Dr. Jeff's and Dr. Tanya's Blog: Treatment: Medication

Treatment: Medication

More Great Patient Resources on Antidepressants

Antidepressants are medicines that treat depression. Your doctor can prescribe them for you. They can improve your mood, sleep, appetite and concentration. It may take several weeks for them to help. There are several types of antidepressants. You and your doctor may have to try several before finding what works best for you.

Medicines sometimes cause unwanted side effects. For example, when you first start your antidepressant you may feel tired, have trouble sleeping or feel sick to your stomach. The side effects usually go away after a short time. Tell your doctor if you have any side effects. You should also let your doctor know if you take any other medicines, vitamins or herbal supplements.

It is important to keep taking your medicines, even if you feel better. Do not stop taking your medicines without talking to your doctor. You often need to stop antidepressants gradually.

National Institute of Mental Health

Start Here

Antidepressant Medicines: A Guide for Adults with Depression(Agency for Healthcare Research and Quality) - http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=10&ProcessID=7
Antidepressants: Medicine for Depression(American Academy of Family Physicians) - http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/012.printerview.html
Also available in Spanish http://familydoctor.org/online/famdoces/home/common/mentalhealth/treatment/012.printerview.html
Medications(National Institute of Mental Health) - http://www.nimh.nih.gov/health/publications/medications/complete-publication.shtml

Overviews

Antidepressants: Selecting One That's Right for You(Mayo Foundation for Medical Education and Research) - http://www.mayoclinic.com/print/antidepressants/HQ01069/METHOD=print
Antidepressants: Summary of Recommendations(Consumers Union of U.S.) - http://www.consumerreports.org/health/best-buy-drugs/antidepressants.htm
Also available in Spanish http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/2pager_SpanishAntidepress.pdf
Depression: How Medicine Can Help(American Academy of Family Physicians) - http://familydoctor.org/online/famdocen/home/common/mentalhealth/treatment/045.printerview.html
Also available in Spanish http://familydoctor.org/online/famdoces/home/common/mentalhealth/treatment/045.printerview.html
Questions and Answers on Antidepressant Use in Children, Adolescents, and Adults(Center for Drug Evaluation and Research) - http://www.fda.gov/cder/drug/antidepressants/QA20070502.htm
Understanding Antidepressant Medications(Food and Drug Administration) - http://www.fda.gov/consumer/updates/antidepressants010909.html

Can sildenafil reverse the effects of SSRI induced orgasmic dysfunction?

Many mental health professionals are interested in how they can best assist their female patients who experience SSRI-induced orgasmic dysfunction. A recent article in Journal Watch (9/08) titled, “Sildenafil effective for SSRI-induced female orgasmic dysfunction,” examines this issue. The article reports on a randomized controlled trial published in the Journal of the American Medical Association. The researchers studied 98 pre-menopausal women who were prescribed SSRIs for depression and developed the side effect of sexual dysfunction. The women were randomized into groups receiving either placebo or sildenafil. And the results? “Compared with placebo, sildenafil was associated with significantly greater improvements in sexual function [specifically orgasm] from baseline to 8 weeks…desire, arousal, lubrication, enjoyment, and pain did not improve.” The results of this study seem to indicate that sildenafil, as an off label use, may be helpful in restoring orgasmic ability while taking SSRIs. Of note, the results of the study should be viewed with caution given the fact that the study was sponsored by the manufacturer of sildenafil.

The Bottom Line: The results of this study seem to indicate that sildenafil, as an off label use, may be helpful in restoring orgasmic ability while taking SSRIs.

Dr. Tanya Korkosz

Dr. Jeffrey Speller

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on October 21, 2008 at 12:46 PM in Treatment: Medication | Permalink | Comments (0)

The most common medication treatments for anxiety disorders

The National Institute of Mental Health offers the following advice with regard to the medication treatment of anxiety disorders.

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the person’s preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person’s symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

People with anxiety disorders who have already received treatment should tell their current doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.

Often people believe that they have “failed” at treatment or that the treatment didn’t work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.

Medications

Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

Antidepressants

Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.

SSRIs

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.

Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat GAD. These medications are started at low doses and gradually increased until they have a beneficial effect.

SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.

Tricyclics

Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication.

Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia. People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks. MAOIs can also react with SSRIs to produce a serious condition called “serotonin syndrome,” which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.

Anti-Anxiety Drugs

High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. One exception to this rule is people with panic disorder, who can take benzodiazepines for up to a year without harm.

Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.

Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.

Buspirone (Buspar®), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.

Beta-Blockers

Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.

Taking Medications

Before taking medication for an anxiety disorder:

Ask your doctor to tell you about the effects and side effects of the drug.
Tell your doctor about any alternative therapies or over-the-counter medications you are using.
Ask your doctor when and how the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
Work with your doctor to determine which medication is right for you and what dosage is best.
Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

Fourteen Great Books on Anxiety Disorders:

Thirteen Resource and Support Groups for Anxiety Disorders:

Additional Resources:

For related articles on anxiety disorders on the Web, click on: “Sphere: Related Content” located at the bottom of this blog post.
For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Anxiety” or type in the keyword “anxiety disorders” into “Google Search” located in the sidebar.
For related articles from Psychology Today, click on the “Psychology Today” banner in the side bar and type in the keyword, “anxiety disorders” into the Psychology Today “Search”.
For more books with related content, click any hyperlinked keyword in the blog or type in the keyword, “anxiety disorders” into “Amazon Search” on the Amazon banner located in the side bar.

Dr. Jeffrey Speller

Dr. Tanya Korkosz

Psychopharmacology Associates of New England

www.psychopharmassociates.com

Posted by Dr. Jeff and Dr. Tanya on September 17, 2008 at 07:47 AM in Psychiatric Disorders: Anxiety Disorders, Treatment: Medication | Permalink | Comments (0)

Dr. Jeff's and Dr. Tanya's Blog

This psychiatry weblog, authored by two Harvard University-trained psychiatrists and former lecturers at Harvard Medical School, offers you psychiatric news and commentary about brain disorders, mental dysfunction, psychological illness, and mental health wellness.

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