Mental Health Issues and Medication Breakdown

**Disclaimer: The information on this page is informational only. It does not constitute medical recommendations. Before using any medication, consult with your medical provider.**

Below are some common mental health issues, and the medications frequently used for treatment.

Depression

Depression is the most common mental health condition in the United States. A persistent negative mood disorder, depression includes feelings of sadness and loss of interest. More than just feeling low, depression is an emotional down that you just can't "snap out of."

Clinical depression may require long-term psychotherapy, medication, or both. Symptoms can start with a trigger event, but neurochemical changes in the brain can cause symptoms to persist even when the trigger is gone.

Drugs for Depression

Antidepressant drugs:

• TCAs - Tricyclic antidepressants (named for specific chemical compounds that act on depressive affect).
• SSRIs - Selective serotonin reuptake inhibitors; keep serotonin in the brain​
• SNRIs - Serotonin-norepinephrine reuptake inhibitors; keep serotonin and norepinephrine in the brain.
• MAOIs - Monoamine oxidase inhibitors; sustain neurotransmitters norepinephrine, serotonin, and dopamine in the brain.

Anxiety

Anxiety is a persistent feeling of tension, worried thoughts, or sense of impending dread. Anxiety can amplify physical health problems like increasing blood pressure.

Anxiety disorders are linked to recurring intrusive thoughts or concerns. People with anxiety disorder may avoid situations out of worry, or may report physical symptoms of stress for no apparent reason such as sweating, trembling, dizziness or a rapid heartbeat.

Drugs for Anxiety

Anti-anxiety drugs:

• SSRIs - Selective serotonin reuptake inhibitors; keep serotonin in the brain.
• Benzodiazepines - Specialized barbiturates that produce feelings of calm and relaxation.
• Beta-Blockers - block receptor sites for epinephrine (adrenaline, noradrenaline). These drugs inhibit the sympathetic nervous system, which mediates the fight-or-flight response.

Attention Deficit (Hyperactivity) Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is marked by inattention and/or hyperactivity and impulsivity.

• Signs and symptoms of
• Inattention: Wandering, lacking persistence, difficulty focusing, being disorganized.
• Hyperactivity: Moving about constantly, fidgeting, tapping, or incessantly talking.
• Impulsivity: Hasty, impulsive actions without forethought. Socially awkward interrupting.

Medications for ADHD

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Schizophrenia

A chronic mental disorder where a breakdown between thought, emotion, and behavior is observed.

• Faulty perception such as paranoia, inappropriate actions and feelings (talking to no one).
• Withdrawal from reality and away from personal relationships. 
• Overcome by grandiose thoughts, fantasy, or delusion.

Drugs for Schizophrenia

• Typical Antipsychotics - Diminish dopaminergic activity in the brain.
• Atypical antipsychotics - Calm the brain's limbic system and the prefrontal cortex. 
• This diminishes impulsivity and poor decision-making.

Dementia

 Dementia is a disease of diminished cognitive function

• The progression of cognitive decline is more drastic than what one might expect in normal aging. 
• Other features of a dementing disease include 
• Personality change.
• Motor and coordination deficits.
• Inability to reason or think abstractly.

Drugs for Dementia

• Acetylcholine Uptake Inhibitors - Enhance acetylcholinergic receptor action in the brain to offset memory loss.
• Calcium Channel Blockers - Prevent calcium from entering brain cells and disrupting neuron communication.
• Antipsychotics - Diminish impulsivity and unwanted behavior by decreasing brain dopaminergic receptor action.

Post-Traumatic Stress Disorder (PTSD)

A psychiatric disorder that some people develop after experiencing or witnessing a life-threatening event or "Trauma"

• Military combat, a natural disaster, a car accident, or a sexual assault are examples of trauma.
• Symptoms of PTSD are
• Suspiciousness.
• Hypervigilance.
• Depression and Anxiety that may or may not be related to the trauma.
• Disturbed interpersonal relationships.

Medications for PTSD

• SSRIs - Selective serotonin reuptake inhibitors; keep serotonin in the brain. Increases positive affect.
• Typical Antipsychotics - Diminishes impulsivity and unwanted behavior by decreasing brain dopaminergic receptor action.

Insomnia

Insomnia is difficulty falling asleep, staying asleep, or feeling satisfied with sleep.

