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Psychiatric
Medication Issues

 

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Page Contents: Introduction / Side-effects / Being an informed consumer / Getting information about your medications / Medication Interactions / Pain Medications

 

 
PSYCHOTHERAPY is hard work. It will often seem counter-intuitive because it does not examine only what is on the surface of your life. To be able to cure the pain and confusion of your life, you really have to examine and change what motivates you to act in ways that cause pain and confusion, and, for the most part, this motivation is unconscious and under the surface of your life. Therefore, your true motivation cannot be examined directly. It must be examined indirectly by digging through all the dirt and filth hidden under the surface. It’s no wonder, then, that most people fear psychotherapy—and fear psychologists.

Consequently, psychiatric medication has a special appeal to it, an appeal that is seen more and more today in advertising. Rather than go through all the hard work of constantly monitoring your feelings, thoughts, and actions, why not feel better without having to do anything at all? Why change your lifestyle? Just take some pills a couple times a day and go about your life as usual.

Now, the truth is, psychiatric medications are generally mandatory for the treatment of disorders such as schizophrenia and mania. For other disorders such as depression, PTSD, anxiety, or obsessive-compulsive disorder, psychiatric medications can, under the proper circumstances, be a helpful adjunct to psychotherapy. That is, medications can suppress your anxiety or alleviate your depressed mood such that you can then feel comfortable enough to do the hard work of psychotherapy.

  

Note carefully, however, that psychiatric medications are not curative. The medications merely suppress unpleasant symptoms for as long as you take the medications. If you stop the medications, the symptoms will flourish again in full strength. Only psychotherapy holds the possibility of a genuine cure by resolving the deep unconscious issues that lie behind the symptoms.

  

Psychiatric medication will usually be prescribed by a psychiatrist, although a general practitioner will sometimes prescribe psychiatric medications in some simple cases such as uncomplicated depression or anxiety. Some specially trained psychologists can also prescribe psychiatric medications. (Pain medication will usually be prescribed by general practitioners or specialists.)

  

And then, of course, you yourself may be “prescribing” your own medications. It may sound odd, but alcohol, nicotine, and “recreational” drugs are psychiatric medications in so far as they blunt guilt, anxiety, feelings of anger or sadness, and physical pain. The use of any “recreational” substance, and the abuse of alcohol, however, only set you on the path of social disobedience and self-indulgence, and this defiles the very purpose of medicine: to improve your social functioning. And nicotine is a case by itself, for it is nothing more than a deadly poison whose use is a death wish grounded in self-loathing.

  

In any case, your psychologist should be told of any medications you are taking—that is, if your psychologist didn’t refer you for a medication evaluation in the first place.

If you have been prescribed psychiatric or pain medications, the following topics may be of interest to you.

 


 
Side Effects

Unfortunately, modern medical science has not reached such a level of sophistication that a drug can be directed to exactly the aspect of brain functioning responsible for any particular symptom. Consequently, many medications simply saturate the brain with specific chemicals that somehow manage to get some symptom relief. I’m sorry if that seems vague, but that’s the way it is.

The result of all this lack of specificity is the problem of side-effects: a medication given to relieve a particular symptom can also cause other unwanted symptoms.

The good news is that some side-effects are mild and usually disappear (during the span of a few days to a couple weeks) after your body has become accustomed to the medication.

 


 
Being an Informed Consumer

Some persons develop side-effects that are just too uncomfortable or too much of a nuisance to tolerate, such as drowsiness, weight gain, constipation, or constant nausea. The best recourse here is to be an informed (and assertive) consumer. This involves

Getting information about your medications side-effect profile;

  

Talking honestly with your doctor about your complaints;

Working with your doctor to find another medication that your body can tolerate.

If your doctor will not work with you to find a tolerable medication, or is in any way condescending, you have the right to seek another prescriber.

It can be quite common, for example, to need to try several different antidepressants before finding one that is both effective and tolerable. Today’s market certainly offers many to choose from—although price can, unfortunately, be a complicating factor for some people.

 


 
Getting Information about your Medication

You have several options here.

1.

Talk to your prescribing doctor.

2.

Read the package insert from your medication.

3.

Look up your medication in the Physician’s Desk Reference (PDR). You can ask your doctor to let you see his/her copy and to make a photocopy of the relevant pages, or you can go to a public library to find a PDR.

4.

Use the following on-line references (but, unlike on the present website with its policy of no advertising, prepare yourself to be inundated with advertisements for medications):
 
• Drug Information from the FDA/Center for Drug Evaluation and Research (US).
• Drugs.com provides information, side-effects, and interactions for prescription drugs.
• RxListallows you to search for drugs and retrieve a wealth of information about usage and side-effects.

 


 
Medication Interactions

 

Always remember that some psychiatric medications can be lethal in combination with other medications or alcohol, and that some non-psychiatric medications, taken in combination, can cause psychiatric symptoms. Therefore, stay informed from your prescribing doctor, from your pharmacist, and from your own research.

