Medication Therapy

When personality disorders or 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), Houston Methodist healthcare professionals find medication therapy to be important part of psychiatric treatment. In some cases, simply correcting the imbalance through medication may resolve symptoms; however combining medication and psychiatric therapy can achieve better results for most patients than either of the therapies used alone.
Thanks to increased public awareness of conditions like depression and anxiety over the past several years, many people are now familiar with antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs). While these medications are beneficial to a great number of people with proper use, they are by no means the proper prescription for every psychiatric condition.
Selective serotonin reuptake inhibitors (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. 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. The selective serotonin-norepinephrine reuptake inhibitors, have shown promise for depression that does not respond to SSRIs alone.
Monoamine oxidase inhibitors (MAOIs) work on serotonin like the SSRIs, but also increase the 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 that has not responded to other treatments.
Tricyclic Antidepressants
One of the earlier forms of antidepressant medication to be used, tricyclic antidepressants (TCAs) 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 are a class of medications that 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 disorders, alcohol withdrawal and obsessive-compulsive disorder (OCD) and for controlling epileptic seizures. Benzodiazepines are most often used as a temporary adjunct to other medications, such as SSRIs.
Originally developed to treat schizophrenia and other psychoses (disorders involving a disconnect with reality), antipsychotics have also proven in recent years to have a positive effect on 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 that 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 atypical. Typical antipsychotics have a stronger effect upon the dopamine receptors, while the atypical have a lower risk of side effects such as tardive dyskinesia (a neurological syndrome causing involuntary body movement), weight gain and tremors.
Anticonvulsants are a class of medications that 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.
Other Medications
In addition to the classes of psychiatric medicines reviewed above, certain specialized medications are available to treat specific disorders:
  • Beta blockers are sometimes prescribed to musicians and performing artists for performance anxiety because they block adrenaline and reduce the physiological effects of the anxiety.
  • Lithium is a mood stabilizer, which is particularly effective for manic episodes. Lithium may also be used in certain cases of schizophrenia