Medications for Mental Illnesses This presentation is designed to help understand how and why drugs can be used as part of the treatment of mental health problems. Medications for Mental Illnesses

Introduction Definitions psy·cho·phar·ma·col·o·gy n. - The branch of pharmacology that deals with the study of the actions, effects, and development of psychoactive drugs. Psychotropic Drug – a drug that affects emotional state. Psychotropics include antidepressants, antipsychotic medications, sedatives, stimulants, and tranquillizers. History Uses and Benefits a. History It was only 41 years ago that the first psychtropic medication, Thorazine, 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. b. Uses and Benefits Anyone can develop a mental illness. 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. 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. Medications for Mental Illnesses

Categories Anti-psychotics (Haldol, Risperdal, Zyprexa) controls hallucinations (e.g., schizophrenia) Antidepressants (Prozac, Zoloft, Lexapro) control feelings of sadness, feelings of hopelessness, and suicidal thoughts (e.g., depression) Mood stabilizers (Lithium, Depakote, Tegretol) control mood swings (e.g., bipolar disorder) Anti-anxiety drugs (Xanax, Valium, Buspar)

Antipsychotic Medications Antipsychotic medications, as their name suggests, act against psychotic symptoms. The principal form of psychosis is schizophrenia. Dosing Myth. The higher the dose, the better. Forms Effectiveness Antipsychotic medications, as their name suggests, act against psychotic symptoms. The principal form of psychosis is schizophrenia. These medications cannot "cure" the illness, but they can take away many of the symptoms or make them milder. Antipsychotic medications - While they have some side effects, newer medications are generally better tolerated and have fewer disadvantages compared to the older medications Myth - Some people might think that the higher the dose of medication, the more serious the illness, but this is not always true. Antisspsychotic medications can usually be taken once per day. Forms – Injectable, dissolvable..Some are available in forms that can be injected once or twice a month, assuring that the medicine is being taken reliably. Effectiveness – Some symptoms diminish in days, while others take weeks or months. For many patients, substantial improvement is seen by the sixth week of treatment, although this is not true in every case. Medications for Mental Illnesses

Maintenance Treatment Some people may need to take medication for an extended period of time, or even indefinitely. usually have chronic (long-term, continuous) schizophrenic disorders, or have a history of repeated schizophrenic episodes, and are likely to become ill again. Medication may be continued in as low a dosage as possible to maintain control of symptoms. Prevents relapse Reduces side effects

Commonly Prescribed Antipsychotic Medications New 1989 – Clozopine (Clozaril) 1994 - Risperidone (Risperdal) 1996 - Olanzapine (Zyprexa) 1997 - Quetiapine (Seroquel) Old 1952 – chlorpromazine (Thorazine) 1950-60s Haloperidol (Haldol) Thioridizine (Mellaril)

Commonly Prescribed Antipsychotic Medications 21st Century 2001 - ziprasidone (Geodon) 2002 – aripiprazole (Abilify) 2006 - paliperidone (Invega) Developments Some of these medications have become available in dissolvable, or injectable forms, which makes can reduce non-compliance.

Would YOU take a medication that caused… Side Effects It is well recognized that many people (around two-thirds in controlled drug trials) discontinue antipsychotics, partly due to adverse effects. A continuous problem for mental health professionals is mental health patients not adhering to their medication regimen. This deviation is the primary cause of crisis concerns. Would YOU take a medication that caused…

Side Effects Restlessness Dry Mouth – Can result in deterioration of teeth due to a lack of saliva. Constipation or Diarrhea Nausea Sunburn Skin rashes Shakiness Tremors Weight Gain Lethargy/Sedation Increased heart rate Lowered blood pressure Diabetes Heart Problems

Side Effects What about…. Seizures Muscle contractions Stiffness Infertility/Impotence Production of breast milk in women Protruding tongue Eyes rolled back Repetitive, involuntary, purposeless movements often of the lips, face, legs, or torso. Failure of temperature regulation centers -- resulting in a medical emergency, as the person's temperature suddenly increases to dangerous levels