• The consequences of insomnia are:
• fatigue
• low energy
• difficulty concentrating
• mood disturbances
• diminished performance at work or school

Drugs for Insomnia

• Hypnotic Sedatives - Increase the activity of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain which is associated with sleep.
• Selected Tricyclics - Drowsiness is a side effect of early tricyclic medication (Trazadone, Amitryptiline). What causes this drowsiness effect has not been determined, but likely it is how these drugs regulate serotonin or dopamine, two neurotransmitters implicated in sleep.
• Benzodaizepines - Increases the efficiency of synaptic transmission of the neurotransmitter GABA (a neurotransmitter) in the Central Nervous System.
• Diurnal Cycle facilitators - Naturally occurring hormones (Melatonin) that regulate mamilian night and day sleep-wake cycles. Melatonin is synthesized and administered in pill form.
• Antihistimines - Agents that block the action of histamine H1 receptor (benadryl), these agents block histamine's effect on wakefulness. When histamine is blocked the brain perceives this as "sleep mode" and a temporary drowsy feeling ensues that can result in sleep.

Discontinuation Use Syndrome

• This syndrome is mile and reversible physical symptoms including:cramps
• sweating excessively
• trouble sleeping
• dizziness, tremors
• hypersensitivity to sound
• a feeling that resembles an electric shock to the head

It can appear when approximately 90% of the drug is out of the system.

Discontinuation symptoms could also include anxiety and depression. Since these may be the reason a person was prescribed medication in the first place, their reappearance may suggest a relapse and the need for ongoing medication treatment.

How to distinguish temporary discontinuation symptoms from relapse are as follows.

Discontinuation symptoms:

• Appear within ten days to weeks of stopping or lowering medication dose; relapse symptoms develop more gradually.
• Can include temporary physical complaints that aren't found in depression, such as dizziness and flu-like symptoms.
• Disappear quickly, while the drug treatment for depression takes weeks to work.
• Resolve as the body readjusts to being without the medication, while recurrent depression continues or may get worse.

Ceasing antidepressants should be planned between you and your prescriber. For quitting, you and your prescriber should take steps to minimize discontinuation that could occur if drugs are withdrawn too quickly.

Additional Information and Resources on Discontinuation Use Syndrome:

• New York Times article
• 
  
• Overview of Discontinuation Use Symptoms

Drug Discontinuation Information

*The below items go in the order of: 1. drug's name, 2. 50% half-life, 3. 99% half-life*

Paxil, 24 hrs, 4.4 days

Zoloft, 26 hrs, 5.4 days

Lexapro, 27 hrs, 6.1 days

Celexa, 36 hrs, 7.3 days

Prozac, 5 days, 25 days

Effexor, 5 hrs, 25 days

Cymbalta, 12 hrs, 2.5 days

Pristi, 12 hrs, 2.5 days

Wellbutrin, 21 hrs, 4.4 days

*(Information was adapted from Joseph Glenmullen, M.D., The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant WIthdrawal, Dependence, and "Addiction" (Free Press, 2006).*

Stopping Antidepressants

Take your time and stay on the medication for six to nine months before considering going off it.

Make a plan and reduce the dosage in increments.

Consider therapy. People who undergo psychotherapy while discontinuing are less likely to have a relapse.

(*For more information on this, see Harvard Medical School, Harvard Health Publications, October 27, 2015, Published November 2010.*)

Antidepressant Treatment Tachyphylaxis

This is something that can come up with patients using medication, specifically with SSRIs. The term "Prozac poop-out" is used because a relapse of depression symptoms rebound. This in turn leads a medication user to feeling fatigued or "pooped-out" because the medication has ceased being effective.

According to verywell, other SSRI's involved with Prozac poop-out are:

• Zoloft
• Paxil
• Celexa
• Lexapro

It is important to note that taking anti-depressants isn't necessarily a fix-all remedy to your symptoms. In fact, WebMD further explains the ups and downs of depression. Take a quick read if you are interested to learn more about the ups and downs involved with depression and medication use.

The best thing to do is talk to your provider, doctor, or therapist regarding your questions and concerns.

You can read up on the links that have been provided, but the best practice is to get professional insight into using and discontinuing medication, especially if something doesn't feel quite right during medication use - whether they are side effects that are uncomfortable, or something like Prozac poop-out.