Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Medication Therapy

Diagnosis and Treatment - Medication Therapy

For those whose conditions result from, or are aggravated by, an underlying chemical imbalance or other disruption in the physical functioning of the brain (such as a brain injury), medication therapy can be an important part of psychiatric treatment. In some cases, simply correcting the imbalance through medication may resolve symptoms; however, a combination of medication and psychiatric therapy achieves better results for most patients than either of the therapies used alone.

Thanks to increased public awareness of conditions such as depression and anxiety over the past several years, many people are very familiar with medications such as SSRI (selective serotonin reuptake inhibitor) antidepressants. While these medications - including Prozac, Zoloft, Paxil and others - are beneficial to a great number of people with proper use, they are by no means the proper prescription for every psychiatric condition. Therefore, other classes of medication, such as tricyclic antidepressants, benzodiazepines and antipsychotics, are often used for other conditions.

Some of the main classes of medications used for mental health treatment are:

SSRIs

Selective serotonin reuptake inhibitors, known commonly as SSRIs, are a widely used antidepressant for the treatment of depression and anxiety disorders, and can be helpful for other conditions including post-traumatic stress disorder (PTSD) and eating disorders. These medications include Prozac, Zoloft, Paxil, Lexapro, Celexa and Luvox. SSRIs raise the level of serotonin, a neurotransmitter linked to mood, by stopping its reuptake, or absorption, into certain receptor cells. As serotonin levels are often low in those suffering from depression, the SSRIs can bring relief by making the chemical more readily available within the brain. Like other antidepressants, SSRIs must be taken consistently for two to six weeks before they operate with full effectiveness.

MAOIs

Monoamine oxidase inhibitors, or MAOIs, work on serotonin like the SSRIs, but also increase availability of two other neurotransmitters known as norepinephrine and dopamine. MAOIs block the effects of a protein called monoamine oxidase, which metabolizes these neurotransmitters after they have finished their work. Unfortunately, lowering the level of monoamine oxidase in the brain can also lead to dangerous spikes in blood pressure, so the use of an MAOI necessitates tremendous dietary and medication restrictions. For this reason, MAOIs are not as frequently prescribed as other antidepressants, although they have proven to be highly effective in treating major depression which has not responded to other treatments.

Tricyclic Antidepressants

One of the earlier forms of antidepressant medication to be used, tricyclic antidepressants (or TCAs) - including Elavil, Tofranil, Anafranil and Sinequan - affect the reuptake of neurotransmitters, much like SSRIs and MAOIs. However, TCAs tend to also have a sedative effect not seen in those classes of antidepressants. TCAs are successfully used in a number of applications other than depression, including ADHD, migraines, insomnia and chronic pain. They generally produce more side effects than SSRIs, but do not require the strict dietary caution of MAOIs.

Benzodiazepines
Benzodiazepines are a class of medications which also function as reuptake inhibitors, but unlike antidepressants (which work on neurotransmitters such as serotonin and norepinephrine), benzodiazepines increase levels of gamma-aminobutyric acid (GABA). GABA is an amino acid within the brain that slows the nervous system and relaxes muscles; therefore, increasing its availability leads to a sedative effect. Benzodiazepines are most successful for rapidly treating symptoms of panic and anxiety disorder, alcohol withdrawal and OCD, and for controlling epileptic seizures. Common benzodiazepines including Xanax, Librium, Valium, Klonopin and Ativan are typically used at the lowest effective dose for the shortest possible time, as they can be highly habit-forming. Their effects are immediate - unlike those of antidepressants - but they also have a short half-life, meaning that their effects last for a much shorter time. Benzodiazepines are most often used as a temporary adjunct to other medications, such as SSRIs.

Antipsychotics

Originally developed to treat schizophrenia and other psychoses (disorders which involve a disconnect in distinguishing reality), antipsychotics have also proven in recent years to have a positive effect upon bipolar disorder , also known as manic depression. Some medications may be more effective for bipolar mania, some for bipolar depression, and others for maintenance therapy. Antipsychotic drugs block the brain receptors which use dopamine, a chemical which - in normal amounts - is linked with feelings of pleasure and reward, but which can also cause mania if the brain produces too much of it.

Antipsychotics are classified as typical (or conventional), or atypical. Typical antipsychotics have a stronger effect upon the dopamine receptors, while the atypical variety does not exhibit as tight a binding effect. As typical antipsychotics have a higher risk of side effects such as tardive dyskinesia (a neurological syndrome causing involuntary body movements), weight gain and tremors, they are gradually being replaced in most treatment by atypical antipsychotics; while these medications have a similar side effect profile, the occurrence is not as frequent or severe.Atypical antipsychotics include Abilify, Seroquel, Zyprexa and Symbyax (a Zyprexa-Prozac combination used for bipolar depression). Typical psychotics include Haldol and Thorazine.

Anticonvulsants

Anticonvulsants are a class of medications which calm excessive nerve activity in the brain. For this reason, they were first used to treat epilepsy and other seizure disorders as well as severe migraines; however, they have also shown effectiveness in bipolar disorder, functioning as mood stabilizers. Some anticonvulsants, such as Lyrica, may help patients suffering from fibromyalgia or other nerve-related pain conditions. Some other commonly prescribed anticonvulsants are Depakote, Topramax, Tegretol and Neurontin. Some of the benzodiazepines, such as Klonopin, are also classified as anticonvulsants due to their similar effect in calming the central nervous system.

Other Medications

  • In addition to other classes of psychiatric medicines, certain specialized medications are available to treat specific disorders. These include:
    BuSpar (buspirone): An anxiolytic, used for the treatment of anxiety disorders. Unlike selective serotonin reuptake inhibitors, this anxiolytic has not been proven to treat depression concurrent with anxiety.
  • Beta blockers (Inderal, Tenormin, etc.): Used mostly for arrhythmias and other cardiac conditions, beta blockers are sometimes prescribed to musicians and performing artists for performance anxiety, as they block adrenaline and reduce the physiological effects of the anxiety.
  • Lithium: One of the first medications available to treat bipolar disorder, lithium is a mood stabilizer which is particularly effective for manic episodes. Lithium may also be used in certain cases of schizophrenia.
  • Wellbutrin (bupropion): Wellbutrin is classified as an atypical antidepressant, as - unlike the SSRIs - it is a norepinephrine and dopamine reuptake inhibitor, without exercising an effect upon serotonin.
  • SSNRIs: A recently introduced class of antidepressants, the selective serotonin-norepinephrine reuptake inhibitors, have shown promise for bipolar depression and depression which does not respond to SSRIs alone. These medications, which include Cymbalta and Effexor, also help with physiological symptoms of depression.