I am angry, very angry. I have many Social Media Communication channels and I have a busy website and a very busy email address. I get a lot of contact from people, kind words on blogs, questions in relation to psychology and psychiatry (which I answer with a massive caveat “I am not a doctor”/”I am not a physician”) This weekend, I was contacted by a young lady out of the blue. She told me how she had been listening to another Mental Health Advocate in Ireland and some of the contributors and authors to the anti-psychiatry approach and had begun to have doubts culminating in her reading a book recently about the power of psychology (something I believe in, but which often has to be coupled with psychiatry)
Anyway, she read the book, stopped her meds, and attempted suicide. I was very saddened by this. She is OK, thank god. I know most of the Mental Health authors that are anti psychiatry and I know the Mental Health Advocates on our small island and I am certainly not going to name author or book, but I have read the same book and it did not suggest cessation of meds, but was pro psychology and anti-psychiatry in a biased manner.
Stating the obvious, we are all different. No two of us are the same. Psychology is a great win, but very often, to benefit from psychology, you will have to be at a certain baseline level. For example, a severely depressed person will rarely benefit from sitting with a therapist, as they will typically be withdrawn, lethargic, feeling empty and distressed. They will not get a thing from the session. It is the same with a moderately depressed person. Psychology stands best chance when the person has the opposite of all the above emotions and feelings. Psychology works best after psychiatry, and then they can certainly go hand in hand with each other. In some cases where a particularly mild depression exists, psychotherapy alone may be the best treatment option. This is the near exception to the rule. Choosing the right treatment plan should be based on a person’s individual needs, medical situation, and the severity of condition. Today I want to end the stigma on medication and put some education out there in relation to the different types of medication so there is less fear and stigma around certain types of medication.
Let’s talk meds!
Quick point -I have studied psychopharmacology and I am a nerd!
SSRIs Selective Serotonin Reuptake Inhibitors (SSRIs). Let’s look at 4. There are 7 though.
What is an SSRI? Knowledge is power and prevents stigma
Selective Serotonin Reuptake Inhibitors block or delay the re-absorption of the neurotransmitter, serotonin, by the original (presynaptic) nerves it was released from. This effect increases the levels of serotonin in the synapses.
Science bit: presynaptic neuron is a nerve cell that releases chemical messengers called neurotransmitters into the synapse, which is a gap at the end of a neuron. The postsynaptic neuron is the nerve cell that then receives these neurotransmitters.
Serotonin is the feel good chemical, this is pretty well known.
Serotonin is found more in areas of the brain that regulates mood. Low levels of serotonin in the synapses in these areas cause mood disorders such as depression. Selective serotonin reuptake inhibitors are used to treat depression, stress, anxiety, and panic disorder. Certain selective serotonin reuptake inhibitors may be used to treat other conditions such as obsessive-compulsive disorder, bulimia and so on.
Let’s End the Stigma on Lexapro
Lexapro (Escitalopram) It is approved by the US Food and Drug Administration for the treatment (of adults and children over 12 years of age) with Major Depressive Disorder-MDD (Depression to you or me!) It is also prescribed for Generalized Anxiety Disorder (GAD). Lexapro has demonstrated a significant benefit for those with severe depression (for example) Lexapro has also shown efficiency in OCD (Obsessive Compulsive Disorder), SAD (Seasonal Affective Disorder) and finally Panic Disorder. Lexapro was approved on basis of four placebo controlled, double-blind trials, three of which demonstrated a statistical superiority over placebo. The typical dosage (starting) is 10MG and often goes up in dosage to 20MG, as long as you are under 65. Lexapro is a very safe medication with a low side effect profile. I personally was on it for a year or two. I had nil side effects.
I was so nervous I started on 5MG; the minimum therapeutic dosage is the 10MG though. Lexapro increases the neurotransmitter Serotonin by blocking the reuptake of the neurotransmitter into the presynaptic neuron. I am aware of a trend a number of years ago of 25MG and 30MG being prescribed, but there’s no benefit proven beyond the 20MG mark. An important point is not to mix with alcohol.
(Science bit! Presynaptic neuron is a nerve cell that releases chemical messengers called neurotransmitters into the synapse, which is a gap at the end of a neuron) I have personally taken and advocate for Lexapro, as mentioned.
Lexapro is a first line treatment now when you go to your GP with a moderate depression nowadays in Ireland. It’s the most popular anti depressant in Ireland.
If you are depressed and have not spoken to your GP before on this subject, it’s a medication not to worry about or feel stigma on, if prescribed. Keep in touch with your GP, of course. No stigma though, OK!