 
Even herbal remedies can interact with psychiatric medications and cause problems. For example,

Ginseng may cause manic behavior, headache, and trembling if taken with the antidepressant phenelzine (Nardil);

Kava should not be combined with sedatives, sleeping pills, antipsychotics, alcohol, alprazolam (Xanax), or drugs to treat Parkinson’s disease;

St. John’s wort may cause interactions if taken with the antidepressant sertraline (Zoloft).

 


 
Pain Medications

There are essentially three pharmacological modalities for treating pain: acetaminophen; non-steroidal anti-inflammatory drugs, or NSAIDs (e.g., aspirin, ibuprofen); and opioids (narcotics).

All patients on opioids will experience dependence, which means that uncomfortable physiological effects (withdrawal) will occur on stopping the medication. This is a basic physiological process and is nothing to be embarrassed about.

Addiction—which commonly refers to a compulsive use of a substance despite the physiological, psychological, or social harm to the user—rarely happens in pain patients. Ignorance of this fact can cause many physicians to under-medicate pain patients, thereby actually prolonging the pain.

  

The use of longer-acting opioids and constant dosing at the acute phase of pain is usually the best form of treatment to prevent the pain from becoming chronic and to allow other aspects of treatment, such as physical therapy, to be tolerated.

  

Therefore, as long as pain medication serves to decrease pain in order to increase functioning, there should be no problems, even with opioids. And, unless the pain is due to a degenerative disease, the ultimate goal of pain medication should be to discontinue the medication eventually in favor of healthy psychological coping.

 

Note: The above common-sense definitions of addiction and dependence are often confused with the DSM-IV [1] diagnoses regarding Substance-Related Disorders:

 
Substance Abuse refers to a maladaptive pattern of substance use leading to clinically significant impairment or distress characterized by such things as

Recurrent substance use resulting in failure to fulfill major role obligations (e.g., work, school, family);

Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile);

Recurrent substance-related legal problems;

Continued use of the substance despite having persistent problems caused by its use.

Substance Dependence refers to a maladaptive pattern of substance use leading to clinically significant impairment or distress characterized by such things as

Tolerance (a need for increased amounts of a substance to achieve the desired effects, or diminished effect with continued use of the same substance);

Withdrawal (see below);

Taking the substance in larger amounts or over a longer time than was intended;

Persistent desire or unsuccessful efforts to cut down the substance use;

Spending a great amount of time in activities necessary to obtain the substance;

Giving up or reducing important social, occupational, or recreational activities because of substance use;

Continuing the use of the substance despite knowledge that its use is causing problems.

Withdrawal refers to

The development of a substance-specific syndrome due to the cessation of, or reduction in, substance use that has been heavy and prolonged;

The substance-specific syndrome causes clinically significant distress or impairment in important areas of functioning.

 

 


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Notes:

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association, 1994.

 
Additional Resources
 
Drug interactions:
Alternative Medicine — Known or Potential Drug-Herb Interactions  from WellnessWeb
Herbal-Drug Interactions  from HealthCastle
 
Medication information:
The best source for such information is the Physician’s Desk Reference, but it’s not available as an on-line data base. So check out these links:
Drug Information  from the FDA/Center for Drug Evaluation and Research (US).
Drugs.com  provides “Information, Side Effects, Interactions” for prescription drugs.
RxList —the Internet Drug Index allows you to search for drugs and retrieve a wealth of information about usage and side-effects.
 
Pain:
American Academy of Neurology  for multispecialty consensus on diagnosis and treatment of headache (migraine).
American Family Physician  for an article on guidelines for the treatment of nonmalignant chronic pain.
American Pain Society
Arthritis Foundation
Imagery and Pain Control  by David Bresler, Ph.D.
International Association for the Study of Pain
National Headache Foundation
Neuropathic Pain
Postgraduate Medicine  for the article Why is chronic pain so difficult to treat?
 
Smoking cessation:
Alcohol and Tobacco  from athealth.com.
Assessing Nicotine Dependence  is an article from the American Family Physician.
Blair’s Quit Smoking Resource Page  is a resource guide for help with quitting.
Do I Want to Quit Smoking?  is a patient handout from the American Family Physician.
Does Cigarette Smoking Cause Stress?  is an article from the American Psychologist.
Health Impact  details the health implications of smoking; from the Tobacco Free Initiative of the World Health Organization.
QuitNet  provides help with quitting, a library of resources, news items, links, and an online support system for people who want to quit smoking.
Treating Tobacco Use and Dependence: Quick Reference Guide for Clinicians  from the U.S. Public Health Service.
 
Related pages within A Guide to Psychology and its Practice:
Medical Factors Affecting Psychology
Psychology and Psychiatry
Questions and Answers about Psychotherapy
Reasons to Consult a Psychologist
Trauma and PTSD
Types of Psychological Treatment
 
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