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How to Use This Book
Nearly 1 in every 2 Americans will develop a mental disorder in the course of their lifetimes. Approximately 25 percent of these men, women, and children will take medication as part of their treatment. This book provides concise and easily accessible information about the major mind/mood medications used in the United States.
To get the most benefit from this book, begin with Chapter 1, which provides essential information about the drugs described in Chapters 2 through 9. Chapter 1 also discusses the concepts and terms used both in the book and by physicians who prescribe mind/mood medications.
Chapters 2 through 9 cover the major categories of psychiatric medications in use today: antidepressants (Chapter 2); medications to treat anxiety (Chapter 3); mood stabilizers, called anti-manic agents (Chapter 4); medications to treat sleep disorders (Chapter 5); antipsychotic medications (Chapter 6); medications for attention deficit disorders (Chapter 7); cognitive-enhancing agents (Chapter 8); and herbal medications with mind/mood effects (Chapter 9). Each chapter begins with a brief introduction about the mental disorders that the medications are designed to treat and provides a general overview of the drugs discussed in the chapter.
After reading Chapter 1, turn to the chapter that focuses on the particular category of medication of interest to you. We encourage you to read the chapter introduction first, since this will give you an overview of all medications in the same category. About half of all patients have difficulty tolerating the initial medication prescribed for their problem; about a third find that the medication does not work for them. An overview of the range of medications available may be helpful in evaluating alternatives if they should be needed. Each medication is presented in a uniform format, with an icon that identifies each category of information:
Generic name: The chemical or pharmaceutical name of the medication. (The generic names of the drugs profiled in this book are accurate for both the United States and Canada. However, some of these drugs may be marketed under different brand names in Canada, so readers there should check with their physicians for the names of Canadian equivalents.)
Available in generic form: Whether or not the medication is available in a generic form.
Brand name: The trade name the manufacturer has given the medication for marketing to the consumer. (Source: In Chapter 9, the origin of an herbal medication or “natural” mind/mood pill. These substances are usually sold in health-food stores and are not regulated by the FDA.
Drug class: The classification of the drug (for example, tricyclic antidepressant), applicable to a group of drugs similar in chemical formulation, mode of action, and uses.
Prescribed for: Indications — reasons to take the medication — approved by the Food and Drug Administration (FDA), as well as other accepted “off-label” uses by physicians.
General information: An overview of the medication, including how it works, why it was developed, and its general advantages and disadvantages.
Dosing information: Concise information concerning how the medication is prescribed, including dosage forms and strengths, when it should be taken, and how the dose should be increased. Many mind/mood drugs are initially given in low doses and then gradually increased.
Common side effects: The most common side effects noted during clinical trials and in clinical practice. These listings do not include every side effect listed in the Physicians’ Desk Reference (PDR), a comprehensive summary of the manufacturers’ package inserts of most prescription medications approved by the FDA. It is also possible that you may experience additional side effects; if so, you should report these to your physician.
Precautions: Cautionary advice concerning the medication you are taking and other drugs you should avoid while taking this medication. The information in this section does not necessarily imply that you should not take the medication; its purpose is to make you aware of these risks when taking a particular drug or class of drug.
Warnings: Medical conditions for which the drug is contraindicated — should not be taken — or other medications that should not be taken with this drug.
Alcohol: Whether or not you can drink alcohol while taking the medication, and interactions with the medication if you do drink.
Food and beverages: Whether or not you should take this medication with food and beverages and whether doing so may either lessen some of the side effects or decrease or increase the amount of medication absorbed into your blood. This section also lists any foods or beverages that should not be taken with a specific medication.
Possible drug interactions: Mind/mood medications can interact with other drugs you are taking, increasing or decreasing their effectiveness or possibly causing dangerous reactions. This section alerts you to other drugs that may be of concern or that should be avoided altogether when taking a medication.
Use in pregnancy and breast-feeding: Whether or not the medication should be taken if you are contemplating pregnancy or are pregnant, and whether you should take it while breast-feeding. As an indication of pregnancy-related risks, the FDA has categorized medications on a scale from A to D, and X. Mind/mood medications are almost never systematically studied in pregnant women. Potential effects on humans are usually drawn from research conducted in mice or other animals. Category A means that controlled studies show no risk to humans. Most mind/mood pills have been classified by the FDA as Category B — “No evidence of risk in humans but adequate human studies have not been performed” — or Category C — “Risk cannot be ruled out.” Category D is used when there has been proven risk to humans but the risk of potential harm to the fetus may be outweighed by the potential benefit to the mother. Category X signifies that the medication should not be used during pregnancy. See Chapter 10, page 406 and Table 10-1, for more information.
Use in children: Whether or not the medication should be used in children and, if so, the conditions for which it is prescribed and the customary doses, if known.