Let’s End The Stigma on Lustral
Quick point – Lustral will be known to many of my overseas readers, as Zoloft (and Sertraline) Again, it is a very well-known first choice treatment that (much like Lexapro) has a very high success rate. It is diagnosed for Major Depressive Disorder and the Anxiety disorders (a little less for Generalized Anxiety Disorder). It is particularly popular in the United States. Its efficacy is similar to Lexapro and again there is a low side effect profile. Typically, Lustral is safe and effective in the older age profile. The dosage levels vary, 25MG or 50 MG are starting dosages and the end dosage can go as high as 200MG .Sertraline is primarily a Serotonin Reuptake Inhibitor (SRI) it works by essentially preventing serotonin from being reabsorbed back into the nerve cells in the brain. For youngsters, Lustral is often prescribed for OCD. It’s important not to mix alcohol with Lustral.
Personal bit!: I was prescribed Lustral before I took Lexapro. Fear prevented me from taking with it alongside shame (which can be considered stigma) Do not let stigma prevent you take this very well recognised safe medication!
Lets End The Stigma on Prozac
Prozac is very well known name, too well known! I will be very honest and say this medication became known with an over-promise of solving all your problems. Even us advocates of Medication for Mental Health accept Prozac won’t solve all your problems! Prozac is also known as Fluoxetine. Again, we have an SSRI. It’s effective for Major Depressive Disorder, OCD, Bulimia Nervosa and is used for Premenstrual Dysphoric Disorder (a severe form of PMS) Prozac entered the market in 1986 and has spawned books like “Let them eat Prozac” which are quite unfair on psychotropic medication including Prozac.
OCD in children: In America, the American Academy of Child and Adolescent Psychiatry states Prozac / Fluoxetine should be used as a first line treatment in kids for severe OCD, as it has been thoroughly tested.
Interesting bit! : In terms of safety, we have randomized phase 1,2,3,4. 1 being screening, 2- establishing med efficacy against a placebo, 3 -final confirmation of efficacy and safety. There is a stage 4 too with efficacy in sales.
Side effects are very mild and this medication has been around a very long time, which in itself is a good sign for safety and efficacy purposes. Prozac wouldn’t be prescribed as much as Lexapro or Lustral in Ireland, but please trust the studies and trials, if you have been prescribed it, take it and work with your doctor and lets end the stigma on a medication that’s been available for nearly as long as I have been on this earth!
Lets end the Stigma on Paroxetine
Parox will be known to a lot of people, as Seroxat (particularly the UK) Parox is short for Paroxetine Parox (again) is an SSRI (and again) treats Major Depressive Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder and also PTSD; Post Traumatic Stress Disorder. It has a similar tolerability to the other three SSRI’s above. Parox is a particularly potent medication. The activity of the drug on brain neurons is likely the reason for its antidepressant effects. The dosage varies with condition, typically highest with Depression, 20MG is often a starting dosage and the dosage can go as high as 50MG.
In the spirit of open and honesty, it’s important to say the GSK (Manufacturing company) have been found guilty on the marketing side to prevent generic versions enter the market.
I would not let this deter you from Paroxetine however; as the medication is the medication that passed all double blind randomized trials and should not be judged by biased marketing from GSK. There are sufficient surveys over time to prove that this medication is as effective as Prozac, Lustral or Lexapro. Thus if you are in your doctor’s office and you get a prescription for Parox/Seroxat, keep in touch with your GP and do not be afraid to take it. End the stigma on fear and end the stigma on Paroxetine.
Lets move to the SNRI side
What’s this SNRI all about?
SNRIs are potent inhibitors of the reuptake of Serotonin and Norepinephrine. These neurotransmitters play an important role in mood. SNRIs can be contrasted with the more widely used Selective Serotonin Reuptake Inhibitors, which act upon serotonin alone.
SNRI’s are effective for Major Depressive Disorder,Post traumatic Stress Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder and thankfully neuropathic pain /chronic musculoskeletal pain and Fibromyalgia
SNRIs work by impacting chemical messengers (neurotransmitters) used to communicate between brain cells. Like most antidepressants, SNRIs work by ultimately effecting changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood, to help relieve depression.
SNRIs block the reabsorption (reuptake) of the neurotransmitters serotonin and norepinephrine in the brain.
What’s out there in SNRIs.
Effexor and Cymalta are the two I’ll focus, I have read and attempted to study five!
Lets end the stigma on Effexor
Effexor is also known as Venlafaxine. As an SNRI, it increases concentrations of the neurotransmitters Serotonin and norepinephrine in the brain and body.
Venlafaxine is used primarily for the treatment of depression and Anxiety disorders. Typical starting dosage is 75MG and increases thereafter in increments in 75MG dosages. At 150MG or less, Effexor is similar to an SSRI. It is once we touch 225 MG or 300MG or 375MG, its acting on Dopamine and is really an SNRI. It’s something I take at present at a higher dosage and I find it very effective. I know in the states, they’ll touch 450MG. Typically here we go up to the 375MG
The extended release (controlled release) version distributes the release of the drug into the gastrointestinal tract over a longer period than normal venlafaxine. This results in a lower peak plasma concentration and less nausea for you or me. I take the extended release.
