Psychiatric medications are among the most frequently-prescribed medications in this country and throughout the world. One in 10 Americans takes an anti-depressant. Yet despite the incessant barrage of multi-media drug promotions, you may not have the answers to the questions you most want answered.
I asked more than a dozen expert psychiatric colleagues, and myself, the questions they most frequently receive about psychiatric medications from people who take them or their families. Here are a dozen of those many questions; the responses are mine.
1. What are the chances that my medication will (or will not) work?
This could be the most frequently asked question — if all who wondered dared to ask it. For a medication to be approved by the Food and Drug Administration (FDA), it must be shown to be safe and effective. “Effective” means that it outperforms the placebo effect, which can result in improvement in more that 30 percent of individuals.
A common example is antidepressant medications for depression, which can improve symptoms for approximately 75 percent of people suffering from moderate to severe illness (mild to moderate depression often responds to non-drug treatments). But the effectiveness of antidepressants depends on finding the right medication for an individual, at an adequate dose (not too little and not too much), taking it reliably for enough time and without barriers to its effectiveness like alcohol or drug abuse. Similar effectiveness is found for anti-manic and anti-psychotic medications, particularly for acute symptoms.
Medications have limited effectiveness in eating and personality disorders, except when used for another co-occurring mental disorder.
But medications do not cure mental disorders; they treat symptoms. Adequate sleep, good nutrition, moderate (or no) use of alcohol and non-prescribed drugs, psychotherapy, the hard work of recovery or rehabilitation, and support are what everyone needs to manage an illness, be it a mental or a physical illness.
2. How soon will it work?
Some medications work in hours, like tranquilizing medications. Some can take up to six weeks or longer, like antidepressants. Some are meant to prevent relapse or recurrence, so they work over time. This is a good question to ask when a doctor is writing the prescription.
3. How will I know if it’s working?
This is a crucial question. I urge patients and their families to set specific goals for treatment early on. Medications work on specific symptoms like sleep problems or anxiety or feeling very blue or agitated; speak with the doctor about what symptoms the medication is meant to improve. Improved functioning at school and work can take more time to achieve than symptoms, but if you are clear about your goals and monitor them (with others you trust) you will know if the medication is working.
4. Will this medication change my personality?
No. Your personality is you; it is who you have been since you were young. The effects of a medication can change how you feel (more focused, more energetic, more clear-thinking — or more restless, sleepier, or without sexual desire) but that is not a change in your personality.
5. Will this medication change my brain?
The goal of a medication for a mental illness is to change how part of the brain is working in order to improve how a person feels and thinks, and enable them to behave more like they want to. There are also unwanted side effects that can result from how a medication can affect other parts of the brain, like regions involved in appetite or alertness or muscle tone. There is no such thing as a perfect medication with only benefits and no side effects, so you will need to weigh benefits and side effects and decide if a medication is right for you.
6. If I take this medication, does it mean I’m crazy?
Talk of craziness remains an unfortunate residue of the stigma that continues to pervade how people think of mental illness (see my recent HuffPost blog “The Painted Bird: Stigma and Mental Illness”).
Mental illnesses are diseases of the brain and mind, not inexplicable happenings or failures of will and character. We need to think of taking medication for a mental illness as part of a comprehensive plan by which a person manages an illness — any illness — and rebuilds functioning at school, home, and work as well as with family and friends.
7. Will I have to be on this medication for the rest of my life?
Not necessarily, but you should not stop a medication suddenly or without discussing it with your doctor. Over time, dosage can be reduced, and with planning a trial off a medication can be tried. People whose illness has gone on for years or who have had repeated episodes of acute problems usually require taking medications for a long period of time in the same way that individuals with diabetes, high blood pressure and asthma do.
8. Will I become addicted to this medication?
None of the antidepressant, mood-stabilizing, or antipsychotic medications are addicting. However, with benzodiazepam tranquilizers and some sleep medications our bodies can develop tolerance (where a higher dose is needed to achieve the same effect) or dependence (where a person experiences withdrawal symptoms if the drug is quickly stopped). This can also happen with many pain medications.
9. Will the medication make me fat?
Many psychiatric medications bring the unwanted side effect of weight gain. But some medications used for similar conditions (for example, in the class of antidepressant or antipsychotic agents) are associated with greater weight gain than others. Carefully considering which medication to use, coupled with attention to diet and exercise, can prevent or minimize weight gain.
10. Can I drink while I’m on this medication?
Excessive drinking (or use of non-prescribed medications or street drugs) is not a good idea for a person whose brain is affected by a mental illness. For those who have a co-occurring alcohol or drug-use disorder, abstinence will be a necessary aim. In some instances, alcohol may interfere or alter blood levels of the medication, so it is important to check with your doctor. For people with no substance-use problem and mild to moderate or stable illness, I usually say that they may be able to enjoy a drink. Try one and see how it feels. For people on psychiatric medications, keep in mind that one drink can feel like two or three.
11. Will this medication affect my sex life?
Serotonin reuptake inhibitors (SSRIs and SNRIs), used especially for depression and anxiety disorders, can produce problems with sexual arousal as well as in achieving orgasm — in men and women. In some cases, a person’s libido, or sex drive, is reduced. For people, however, who lost their drive from depression, it can improve with treatment. There is one antidepressant, bupropion, which has not shown these problems. For other antidepressants, there are ways to help by adjusting the dose or timing of the drug or using a medication to enhance sexual functioning.
Other types of medication (for high blood pressure, heart disease and other general medical conditions) may affect sexual desire and performance, so if that is happening to you, speak with your doctor. Losing the pleasure of sex — for you or your partner — may not need to be a consequence of taking medication.
12. My child refuses to take a medication. Can I hide it in his or her food?
Trust is the bedrock of every relationship. A family can feel very desperate and want to do something like this when a loved one refuses treatment and is suffering and failing. But the cost in loss of trust usually outweighs any (temporary) benefits.
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
For more by Lloyd I. Sederer, M.D., click here.
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