About Treatment: Medications & More

Before beginning any treatment you will likely have questions. Many mental health issues are profiled in the media. Often medications are discussed and eventually advertised directly to you “The Consumer”. This often brings up concerns you may want to discuss in your evaluation.
 Frequently asked questions include:

• “How long will I take this medicine?”
• “Is this really a disorder?”
• “Will the medications take away my personality or creativity?”
• “How will this effect the growth and development of my child?”
• “Why do you recommend psychotherapy?”

It is important to find as much information about your condition and treatment as possible. The treatment pages will give a brief over view of what is currently available.

Medications:

 Part of your evaluation involves determining the best course of treatment to address your concerns. Psychiatrists use medications to treat a variety of conditions. Medications effect patients differently. It is very important to have regular follow up concerning the course and progress of your treatment. Your input is essential to achieve an optimal outcome.

 Below is a list of medications organized by their general drug class. Many effects of medications are common to a class. Each list includes all or most of the medications in that class.

Antidepressants:

 While they are effective at treating depressive disorders, these medications have uses beyond treating depression. Many are used to treat Anxiety Disorders such as Panic Disorder and Obsessive/Compulsive Disorder even Attention Deficit/ Hyperactivity Disorder.

• SSRI: Selective Serotonin Reuptake Inhibitors: include Prozac fluoxetine, Zoloft setraline, Paxil paroxitine, Luvox fluvoxamine, Celexa citalopram Lexapro escitalopram and others.

• SNRI: Serotonin/Norepinephrine Reuptake Inhibitors: Include Effexor venlafaxine, Remeron mirtazapine and Cymbalta duloxeitine

• MAOI: Nardil phenelzine,  Parnate tranlcypromine and others , these medicaitons require you to follow a strict diet to avoid serious or life threatening side effects. They are not widely used presently.

• Wellbutrin bupropion
• Anafranil clomipramine
• Tricyclic Antidressants and others: Anafranil clomipramine, Ascendin amoxapine, Desyrel trazadone , Elavil amitriptyline, Ludiomil maprotiline, Norpramin desipramine, Pamelor nortriptyline, Sinequan doxepine, Tofranil imipramine

Anit-anxiety or Anxyolytics:

 Over the past 15 years Antidepressants have become the preferred medications to treat a variety of anxiety disorders. Other medications used include:

• SSRI: Selective Serotonin Reuptake Inhibitors: include Prozac fluoxetine, Zoloft setraline, Paxil paroxitine, Luvox fluvoxamine, Celexa citalopram Lexapro escitalopram and others.

• SNRI: Effexor venlafaxine
• BENZODIAZEPINES: Valium diazepam, Ativan lorazepam, Xanax alprazolam, Restoril temazepam,  Klonopin clonazepam, Serax oxazepam, Tranxene clorazepate and Doral quazepam, Librium chlordiazepoxide
• Atarax hydroxyzine, Vistaril hydroxyzine pamoate
• Buspar buspirone
• Beta Blockers: Inderal propanolol,  Atenolol tenormin

MOOD STABLILIZERS:

 Many of these medications were originally used to treat seizure disorders. The newer atypical antipsychotics have benefit in treating mania. Studies have shown benefit to patients who deal with Bipolar Disorders in both manic and depressed states, Treatment-Resistant Depression, Impulse Control Disorders. Included here are:

• Depakote divalproex sodium, Depakene valproic acid , Tegretol carbamazepine, Lamictal lamotrigine, Topomax topiramate, Neurontin gabapentin, Tripletal oxcarbazapine
• Atypical Antipsychotics: Risperdal risperidone, Zyprexa olanzapine, Seroquel quetiapine,  Geodon ziprasidone, and Abilfy aripiprazole, Invega Paliperidone, Clozaril clozapine

•  Eskalith/Lithobid lithium

Sleeping Aids:

 The “ non-benodiazipine benzodiaezipine”—it acts to promote sleep while minimizing the “hang over” some people feel from other sleep aids. Included here are:
· Ambiem zolpidem, Lunesta eszopiclone

• Others include: Rozerem ramelteon,  which increases levels of melatonin in the brain. Sonata zaleplon, which acts for only a short time.

