCPPAssistant ProfessorThe University of MarylandSchool of MedicineHow may people take medicationsHow many people think they don’t need medications?
2Medication Challenges Drugs don’t work in patients who don’t take them.— C. Everett Koop, M.D
3ObjectivesReview mental illnesses and substance abuse risk in young adults.Discuss risks and benefits of medications in young adults.Empower young adults to seek important information about their medications.
4Adolescence and Young Adulthood Changes in family relationshipsIncreased academic loadIncreased responsibilitiesJob experiencesDrivingIn other words, there’s a lot going on!
5Considerations for Systems of Care Transition-age youthbetween child focused and adult-focused staffYounger people with severe mental illnesses could be at risk for missing milestonesEarly recognition and seeking treatment are important steps80% of persons with depression improve with treatmentNordqvist, 2009
6Costs of Mental Illness- MDE in Young Adults Depression in young adults is associated with increased risk of:substance abuseunemploymentearly pregnancyeducational underachievementSuicide: third leading cause of death in 14- to 24-year-oldsCenters for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. Suicide prevention: youth suicide
7Mental Health and Substance Abuse Mental illness: more common in late adolescents and young adults than in youth under age 16Half of all lifetime cases of mental health and substance use disorders occur by age 14¾ by age 24If not addressed, mental health issues mayAffect academic and employment achievementIncrease likelihood for justice system involvementHinder relationship developmentMasi and Cooper, 2006; Kessler et al., 2005
8Mental Health by the Numbers In the past year:1 in 10 teens ages had a major depressive episode1 in 5 young adults (18-25) had a mental illness4% of young adults had a serious mental illnessThis group generally had poorer quality of life than persons without mental illnessTHE CBHSQ Report, May 2014
9Mental Health: Unmet Needs Needs are not always met1 in 10 teens ages had a major depressive episode (MDE)60% did not receive mental health services1 in 5 young adults (18-25) had a mental illness67% did not receive mental health services4% of young adults had a serious mental illness47% did not receive treatmentSAMHSA, 2013
10Why? Young adults are healthy New onset of symptoms Less regular interaction with physicianNew onset of symptomsLess knowledge that a diagnosable conditionRecognition of need for interventionYoung adults report less use of counseling services among persons with depressionDecision-makingYu et al., J Adolesc Health 2008
11Why Not Seek Treatment? Stigma “I couldn’t pay” “It’s hard to make appointments”“I don’t know who to see”“How will talking or taking a pill help?”According to college students surveyed, stigma still the #1 barrier to seeking helpYu et al., J Adolesc Health 2008; College Students Speak 2012
12Co-occurring Illness: Impact on Recovery Twice as high in young adults vs 26+19% vs 7%SUD can increase challenges to persons with another mental health conditionPhysical healthTreatment responseIncreased risk of legal/familial issuesBeing empowered to seek and receive treatment is important in addressing these challengesYoung adults:higher rates of co-occurring SUD, MI6/10 persons with SUD also suffer from another MIPersons with a history of abuseor other trauma at increased riskYoung adults have higher rates of co-occurring substance use disorder and mental illness than older adultsCBHSQ, Results from the 2012 National Survey on Drug Use and Health
13The Good News: Effective treatments are available Non-medication treatmentMedicationCombination of different treatmentsMedications are effective in treating the symptoms of many disordersYoung adults may have individual needs and challenges that can be addressed to optimize benefit from treatment
14What are Medications ? A medicine or drug changes how your body works Treats or prevents a disease or symptomMedication can be:PrescriptionOver-the-counterHerbalsDietarySupplementsWhen used correctly, medicines can lead to:Better life qualityHealthier lifeLonger life
15Psychiatric Medications How they work Relieve symptomsHelp prevent return of symptomsNot one medication is going to work for everybody!!!Medications Do Not Cure Mental Illness
16Why do I Need to Take Medications? Benefits of taking my medications Decrease symptomsHelps stabilize your mood and thinkingImproves your ability to function during daily activitiesDecrease hospitalization and emergency visitsImproves your quality of lifeDecrease tension in your personal relationshipsSometimes, it’s hard to know how the medicine will affect you until you try it
17Medications Take Time to Work Most psychiatric medicines work gradually before you see the full benefitsDepression – 4-6 weeksSchizophrenia – weeks to monthsBipolar - weeksAnxiety – weeks to monthsADHD - immediately
18Be Part of the Medication Decisions Get InformationFind out about different types of medicationsTalk with others who have similar symptomsTalk with your doctor about side effectsSometimes the only way to know if the medication is right for you is to try it!Ask questionsRequest changes if neededDon’t give
19KNOW YOUR MEDICATIONS! Questions to ask your health care provider What is the name of the medication? Is it known by other names? Is there a generic?What is the medicine for?How should I take it? Should I take it with food?When will the medication begin to work?Why is it important for me to take this?What are the possible side effects?Can I take this medication with other medications or vitamins?Is the medication addictive?How long do I need to take the medication?
