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A Guide to Making Medication Choices

By  Melissa Moses, Psy.D., William James College, Newton, MA and Kelly Weaver, M.A., Team Leader, William James College INTERFACE Referral Service, Newton, MA

Mental illnesses are currently among the most common conditions diagnosed. In the U.S., one in five adults has a diagnosable mental illness in any six month period. According to the National Institute of Mental Health, about 90 percent of these people will improve or recover if they get treatment. Prescribers, including psychiatrists, primary care physicians, and psychiatric nurses, have a variety of treatments available to help their patients. Most often, prescribers will work with a new patient to construct a treatment plan that includes both psychotherapy and psychiatric medication.

What are psychiatric medications?

Psychiatric medications, also known as psychotropic medications, treat mental disorders. Most, though not all, medications focus on controlling the four major categories of psychiatric disorder: anxiety, depression, schizophrenia, and mania.

Psychiatric researchers believe that people suffering from many mental illnesses have imbalances in the way their brain metabolizes certain chemicals, called neurotransmitters. Nerve cells use neurotransmitters to communicate with one another, and imbalances may result in the emotional, physical and intellectual problems that mentally ill people endure. New knowledge about how the brain functions has permitted psychiatric researchers to develop medications which can impact the way the brain produces, stores, and releases these neurotransmitter chemicals, alleviating the symptoms of the illness.

How are medications used to treat mental disorders?

Medications treat the symptoms of mental disorders. They cannot cure the disorder, but they make people feel better so they can function in daily life.

Medications work differently for different people. Some people get good results from medications and only need them for a short time. A person with depression may recover after taking a medication for as briefly as six months, and may never need it again. People with disorders like schizophrenia or bipolar disorder, or people who have long-term or severe depression or anxiety may need to take medication for a longer period.

Doses can be small or large, depending on the medication and the person. Efficacy and side effects vary based on the medication and the person. Factors that can affect how medications work in people include:

  • Type of mental disorder, such as depression, anxiety, bipolar disorder, and schizophrenia
  • Age, sex, and body size
  • Physical illnesses
  • Habits like smoking and drinking
  • Liver and kidney function
  • Genetics
  • Other medications and herbal/vitamin supplements
  • Diet
  • Whether medications are taken as prescribed

How is medication prescribed?

Psychiatric medications are formulated to treat specific conditions, and they must be monitored by a prescriber who is skilled in treating your illness. Like most medications, psychiatric prescriptions may take a few days or a few weeks to become fully effective.

Before deciding whether or not to prescribe a psychiatric medication, psychiatrists either conduct or order a thorough psychological and medical evaluation which may include laboratory tests. After a patient has begun taking a medication, the psychiatrist closely monitors his or her patient's health throughout the time the patient is taking the medicine. While medications can be effective in controlling the painful emotional and mental symptoms, psychiatric medicines can produce unwanted side effects. Often, the side effects disappear after several days on the medication; if they don't, the psychiatrist may change the dose or switch to another medicine that maintains the benefits but reduces the side effects. The psychiatrist may also prescribe a different medicine if the first one does not alleviate symptoms within a reasonable period of time.

Children require special consideration before beginning psychiatric medications. A decade ago, the U.S. government began trying to ensure that prescription drugs used to treat children are effective and safe. However, conducting clinical trials in children is difficult as it involves addressing ethical issues and assessing risks. Doctors still have little information to guide them when they administer many medications to children.

Medications can make a positive difference by acting on symptoms right away and allowing the child to reach key developmental phases and milestones. However, these medications also can have serious side effects or they can stop working, in which case a doctor is pushed to increase the dose or add a second medication. Scientists do not know what the consequences are with long-term use of these drugs. The concern is that psychiatric medications can have a very different impact in children than they have in adults.

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