Use in seniors: Whether the medication needs to be taken in lower doses by adults over the age of sixty-five. This entry also notes whether some side effects of certain medications may be more bothersome or potentially harmful to seniors, or whether the drug should be avoided altogether. Because the capacity to metabolize and excrete medications declines with age, certain medications may need to be taken in lower doses. See Chapter 10, page 428, for more information.
Overdosage: General information concerning the signs and symptoms of overdose, and what to do if someone you know takes too much of a prescribed medication.
Special considerations: A concise review of the medication discussed and a summary of some of its unique advantages and disadvantages.
Because of widespread interest in alternative preparations to treat mood/mind symptoms, Chapter 9 reviews the more common herbal agents used in the United States today. Chapter 10 discusses special considerations for women, children, and seniors.
The book also includes color photographs of the twenty-five most commonly prescribed mind/mood medications. The majority are antidepressants, anti-anxiety agents, or medications for sleep. At the back of the book are an index of all the medications discussed in the book, a concise glossary of terms and phrases used in the text, and a resource directory with addresses and phone numbers of organizations you may turn to for more information concerning a particular mental disorder or to obtain more information about mental illness and mental-health professionals.
Mind, Mood, and Medications
Why do I feel this way? Why am I so moody? Is there anything I can do to feel better? Can anyone help?
At some point in life, almost everyone asks these questions. We all experience sadness, worry, rage, self-doubt, even despair. Often these feelings are short-lived, but sometimes they continue for days or weeks, coloring the way we view ourselves and the world. A life crisis — an accident or illness, a huge financial setback, the loss of someone dear — may be responsible. In other cases, gloom or anxiety may descend for no apparent reason.
Like physical problems, persistent emotional aches and pains can affect every aspect of life. More than 1 in every 4 Americans suffer from a mind/mood problem so severe that it interferes with their ability to keep up with their daily routines, do their jobs, care for their families, or relate to others as they once did. No one, regardless of age, gender, education, or income, is immune.
According to the National Institute of Mental Health’s (NIMH) landmark Epidemiologic Catchment Area (ECA) Survey, about 27 million adults and 7.5 million children in the United States have a diagnosable mental disorder; this is more than the combined total of individuals with cancer, heart disease, and lung disorders. In another major study, the National Comorbidity Survey (see Table 1-1), almost half of those queried reported having at least one mental disorder over the course of their lifetimes; almost 30 percent had been troubled by a disorder in the previous twelve months. Adults are not the only ones affected. According to some reports, the number of troubled children has increased to as many as 11 to 14 million youngsters.
Table 1-1: How Common Are Mind/Mood Disorders?
Anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, specific phobia, generalized anxiety disorder)
Affected in a given year: 17.2%
Affected in some point in life: 24.9%
Depressive disorders (major depression, manic depression, dysthymia)
Affected in a given year: 11.3%
Affected in some point in life: 19.3%
Alcohol dependence or abuse
Affected in a given year: 9.7%
Affected in some point in life: 23.5%
Drug dependence or abuse
Affected in a given year: 3.6%
Affected in some point in life: 11.9%
Any mental disorder
Affected in a given year: 29.5%
Affected in some point in life: 48.0%
Source: Kessler, R., et al.: “Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States.” Archives of General Psychiatry, vol. 51, January 1994.
The most surprising — and disheartening — fact is not that so many people are troubled but that so few get help. According to NIMH statistics, 7 in every 10 Americans with a mental disorder do not receive any treatment. These individuals may never realize why they cannot function the way they once did or why their lives have become difficult and joyless. They may try to tell themselves that they are simply overworked or stressed out. Even when they suspect that something more serious is wrong, many hate to admit, even to themselves, that they have a problem. They blame themselves, as if becoming anxious or depressed or feeling out of control is somehow their fault in a way that a medical condition such as diabetes or arthritis could never be. Often they fear that no matter where they might turn, no one will be able to help them. And nothing could be farther from the truth.
During the last two decades the mental-health field has undergone a quiet but profound revolution that has produced new forms of help and new reasons for hope. We now have a much better understanding of how the mind and the brain work and of what can go wrong and why. We know more about the complexity and variety of problems that can develop. We have identified patterns of vulnerability and the biological components of many mental illnesses. And we have an impressive collection of highly specific, carefully tested, and scientifically proven medications that can help most of those who seek treatment.
In 1840, in the first official attempt to gather information about mental illness in the United States, the Census Bureau recorded the frequency of a single category: idiocy/insanity. By the beginning of the twentieth century, early psychiatrists had identified more than a dozen mental illnesses. For decades, however, American psychiatry viewed all mental illnesses, as psychiatrist Karl Menninger put it, “as being essentially the same in quality, although differing quantitatively and in external appearance.” This view has since given way to a search for greater specificity and precision in both diagnosis and treatment.