24Side Effects Be aware of side effects and how to handle them Don’t be afraid of all the side effects listed in the medication leafletJust because a side effect is listed in the literature does not mean you will get itDon’t be afraid to talk with your clinician about side effectsNot talking to your physician about side effects will increase your likelhood of stopping the medication
25Side Effect Checklist –Less Severe SymptomsPossible Solutions to Side EffectEyes sensitive to lightWear sunglasses, hat or visor; Avoid prolong exposureDry mouthIncrease water intake; Use hard candies or sugarless gumStomach upsetTake medication with mealsConstipationIncrease water intakeIncrease physical exerciseEat green leafy vegetablesTalk with doctor or pharmacist about mild laxativesTirednessTalk to your doctor about switching entire daily dosage at bedtimeTake brief rest periods during the dayMild restlessness, muscle stiffnessExercise, take short walks, stretch muscles, relax to musicWeight GainExercise, watch diet and reduce overeating
26Side Effect Checklist –More Severe Contact your doctor Blurred visionDrooling or difficulty swallowingTremors (involuntary shaking or tightening of muscles)Diarrhea for greater than 2 daysMuscle rigidityRashExcessive sedationExtreme difficulty urinatingInvoluntary movements of mouth, tongue, hands or other parts of the body
27What are Psychotropic Medications? AntipsychoticsAntidepressantsMood StabilizersStimulantsAntianxiety/ Hypnotics
28Antipsychotics Typical Antipsychotics Atypical Antipsychotics Clozapine (Clozaril®)Olanzapine (Zyprexa®)*Risperidone (Risperdal®)*Paliperidone (Invega®)*Quetiapine (Seroquel®)Ziprasidone (Geodon®)Aripiprazole (Abilify®)*Asenapine (Saphris®)Iloperidone (Fanapt®)Lurasidone (Latuda®)chlorpromazine (Thorazine®)thioridazine (Mellaril®)loxapine (Loxitane®)molindone (Moban®)perphenazine (Trilafon®)trifluoperazine (Stelazine®)thiothixene (Navane®)fluphenazine (Prolixin®)*haloperidol (Haldol®)**Available in a Long Acting Injection(usually take every 2 weeks or monthly)
29Side Effects of Antipsychotics DrowsinessSome are more than otherUsually resolves in a few weekAnticholinergic Side EffectsDry MouthConstipationUrinary retentionBlurred visionIncrease heart rateDecreased sweatingIncrease Prolactin
30Side Effects of Antipsychotics Cardiovascular side effectsMay need a EKGWeight Gain, Diabetes, increase cholesterolMore commonly seen with the atypical antipsychotic.Make sure you physician is monitoring your weight, blood sugar and cholesterolExtrapyramidal Side Effects (EPS)DystoniasPseudoparkinsonismTardive DyskinesiasAkathisiasMost Commonly seen with the typical or older agents
31Common Antidepressants SSRIsProzac® (Fluoxetine)Zoloft® (Sertraline)Paxil® (Paroxetine)Celexa® (Citalopram)Lexapro® (escitalopram)Luvox® (Fluvoxamine)SNRIsEffexor® (Venlafaxine)Cymbalta® (Duloxetine)Pristiq® (Desvenlafaxine)OthersWellbutrin® (bupropion)Remeron® (mirtazapine)Older Antidepressants (mainly used for sleep or other indications)TrazodoneAmitriptylineDoxepinAll Antidepressants have a suicide warning in people <25 years old