• Still others have already been listed: the antianxiety medications—benzodiazepines, Seroquel quetiapine, in the neuroleptic class, Desyrel trazadone, Atarax and Vistaril hydroxyzine

 It is also important to observe good sleep hygiene like regular bedtimes, limiting alcohol and caffeine, limiting activity around sleep times. Keeping your room slightly cool and dark. Only sleep in your bed: don’t work, watch TV, talk on the telephone, cell phone, computer or eat in bed.

Neuroleptics:

 Also called antipsychotics these medications include two general types: typical and atypical antipsychotics. Both classes treat problems such as schizophrenia, bipolar disorder, disruptive disorders, but have different effect profiles. Included here are:

• Atypical Antipsychotics: Risperdal risperidone, Zyprexa olanzapine, Seroquel quetiapine,  Geodon ziprasidone, and Abilfy aripiprazole, Invega Paliperidone, Clozaril clozapine

• Typical Antipsychotics:, Haldol haloperidol, Loxitane loxapine, Mellaril thioridazine, Moban molindone, Navane thiothixine, Orap pimozide, Permitil fluphenizine, Pondimin fenfluramine, Prolixin fluphenazine, Stelazine trifluoperazine, Thorazine chlorpromazine, Trilafon perphenazine

 Stimulant Medications:

These are used to treat ADHD or Attention Deficit/Hyperactivity Disorder in children and adults. They also have a role in the treatment of Depressive Disorders and some Sleep Disorders. Included here are:

• Methylphenidate which is the generic drug for: Ritalin, Concerta, Metadate CD, Ritalin LA. Foaclin XR is also closely related to methylphenidate.
•  Dextroamphetamine which is the generic drug for Adderall immediate release and extended release, Dexadrine tablets and Spansules.

• Vynase lisdexamfetamine is called a Prodrug because of the way it is metabolized by the body. It has a similar effect as other stimulants.

Non-Stimulant Medications:

These medications are used to treat ADHD but act differently. They are found in other medication classes:

• Wellbutrin buproprione also used to treat depression 
• Stratterra atomoxetine

• Provigil monafadil—also used to treat Narcolepsy and Obstructive Sleep Apnea

• Catapres clonidine was originally used for high blood pressure, is helpful also for ADHD, and TIC disorders

• Tenex guanfanicine used for ADHD

Treatment for Dementia/Alzheimer’s Disease:

Cholinesterase Inhibitors:

• Cognex tacrine, Aricept donepezil, Exelon rivastigmine, galantamin
• Namenda  memantine

Substance Abuse Treatments:
Used to treat problems with alcohol and opiate abuse and dependence and abuse.

• Vivitrol, Revia naltrexone-is used in treating both alcohol and opiate dependency
• Antabuse disulfiram, acamprostate
• Methadone, LAAM and Buprenorphine are used to treat opiate dependency

Non-Pharmacological Therapies:
These therapies represent both old and new apporaches to treatment. Some are still experimental.

· ECT / Electroconvulsive Therapy for severe depression, bipolar disorders, some psychotic disorders. Studies have consistently shown benefit to patients with the procedure.

· TMR: Transmagnetic Resonance Imaging is mostly still performed in tertiary or research hospitals, but does have positive effects mostly for depression.

· VNS / Vagus Nerve Stimulation involves implanting a pacemaker like device in the chest wall and connecting to Vagusl nerve. Continuous impulses sent to the Vagus nerve help patients with treatment resistant depression or TDR.

Alternative Therapies:

This category includes some treatments with proven benefit.

Light Box Therapy:

 Used to treat depression, often Seasonal Affective Disorder “SAD” these boxes can be purchased from on line sites.

Herbal Therapies:

 While popular as a “natural” treatment, these compounds may or may not have documented benefit. The full effect of these compounds has not usually been studied and concentration of active ingredients may vary widely between products.

• Omega Three Fatty Acids—or fish oils, seem to have some benefit in treating mood disorders

• St. John’s Wart—an often-studied herbal medication for depressive disorders, usually mild.

• Capsaicin or capsicum for energy
• Gynkgo Biloba-- to boost memory
• Melatonin--to promote sleep