Side Effects Some of these side effects are permanent, even after the medications have been stopped Many of these medications are also lethal when taken in excess Desirable side effects Desirable side effects: For instance, the sedative effect of some antipsychotic medications is useful for patients who have trouble sleeping or who become agitated during the day Medications for Mental Illnesses

Anti-Manic Medications Referred to as Mood Stabilizers Commonly associated with bipolar disorder Treat a manic “high” Can decrease aggressive behaviors a manic "high," - may be overactive, overtalkative, and have a great deal of energy. Switch quickly from one topic to another and can easily be distracted. Sometimes, the "high" person is irritable or angry and has false or inflated ideas about his position or importance in the world. Often, he shows poor judgment. Mania, untreated, may worsen to a psychotic state. Medications for Mental Illnesses

Lithium Use Effectiveness Regular blood tests are an important part of treatment with lithium Side Effects Lithium is a salt (lithium carbonate). It is naturally occuring, and found in rock formations. Anything that lowers the level of sodium in the body may cause a lithium buildup and lead to toxicity Signs and Symptoms of lithium toxicity Use – Evens out mood swings Effectiveness - Will diminish severe manic symptoms in about 5 to 14 days Side effects - drowsiness, weakness, nausea, vomiting, fatigue, hand tremor, or increased thirst and urination Anything that lowers the level of sodium…Examples include 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. Toxicity - Some diuretics (which 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 Toxicity - Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat, and seizures. A lithium overdose can be life-threatening. Medications for Mental Illnesses

Anti-convulsants Not all patients with symptoms of mania benefit from lithium. Some patients respond to anti-convulsant medications that are usually used to treat seizures/epilepsy. Commonly prescribed anti-convulsants Depakote Tegretol Lamictal Commonly Prescribed AntiConvulstants: Depakote Side effects include headache, double vision, dizziness, anxiety, or confusion, and liver dysfunction Regular blood tests are needed to ensure safe levels in the blood, and to closely monitor liver function Tegretol Side effects include drowsiness, dizziness, confusion, disturbed vision, memory impairment, and nausea. Regular blood tests are needed to ensure safe level of medication in the blood Lamictal Most common side effect is rash. Regular blood tests are not needed with Lamictal. Medications for Mental Illnesses

Antidepressant Medications Uses Depression Anxiety Insomnia Effectiveness Uses - Antidepressants are used most widely for serious depressions, but they can also be helpful for some milder depressions. They reduce the symptoms of depression and help the depressed person feel the way he did before he became depressed. Antidepressants are also used for disorders characterized principally by anxiety. Effectiveness – Dosage of antidepressants vary, depending on the type of drug, the person’s body chemistry, age, and sometimes body weight. Dosages are generally stared low, and raised gradually over time until the desired effet is reached without the appearance of troublesome side effects. It can take two to three weeks for antidepressant medicines to start to work. Medications for Mental Illnesses

Antidepressant Medications Older Tricyclic medications MAOIs (Monoamine Oxidase Inhibitors) Newer Some commonly prescribed SSRIs are: fluoxetine (Prozac) Escitalopram (Lexapro) paroxetine (Paxil) also used to treat Panic Disorders sertraline (Zoloft). fluvoxamine (Luvox) also used to treat Obsessive Compulseive Disorder Older - Tricyclic medications and MAOIs (Monoamine Oxidase Inhibitors) - Due to introduction of newer and more effective medications these types are more rarely prescribed. These types of medications have numerous side effects – seizures, cardiac arrest, etc. MAOI’s have dietary restrictions that are very difficult to adhere to. Newer - The last few years have seen the introduction of a number of new antidepressants. Several of them are called "selective serotonin reuptake inhibitors" (SSRIs). - they act on one specific neurotransmitter, serotonin. Medications for Mental Illnesses