32SSRI and SNRI Side effects GI – Nausea/Vomiting/DiarrheaInsomniaHeadacheNervousness/JitterinessWeight Gain/weight lossSexual dysfunctionHypertension (SNRIs only)Withdrawal reactionDizziness, insomnia, anxiety, agitation, nausea, vomiting, sweating, tingling, headache, sensory disturbancesMost Side Effects go away in 2 weeks
33Others Bupropion (Wellbutrin®) Mirtazapine (Remeron®) Trazodone Comes in many different dosages forms (Wellbutrin®, Wellbutrin SR®, and Wellbutrin XL®)Avoid if you have a history of seizuresAlso used in smoking cessation and ADHDMirtazapine (Remeron®)Sedation and Weight gainOften used for sleepTrazodoneOld antidepressant now used for sleepPriapism rare side effect
34Antidepressants and Suicide All antidepressants have a black box warning for increase risk of suicide in children up to age 24Greatest risk of suicidal behavior is when a person 1st starts taking an antidepressant (usually around week 2)Children who develop anxiety, agitation restlessness with AD treatment may be at an increase risk for developing SIOverall, long term use of AD have been shown to decrease suicide in general population4% Risk of Suicide with Antidepressants vs. 2% with placeboHammad TA.Kratochvil CJ, et al. J Child Adolesc Psychopharmacol; 2006;16:11-24
35Mood Stabilizers / Anticonvulsants LithiumValproic Acid (Depakene®, Depakote®, Depakote ER®)Comes in many dosage forms, make sure you have the correct one prescribedCarbamazepine (Tegretol®)Also comes in many different dosage formsLamotrigine (Lamictal®, Lamictal ER®)
36Important Information - Lithium Don’t get dehydrated!!Many interaction (Advil, Aleve, Motrin, diuretics)Narrow Therapeutic index (0.5 – 1.2 meq/L). Easy to reach toxicity
37Common Side Effects of Mood Stabilizers Sedation (takes a few days to get use to side effects)Stomach (usually well tolerated)TremorLess Common but more severeCall physician if these occurDecrease platelets (Increased bruising)Decrease white blood count (frequent infections)Liver impairment (yellowing of the skin, abdominal pain)RashDrug levels are monitored for most mood stabilizers
39Adverse Effects - Stimulants Anorexia/Wt lossStomach painInsomniaRebound SymptomsIrritabilityDepressed MoodZombie StateOthersHypertensionHallucinationsTicsKey PointsTalk with your doctor if you have a pre-exsisting heart conditionAnorexia –give high calories meals when stimulants are low (breakfast/evenings)Stomach pain – administer stimulants after foodInsomnia – administer stimulant as early in the day as possible, discontinue afternnoon or evening doses. Consider adjunctive clonidine or sedating ADRebound symp – overlap stimulant dosing, use a second dose of long-acting stimulantDysphoria-reduce dose, consider different stimulant, consider comorbid diagnosisZombid- reduce dose, change stimulant
41Benzodiazepines – Side Effects DrowsinessClumsiness (ataxia)FatigueConfusionMemory problemsSlowed breathingADDICTIONUSE CAUTION WHILE DRIVING OR OPERATING HEAVY MACHINERY
42Hypnotics Non-addicting Risks of Addiction Trazodone HydroxyzineDoxepinRozerem (Ramelteon®)Risks of AddictionLunesta® (Eszopiclone)Sonata® (Zaleplon)Ambien® (Zolpidem)Benzodiazepines
43Abnormal Sleep Behaviors Warning on all prescription hypnoticsSleepwalking, sleep driving, sleep eating, etc..
