By Jeffrey Borenstein, M.D.
When it comes to psychiatric treatment, we are living in very exciting and hopeful times. We are all touched by psychiatric illnesses. Most people have friends or loved ones who at some time require psychiatric care. Whether it is to treat depression, schizophrenia, bipolar disorder, alcohol/chemical dependence or more recently, the stresses of living with the ongoing fear of terrorism, we all know someone affected.
People who live in Queens are fortunate to have a number of prestigious hospitals, clinics and programs for treating mental illness and chemical dependency. We have many excellent psychiatrists, psychologists, social workers and other mental health professionals.
Our psychiatrists are on the cutting edge of treatment and are able to use a number of new medications that can more effectively treat a variety of psychiatric conditions.
Depression is a common illness. According to the National Institute of Mental Health, 9.5 percent of the population, or about 18.8 million American adults, suffers from a depressive illness. Most people who have depression do not seek treatment, even though effective treatment is available. You should be familiar with the symptoms of depression so you can help a person you care about identify the problem and seek treatment.
Symptoms of depression include a sad or anxious mood, feelings of hopelessness and guilt, anhedonia (inability to enjoy activities that were once enjoyed), decreased energy, difficulty concentrating, insomnia or oversleeping, appetite disturbance and thoughts of death or suicide. If you or a loved one is experiencing these symptoms, you should seek professional help. If you do have depression, you will probably be treated with anti-depressants.
Anti-depressants are one of the most commonly prescribed classes of medications in the United States. Four of the 10 most widely sold drugs in the United States are anti-depressants, and they account for annual sales of $10 billion.
The selective serotonin re-uptake inhibitors, or SSRIs, are the most widely used. The first SSRI introduced in the United States was Prozac, in 1988. Since then, a number of other SSRIs have been added to our arsenal of treatments. These include Zoloft, Paxil, Effexor, Luvox, Celexa and Lexapro.
In addition, a number of new anti-depressants with somewhat different mechanisms of action are also effective. These include Serzone and Wellbutrin. The older generation of anti-depressants, the tricyclics, are also effective and are still widely used. The most important thing to remember is that if you or a loved one has depression, it will in all likelihood respond to one of these treatments.
The recent pharmacologic advances in anti-depressants has not only advanced the treatment of depression, but also the treatment of other conditions. They are used to treat post traumatic stress disorder, obsessive-compulsive disorder, panic disorder, anxiety and bulimia.
If you or a loved one has one of these conditions, you will be able to experience relief with treatment that may include anti-depressants, along with talk therapy and other modalities.
Another class of medications used for treating bipolar disorder, or manic-depression, is called mood stabilizers. According to the National Institute of Mental Health, more than two million American adults, or about 1 percent of the adult population, have bipolar disorder.
Symptoms of mania include increased energy, excessively euphoric mood, extreme irritability, racing thoughts, distractibility, decreased need for sleep, spending sprees, increased sexual drive, poor judgment and aggressive behavior. In addition, people with bipolar disorder have an increased risk of suicide.
Fortunately, bipolar disorder is treatable with mood stabilizers. The first medication in this class was lithium, and it is still widely used. More recently, a number of the anti-convulsants have been found to have mood-stabilizing effects.
These include the following medications: Depakote, Tegretol, Lamictal, Neurontin, Trileptal and Topamax. Depakote is the most commonly used drug in the treatment of bipolar disorder in the United States. Sometimes these medications are used in combination with other medications to optimize the therapeutic results.
Mood stabilizers also are effective in a number of other conditions. Many are sometimes used to treat specific symptoms, such as aggression, agitation and impulsivity in patients with a variety of disorders.
Anti-psychotics are another class of medication, and they are the first line of treatment for schizophrenia. According to the National Institute of Mental Health, approximately 1 percent of the population develops schizophrenia during their lifetime; more than two million Americans have this illness. People with schizophrenia experience the condition of psychosis, which may include hallucinations, delusions and paranoia.
Schizophrenics also experience social isolation, withdrawal or unusual speech, thinking and behaviors. The movie A Beautiful Mind portrayed many of the symptoms of schizophrenia in a way that allowed the audience to have an understanding of what it is like to have this illness.
Approximately 50 years ago, the first anti-psychotic medication revolutionized the treatment of psychosis. But until recently, the benefits of the anti-psychotics have been greatly limited due to significant side effects.
More recently, the “atypical anti-psychotic” medications have brought about a significant improvement in the treatment of psychosis due to their less severe side-effect profile. People receiving these new medications still may experience side effects, and a psychiatrist should carefully monitor their use.
The atypical anti-psychotics include Clozaril, Risperdal, Zyprexa, Seroquel, Geodon and Abilify. In addition to being useful in treating schizophrenia, a number of the atypicals also are used to treat bipolar disorder, psychotic depression, agitation associated with psychosis and drug-induced psychosis.
The new psychiatric medications give new hope to people. Nevertheless, many people with psychiatric conditions do not seek help. I hope this article encourages people to seek help and also encourages friends and loved ones to reach out to those who need assistance. The support of friends, loved ones and caring professionals who reach out to people can truly bring about miracles.