Where does depression hurt? SNRIs (serotonin and norepinephrine reuptake inhibitors) are a newer class of medications. Effexor Wellbutrin or Zyban Cymbalta SNRIs (serotonin and norepinephrine reuptake inhibitors) are a newer class of medications. Effexor Wellbutrin or Zyban Cymbalta They have more effect on norepinephrine and dopamine than on serotonin. Can effectively treat certain types of chronic pain. Medications for Mental Illnesses

Anti-Anxiety Medications Xanax Klonopin Librium Valium Ativan BuSpar Vistaril Inderal Anxiety - A high level or prolonged state of anxiety can be very incapacitating, making the activities of daily life difficult or impossible. There are a number of antianxiety medications currently available. The most commonly prescribed medications for most anxiety disorders are benzodiazepines. Benzodiazepines include: Xanax, Klonopin, Valium, Librium, Ativan, and several others. Medications for Mental Illnesses

Anti-Anxiety Medications A non-benzodiazepine, buspirone (BuSpar), is used for generalized anxiety disorders. Antidepressants are also effective for panic attacks and some phobias and are often prescribed for these conditions. The medications approved by the FDA for use in OCD are the antidepressants Anafranil, Prozac, and Paxil.

Antianxiety Medications Benzodiazepines have a very strong potential for the development of tolerance and dependence Side Effects Interaction with Alcohol Withdrawal reactions Side Effects - Benzodiazepines may also cause behavior changes in some people, similar to those seen in people who act differently when they drink alcohol. More extreme changes, such as confusion, agitation, and hallucinations, also are possible. Interaction with alcohol – The combined effects of benzodiazepines and alcohol or other CNS depressants (drugs that slow the central nervous system) can be very dangerous, leading to unconsciousness or, rarely, even death. Withdrawal reactions - anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, and, in more severe cases, fever, seizures, and psychosis Medications for Mental Illnesses

Anti-anxiety Medications Occasionally, for specific reasons, one of the following medications may be prescribed: antipsychotic medications antihistamines (such as Atarax, Vistaril, Benadryl) barbiturates such as phenobarbital beta-blockers such as propranolol (Inderal, Inderide) – normally used to treat heart conditions

Medications used to treat insomnia Over-the-Counter Sleep Aids: Most of these sleeping pills are antihistamines. Benadryl, and antihistamine, is the sleep aid in Tylenol PM. They generally work well but can cause some drowsiness the next day. Benzodiazepines – Restoril Antidepressants – Trazodone (Desyrel) Lunesta Rozarem Sonata Ambien

Ambien And Driving In March 2007, the FDA issued warnings for prescription sleep aids, alerting patients that they can cause complex sleep-related behaviors, including “sleep driving.” New research indicates that misuse of Ambien could be contributing to accidents on the roads. A lot of people are not just taking Ambien – they are mixing it with other drugs, or they are taking alcohol – and when you combine all those things together, that's trouble.

Reasons patients do not take their medications as prescribed Side effects They start feeling better and think they no longer need the medications The stigma associated with being mentally ill -- they don’t want people to know they have a mental illness. Unawareness of illness – some experts estimate that up to ½ of those with serious mental illnesses are unable to perceive that they are ill.* *Amador XF, David AS, eds. Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. 2nd ed. New York, NY: Oxford University Press; 2004:177 93.

The Right to Refuse Treatment A person may not administer a psychoactive medication to a patient who refuses to take the medication voluntarily unless the patient is in need of a medication related to an emergency, or the patient is under an order authorizing the administration of the medication regardless of the patient’s refusal.

Symptom Relief, Not Cure Medications help relieve the symptoms associated with mental illness, but they usually do not provide a cure. Many 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 bipolar disorders, medication may have to be taken indefinitely. Psychotherapeutic medications do not produce the same effect in everyone -- all factors must be considered