One of the major advances in the quest came in 1980, not in the form of theory, technique, drug, or doctrine, but in a book: the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM, as it is commonly called. A revised version of this edition, published in 1987, and a completely overhauled fourth edition, DSM-IV, published in 1994, spell out explicit characteristics, or diagnostic criteria, for almost 300 disorders. Rather than focusing on the whys of mental illness, DSM emphasizes the whats — the specific signs and symptoms that characterize various psychiatric disorders. As a result, even when mental-health professionals disagree about or do not know the possible causes of a disorder, they can agree on how it manifests itself, and this common base enables them to assess treatments most likely to bring about recovery. DSM has given mental-health professions a shared language. Because its criteria are widely accepted, physicians, psychology, psychiatry, and social work trainees, and medical and nursing students use DSM as a textbook. Insurance companies base reimbursements on it. Research agencies and foundations fund investigations according to the DSM criteria.
Mental illness, as well as attempts to cure it, dates back to the oldest societies. The ancient Greeks pushed depressed individuals from the tops of cliffs into the sea to shock them out of their despair. In the Middle Ages, priests used exorcism to cast out the “demons” of madness. With the dawn of modern psychiatry, treatments were developed that were more humane but not necessarily more helpful. Only in recent years have mental-health professionals been able to offer a wide range of therapies — more numerous, more varied, and more precisely targeted than ever before — that have proved effective against common and often crippling disorders. These include new psychiatric medications that correct chemical imbalances in the brain and new psychotherapies that use cognitive, interpersonal, behavioral, and other techniques to produce lasting benefits within weeks or months. The combination of drug and psychological treatments — an approach that, not very long ago, many doubted would ever work — has proved even more helpful for many individuals than either psychotherapy or medication alone.
Although most people do not realize it, treatments for severe mental illnesses, such as major depression, bipolar (manic-depressive) illness, panic disorder, and schizophrenia, are as effective as or more effective than those available in other branches of medicine, including surgery. Therapies tailored to an individual’s particular condition and needs can help 70 to 80 percent of those who suffer from depression, bipolar disorder, or panic disorder. More than 60 percent of those with schizophrenia can be relieved of acute symptoms with proper therapy, and advances in medication are pushing this percentage even higher.
The revolution that has brought so much excitement and hope to the mental-health field is far from over. The coming years will undoubtedly yield new insights, advances, medications, and therapies to treat common disorders and prevent recurrences. In the past, those with manic-depressive illness typically spent half of their adult lives disabled, often in psychiatric hospitals. Thanks to medications that prevent debilitating mood swings, 75 to 80 percent now live essentially normal lives — a change that has saved the United States economy more than $40 billion since 1970. Similar progress has been made in major depression. As recent studies have shown, as many as 80 percent of those who become depressed experience a recurrence within ten years and face increased risk of job loss, marital breakups, and suicide. Maintenance treatment with antidepressants can prevent these terrible problems and keep individuals well.
The Mind/Mood Center: The Brain
To understand how medications work requires some basic information about the brain. The last and greatest biological frontier, more complex and more challenging than anything else in the entire universe, the brain represents the sum of human knowledge, emotion, memory, experience, and creativity. It enables us to think and talk, to remember and anticipate, to work and play, to express our needs and control our desires. Some describe the spongy mass of gray and white matter within the skull as an enlightened machine that combines the analytic ability of a computer, the organizational skills of a filing system, and the communications network of a telephone switchboard. Yet no machine or invention, however sophisticated, can crack a joke, dream of daffodils, write a poem, believe in a hereafter, or fall in love.
The brain has intrigued scientists for centuries, but only recently have its explorers made dramatic progress in unraveling its mysteries. Leaders in neuropsychiatry, the field that brings together the study of the brain and the mind, note that 95 percent of what is known about brain anatomy, chemistry, and physiology has been learned during the last decade. These discoveries have reshaped our understanding of the organ that is central to our identity and well-being, and they have fostered great hope for more effective therapies for the more than 1,000 disorders, psychiatric and neurological, that affect the brain and the nervous system.
There is so much scientific excitement centering on the exploration of the brain that some mental-health professionals worry that the powers and potential of the mind will be neglected. In fact, the study of the brain is not only changing our understanding of mental illness, but it is also challenging the conventional view that the mind and brain are distinct from each other. We are learning that these two aspects of consciousness work as one, and that mental experiences affect brain processes, and vice versa. The more we discover about the molecular mysteries of the brain, about the energy that causes tiny clumps of cells to make an idea blossom or a feeling form, the more we understand about how we think, learn, create, communicate — in essence, how the mind does all the things that make human beings unique.