Effexor is known to a be potent SNRI. I have never experienced any side effects on Effexor XR. The XR standing for slow release.
Let’s end the stigma on Effexor by giving you a little bit more information and giving you a personal experience.
Interesting! : Some doctors may prescribe venlafaxine off label for the treatment of Diabetic Neuropathy. Damn effective studies too!
Let’s End the Stigma on Cymbalta
Cymbalta is also known as Duloxetine
Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SSNRI). Cymbalta works by positively affecting communication between nerve cells in the central nervous system and can restore chemical balance in the brain.
Cymbalta is used to treat Major Depressive Disorder and is used for Generalized Anxiety Disorder in adults and kids at least 7 years old.
Cymbalta is also used in adults to treat Fibromyalgia (An increasing chronic pain disorder where there are various trigger points are affected and there can be widespread muscle ache and headaches and tiredness and “Brain Fog) It works too, as I have Fibro myself.
There is a 30MG dose, but typically doctors will start at 60MG and this can be raised to 90MG and ultimately 120Mg
I have taken Cymbalta before and my experience was very positive with an effect on muscle pain
Information is knowledge and helps End the Stigma
SSRIs and SNRIs have typically replaced older medication such as TCA – Tricyclic Anti-depressants such as Amitriptyline and Anafranil. Amitriptyline is still used and for pain. Anafranil is the gold standard treatment for OCD. There are some increased side effects with TCA’s, but I have taken Amitriptyline and.Anafranil and I would speak well of both.
In ending stigma, it’s important to say, generally all antidepressant medications work about as well as each other to improve symptoms of depression and to keep depression symptoms from coming back. For reasons not yet well understood, some people respond better to some antidepressant medications than others. I cant tell you the answer why I am afraid!
Once a person begins taking antidepressants, it is important to not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It’s important to note medication can take 4-6 weeks to begin. Some people get hung up on side effects, but being honest, I see side effects as a positive thing! Why? The reason being that they are a sign that the medication is in your blood stream and beginning to work.
Aidan, you are ignoring Side Effects??
No, again I see side effects as a positive thing! Why? The reason being that they are a sign that the medication is in your blood stream and beginning to work. I don’t want them hanging around long though!
The whole issue regarding side effects is over hyped. As above you will experience some if the medication isn’t working.
I am not going to deny side effects can occur
What are the possible side effects of antidepressants?
The most common side effects listed by the FDA include:
Nausea and vomiting
If you do get one of the above, its likely they will pass after a short number of weeks, if not less.
Kids, pregnancy and miscellaneous points
You will often hear people say they had dreadful side effects and discover they were bipolar. Its critically important for those with Bipolar not to take an anti-depressant. You will have an adverse reaction. Here we look at Mood Stabilizers and Anti Psychotics.
Children can take these medications, but only if prescribed by a GP or preferably a Consultant Psychiatrist. They talk of anti depressants for kids from 7. I personally would like the child to be a teenager, but circumstances determine!
Older folk have to be careful when taking medications, especially when they are taking many different medications. It’s important to have one doctor, one specialist (if applicable) and one long standing pharmacist
The research on the use of psychiatric medications during pregnancy is limited. Decisions on treatments for all conditions during pregnancy should be based on each woman’s needs and circumstances, and based on a careful weighing of the likely benefits and risks. Hence, you can extract pregnant women from my paper.
Realistically, it is always about benefits against risks. The benefits are improved mood, energy, reduced anxiety, greater wellbeing and then opportunity to engage in Psychotherapy and exercise when you are feeling better.You will only regret what you do not do in life. Thus if you are experiencing a severe depression or chronic anxiety, why suffer? Take the risk. End the stigma on meds for the mind.
There are many negative side effects if you go to Google, but here’s an important point, there’s scaremongering going on. There are people out there who deliberately negatively review meds. In addition, its those who have had a negative experience who will write a “review”. Personally If I was starting a new med, I would not go near the internet. I would talk to my doctor and I would talk to my pharmacist.
Don’t forget to read the Patient Information Leaflet either, as I know many people ignore or even bin these! It contains a lot more information than I can put down in a blog post!
Finally, don’t listen to the Mental Health Advocates who are telling you to go alone with Psychotherapy if your doctor has prescribed medication. Do not make the mistake of the young woman I refer to at the beginning of this blog post and stop your medication. Often a dual approach will work (the psychotherapy I am not dismissing!) I hope I have helped eliminate fear and shame a stigma surround medication for mental Health. I am open in saying I take meds. They are fantastic in terms of they brought me from a point where I was dreadfully ill and near mute and suicidal to now where I feel chatty and confident and where I can work well, and can contribute to society alongside my writing and efforts to help other
I am here if anyone wants to talk. You can reach out to me on Social Media. I have about 50K followers. Share this pls.