Psych meds: misplaced fear

The first appointment with a psychiatrist is usually quite frightening. The decision to seek help is finally made after a long period of suffering with symptoms, not understanding it, not knowing how to explain it. After suffering for a long time seeking treatment feels so frightening and leads to feelings of vulnerability. I have had many people come to the office and express the feeling that being at the appointment is the ultimate acknowledgement of defeat and resignation to the fact that they have sucummed to mental illness after a very long time of resistance and fighting it, as though it is moral failure.


The whole idea of chemicals that alter your mood, thinking and behaviors are frightening to many people. The internet is full of the propagation of this fear (almost to the point of instilling paranoia) of medications, psychiatry, psychology, alleged "thought control", etc. In opposition to the medical community's attempt to help suffering patients, pop media preys on fears and guilt and offer no alternatives. Though our culture accepts mood and behavior alteration of Miller Lite, Starbucks, tobacco, and even marijuana, to some extent, Prozac, Zyprexa, etc becomes a dreaded and even hated concept. There isn't such a drive against alcohol which causes more illness and deaths than all the psychopharmacueticals will ever cause. Even caffiene is not benign, contributing to peptic ulcer, GERD and hypertension, but no one gets upset over Americans' increased dependance on it.

I have heard ministers discouraging their parishoners from taking antidepressants, as though it is a spiritual weakness that chemical imbalances occur.

I am not trying to belittle the point that all medications have the potental for harm, including death, but emotional illness can be even more devastating to patients who suffer and the families who are also affected. People die of mental illness every day and pop media and internet should be supportive of patients and help them in their quest for alleviating their affliction and not alienate them from a potential for remission.

Sexual side effects of antidepresssants

Sexuality is an important aspect of who we humans are. It is important on a personal and emotional level and in our relationships and connections to our significant others. Depression quite often takes away one's ability to enjoy just about anything, including sex. Unfortunately, medications that treat depression all too often also squelch sex drive and the ability to orgasm. When depression improves and the desire to resume normal life activities comes back, the desire for sexual relations often does not. Most of the newer antidepressant medications work by focusing in on increasing the brain chemical serotonin and it appears that when this neurotransmitter is increased and there is too great of an imbalance between serotonin and another neurotransmitter, dopamine. That's when you get sex drive and orgasm problems.

Though an ideal option is switching to a medication that is as effective and has less side effects, often a particular anti-depressant's effect may be better than all others tried, however and the option to switch medications is not viable. Addition of a medication that may increase Dopamine may need to be considered in order to offset the imbalance and correct the problem. The following are options to consider:

Ginko biloba- natural option
Wellbutrin
Stimulant medications
Buspar
Amantadine
Viagra- this option has been helpful for women as well, works best for anorgasmia rather than lack of libido

There are probably other options I am leaving out but this is a good start. Don't be shy to bring up any concern you may have with your doctor.

Rethinking Atypicals

When the new "atypical" antipsychotics came out we were excited to see the problem of Tardive Dyskinesia was no longer the great worry. We became comfortable and complascent with prescribing the medications and we found them extremely helpful for not only psychosis but bipolar symptoms including mood lability, anger and insomnia. They, indeed, have been enormously helpful and a far cry from the older, side effect laden "typicals", but at what costs?

We have been aware of the risk of diabetes with these medications but we attributed it to the weight gain that fostered insulin resistance, as anyone who gains weight elevates their risk. We have been feeling secure in monitoring fasting blood sugars and Hemaglobin A1c as markers of a problem. This, however, as it turns out, may not be adequate or even helpful It appears that what the body does to compensate for the insulin resistance is increase the amount of insulin production from of the pancreas. Unfortunately, what we know of pancreatic functioning is that insulin production over time diminishes naturally with age. If we over tax the pancreas (with obesity, poor dietary habits, atypical anti-psychotic medications, etc) the risk of developing diabetes is much higher.

Given the above, we, as a profession, need to adapt our prescribing habits to what we are learning. We will need to go back to the old mentality of using anti-psychotic, whether typical or atypical, with caution. We certainly need to use them as necessary but maybe for shorter periods of time and with the expectation that if we can replace them with other medications (eg, mood stabilizers in the case of bipolar), we should plan on doing so. Perhaps adding adjunctive medications (though the fewer medications the better) or natural supplements (such as cinnamon) may be worth considering. The atypical antipsychotic medications are exceptionally good treatments and far better than the other older options and hopefully, the pharmaceutical companies can work further on identifying new medications with at least equal efficacy and less risk. In the meantime, we keep trying to understand what best to do to help our patients.