Medication can help people with mental illnesses in several ways. It can relieve the distress and anguish caused by illness by controlling symptoms, such as depression, mania, panic attacks, obsessions, and hallucinations. It can also prevent relapse in both schizophrenia and mood disorders. Certain medications can also reduce the negative symptoms of schizophrenia. Medication is so important that it is often considered essential in the treatment of mental illness, particularly if the illness is severe and persistent. However, medication does not “cure” the illness and, of course, can have side effects. In each case, therefore, the risks must be weighed against the benefits of taking a medication or not.
It is important to know the names of prescribed medications (both the manufacturer’s trade name and the chemical generic name), as well as the dosage, therapeutic benefits, and possible side effects. Keeping a written record of all this can be very useful at a later date. Any other doctor or dentist should be aware of all medications taken to ensure that any medical operation or treatment is undertaken without risk of interaction with the psychiatric medication.
Medications vary as to the amount of time needed before taking effect (from a few minutes or hours in the case of anxiolytics to several weeks in the case of antidepressants). Side effects, however, can appear very rapidly, leading many people to stop their medication before they take full effect. Many side effects, though, are only temporary and may disappear after a few weeks. Ongoing treatment with medications should be supervised carefully.
Antipsychotics (also known as neuroleptics) are prescribed to counteract psychotic thinking that can occur with schizophrenia, mania and extreme depression. They help stop hallucinations, delusions and agitation, and significantly reduce the rate of relapse. The most common antipsychotics are Zyprexa, Risperdal, Haldol, and Seroquel.
Some antipsychotics are injectable in intervals ranging from one week to several months. Often, the total dosage of the medication may be reduced by giving an injection, because it is better absorbed in this form. Injections are preferable for persons who are either non-compliant or forget to take their pills.
Use of antipsychotic drugs can produce side effects. It is important to discuss with the physician or pharmacist the side effects of each medication, since the profile can vary considerably with the dose and medication taken. Following are typical side effects of antipsychotics:
– Dizziness, dry mouth, blurred vision, urinary retention, and constipation. These symptoms are due to the antichlorine effect and may decrease or disappear with time. Notify your physician if the constipation is persistent.
– Stiffness, shakiness, restlessness, muscle spasms (especially neck, eyes or tongue) and akathysia (fidget/need to walk).
– Lack of concentration or memory loss, reduced libido, increased saliva, sensitivity to the sun. In certain cases, these effects may improve with time. They are not permanent because they disappear once the medication stops.
– Flu-like symptoms with fever, sore throat, rash, stomach pain, diarrhoea, vomiting or asthma. These symptoms represent an allergic reaction, which is rare and usually occurs during the first month of treatment. Notify a physician of all these symptoms.
– Involuntary movements, especially of the mouth and fingers. When antipsychotics are used for extended periods of time, these symptoms of tardive dyskinesia may develop. Certain precautions may be taken to prevent tardive dyskinesia, such as keeping the dosage of the medication to the minimum and, perhaps, the use of vitamins E and C. Although tardive dyskinesia may improve, it is sometimes irreversible.
These symptoms are due to the neuroleptic effects on the extrapyramidal system, a part of the brain that controls muscle movements. They are worse in young males and often require a medication to counter the side effects. Medications for these reactions include Kemadrin and Cogentin.
These drugs are used to treat depression by reducing the symptoms of sadness, agitation, irritability, and inability to enjoy life. Some are also useful for panic attacks, obsessive-compulsive disorder, and chronic pain. Antidepressants are different from most medications since they are slow to act: with the adequate dosage, it takes two to six weeks to see if the patient reacts favourably to the medication. Overall, antidepressants can help 70 to 80 % of people with major depression. As with antipsychotics, antidepressants treat the symptoms but do not cure the illness, so they must be taken for the natural duration of the depressive episode. Like many other drugs, can be toxic when taken in overdose, so the prescribed dosage should be carefully followed.
There are many antidepressants on the market, which may lead to confusion. The choice of medication may be based on its side effects, the presence of agitation or anxiety, lack of energy or the experience that the person already has with a previous antidepressant. Antidepressants are grouped according to their mode of action and structure.