44Hurdles with Medication I forget to take my medicationI’m not ill, I don’t need medicationI don’t feel any different, so my medication must not be workingI feel great, so I don’t need my medication anymoreI can’t afford my medicationI don’t want any side effectsRegimen complexityDosing frequency greater than twice dailyRemembering doses and refillsDepressionAdverse effects or fearing themUnderstanding the regimenBelief and confidence in therapyCostAbility to read the prescription label
46Helpful hints to remember to take your medications Pill BoxAsk your pharmacy if the “bubble pack” / “blister pack” or fill pill boxes
47Helpful hints to remember to take your medications Make a CalendarSet Alarms / Reminders
48Helpful hints to remember to take your medications Smart Phone Apps (free)iPhone and AndroidMyMedScheduleMyMedsMedSimplePillManager
49Helpful hints to remember to take your medications Make it part of your daily routineAways Keep Medication out of the Reach of Children!
50Other Options Long acting injections are options for certain medicines Once every 2 to 4 weeks VS taking pills every dayOral medicines that can be taken once daily may offer benefit over others that need to be taken multiple times a dayIf scheduling medicine doses is a challenge, ask your doctor about options!
51High Cost MedicationsAsk your doctor or pharmacist for a cheaper alternativeLet your doctor know you can’t afford a high cost medicationVisit RxAssist or Partnership for Prescription AssistanceWebsites for prescription assistance programLook for medication couponsGet price quotes-GoodRx (www.goodrx.com) offers price comparisonsAsk about medication samples
52Using Your Medications Safely Avoid Alcohol and Street drugs while on psychiatric medicationBe up front about what you usually useBe careful while driving or using machineryNever stop your medication abruptlyIf you miss a dose – Never double up on the medicationIf your medication makes you feel sick – talk with your doctor or pharmacist ASAPIf you are thinking about becoming pregnant or breast feeding talk with your doctor or pharmacistMake sure you doctor knows ALL your medications
53Dietary Supplements & Herbal Medications Allows talk with your doctor or pharmacist prior to takingMany have drug interactions and may worsen your diseaseHerbal medications do not follow the same rules that prescription drugs do.Manufacturers do not have to prove that the product is safe, effective, or that it contains the ingredients on the label.
55Feeling better is a sign the medication is working Always talk to your doctor before stopping a medicationSome medications have to be gradually lowered before one can get completely offSome illness, like schizophrenia, require lifelong treatment.Treatment durations among individuals
56Remember it takes time for medications to work Psychiatric Medications treat symptoms – they do not Cure Mental illnessYou still may have some symptoms while on medicationsTalk with your doctor if you don’t think it is working
57Consider a long acting injectable medication if available REMEMBERGet a pill boxSet AlarmsAsk your doctor to simply your regimenMake it part of your routineConsider a long acting injectable medication if available
58REMEMBER – BE IN CHARGE OF YOUR MEDICATION Be sure you have the correct dosageFind out about different types of medicationsTalk with your doctor about side effectsAvoid Medication interactionAsk questionsRequest changes if neededDon’t give
59Where do I get more information NAMI Information on TreatmentNAMI On Campus
60SummaryMental illness is common among young adults and may occur with SUDDevelopmental and lifestyle challenges contribute to the complexity of seeking and getting the most out of treatment interventionsThese illnesses can be addressed and treatedMedications are helpful treatment options for many symptomsBeing empowered to seek information and optimize medication use is an important aspect of the road to recovery