Mind Matters: Is your medicine safe and necessary?

Questions about medications for psychiatric and mental health conditions frequently arise in therapy. People want and need to know if medications are safe, effective and really necessary. I will attempt to address some of these concerns.

Three classes of drugs affect the brain; they are known as psychotropic medications. Tranquilizers treat anxiety, certain forms of agitation and promote sleep. Mood stabilizers help to maintain a consistent mood level, needed for bipolar disorder. Antipsychotics are used mainly for psychosis but are also very effective for reduction of anxiety, as sleep aids and may be used to enhance the effects of mood stabilizers and/or antidepressants.

Medications are not always needed for emotional or psychological conditions; sometimes therapy alone is sufficient. Medications are indicated when symptoms interfere with functioning for two weeks or longer; sooner in a psychiatric crisis. Symptoms that might interfere with functioning include severe anxiety, panic disorder, and persistent insomnia. Major depression with difficulty concentrating, lack of motivation, poor appetite and suicidal thoughts indicate a need for medication.

Psychiatric emergencies include suicidal thoughts or intention and psychotic thinking. A psychotic person has lost touch with reality and experiences irrational thoughts with inappropriate and sometimes dangerous behavior. A psychotic person cannot be reasoned with and may be a danger to self and/or others. Medication is always needed to treat psychoses.

Severe or intolerable anxiety, panic attacks, depression, agitation, or hallucinations are warning signs of a psychiatric problem that needs to be treated medically. Severe depression manifested in poor concentration, low motivation and energy, poor appetite and hopelessness is a condition for which medication is necessary. In some cases of depression, one or more medications are needed. The usual procedure is to begin with one antidepressant drug. It can take two to six weeks for antidepressants to “kick in” enough that improvement is noted. Because depression is often accompanied by anxiety and/or agitation a tranquilizer may be added during the first few weeks until the antidepressant takes effect. Then the tranquilizer should be tapered off to prevent addiction. During this time a therapist should be available to provide close monitoring, support and encouragement.

Antipsychotics are very powerful with strong sedative effects. They are used to treat conditions such as schizophrenia and bipolar disorder. Occasionally they are also given in small doses along with antidepressants to depressed individuals who are unable to sleep and relax. Because they are not addictive they can superior to tranquilizers in certain circumstances.

Psychiatric disorders result from chemical changes within the brain which are usually genetic. For that reason no stigma should be attached to the need for psychotropic drugs. They help to reestablish a chemical balance in the brain. Psychotherapy, relaxation techniques, exercise and meditation also augment the effects of medication.

Anyone on psychotropic drugs should never stop them abruptly. While only tranquilizers are addictive, the body will react to abrupt withdrawal of any of these drugs. The newly balanced brain needs time to adjust gradually by tapering off under medical supervision.

The question of how long medication will be necessary always arises. The answer is that it depends on the situation. A minimum of six months is recommended after which a trial taper with medical supervision might be feasible. In the case of being on several prescriptions it may be that one or two will be needed longer than others. Everyone’s chemistry and metabolism are different and currently there are no scientific methods to determine which medication and dosage will be best for an individual. It’s truly a method of trial and error that can be very frustrating.

Many medications have side effects. Even aspirin does. Therefore to ensure safety regular blood work should be a part of treatment for some medications. Although it is the prescriber’s responsibility one should be aware of whether blood testing is needed. Medications can be lifesavers when used appropriately but they are not a panacea. Don’t be afraid to ask questions.


Elinor Stanton is a psychiatric nurse practitioner on Marco Island. She has 30 years of experience as a therapist in private practice and with a large health maintenance organization in Boston. Send comments and questions to etseven@aol.com or call 394-2861. Visit her Web site at http://www.etseven.net.

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