The side effects of antidepressants vary considerably according to the category and it is always good to check with the physician or the pharmacist to know the effects of the prescribed medication. The most common side effects are dry mouth, blurred vision, urinary retention, and constipation. These symptoms are due to the antichlorine effect and may decrease or disappear with time. In some cases they may cause stomach upset, weight gain, nightmares, inability to sleep, sexual difficulties, or increased seizure activity in people who already suffer from epilepsy.
Notify your physician if the symptoms persist over a long period of time.
For severe and persistent depressions that do not respond to traditional antidepressants, the physician can suggest a potentialization strategy: adding another medication such as Lithium to increase the efficacy of the antidepressant.
These drugs are used to relieve the symptoms of severe anxiety, panic attacks, short-lasting sleep disorders, and to increase the effects of antipsychotics among highly agitated patients. They also help relax muscle spasms, reduce the agitation caused by antipsychotics (akathysia) and cause sedation. They should normally be used for short periods of time because they are addictive and may produce severe reactions when used with alcohol. Commonly used anxiolytic medications are Ativan, Rivotril, Buspar, and Serax.
Side effects can include dizziness, drowsiness, loss of muscle coordination, blurred vision, agitation, decreased memory, increased appetite, and diarrhoea. Nevertheless, there is a place for anxiolytics when a person is receiving regular mental health care.
Drugs in this category are used to treat hypomania (state of perpetual excitement with an overabundance of energy, lack of sleep, irritability, etc.), mania, and psychosis in bipolar disorder (alternation of mania and depression). The most common medications in this group are Lithium, Epival and Topamax.
Lithium is the most common mood stabilizer. Lithium is not a tranquillizer but works in a more fundamental way to settle the person’s mood so that he can sleep, eat, think, feel and relate more normally. In acute mania, Lithium is often combined with other medications including the more powerful antipsychotics. People with bipolar disorder take Lithium continuously even when they feel better in order to prevent episodes of mania or depression from returning.
Lithium has side effects which may include tremor, nausea, diarrhea, frequent urination, weight gain, marked thirst, and water retention. If the lithium level gets too high in the blood, side effects will include lethargy, changes in mental function, vomiting, and diarrhoea. For this reason the dose of Lithium is carefully controlled by regular blood tests during visits to the doctor. Long term side effects of Lithium can include decreased functioning of the thyroid gland, kidney damage, and heart problems, so these too are checked regularly.
For more information on psychiatric medications:
Cognitive Behavioural Therapy (CBT)
This type of therapy focuses on how a person thinks and consequently acts. It revolves around understanding how we think and how those thoughts affect our actions. This type of therapy can be done in groups or individually with a therapist. According to the Centre for Addiction and Mental Health (CAMH), CBT is structured, problem-focused, goal-oriented, and puts great importance on teaching and learning new strategies and skills.
Usually used to treat anxiety disorders, this type of therapy involves having the individual expose him or herself to what it is that brings them anxiety in a safe environment (in small steps; not all at once). By exposing themselves to what they fear, they can eventually overcome their fear. The exposure can happens in different ways: gradual, which starts with what is less feared to the most feared; flooding, which means immediate exposure to the individual’s greatest fear; and systemic desensitization, which combines relaxation techniques and exposure in order to facilitate the process.
This approach focuses on educating an individual and providing a treatment plan that will best help them. In Quebec, there are professionals called psychoéducateurs who often see people in their office or even come to the individual’s house to work on the difficulties they are facing such as anxiety, for example. If you would like more information on how to get a psychoéducateur, contact your local CLSC or call 8-1-1.
This type of therapy, also called talk therapy, focuses on the expression of emotions. The individual sits down with a therapist and talks about how they are feeling and what is worrying them, as well as any other topics the client wishes to bring up. The therapist or psychologist then helps the client work through their problems. There are different approaches to psychotherapy, such as cognitive-behavioural and humanistic, but generally psychologists select from all approaches in order to help the client.
There are many that say support groups have helped them in their recovery. Sometimes talking to someone who is going through the same, or similar, experience as you can bring a sense of calm. It can also encourage you to reach out to others and not go through something alone.
AMI-Quebec has support groups several times a month! Click HERE for more info.
Looking for therapy or counseling? Click HERE to visit the Counseling and Therapy section of our resource list.