Medical Treatment

Biological or medical treatment has progressed very well in the past few decades. Doctors and scientists have developed various methods to treat mental illnesses including different medications. Biological treatments are studied more than any other methods of treatment. There are tons of research studies about the effects and side effects of these treatments, so we know a lot about them.

Obviously, nobody wants to receive medical treatment. But sometimes these treatments are crucial. The whole idea is to help people snap out of dark feelings and thoughts. You can combine them with other forms of treatment or self-help strategies for the best outcome.

How does medication work?

To understand how medications work, you need to know a bit about the brain first. The brain is made of very tiny blocks called neurons. They work with electricity and chemicals. You can imagine them as extremely thin wires. There are billions of such tiny wires in the brain. They are connected with each other and hence make a huge network. Neurons conduct electricity from one end to another. But neurons don't directly pass electricity between themselves. They do communicate using chemicals called neurotransmitters.

The above picture shows a synapse or where two neurons meet each other. As you can see, neurons are not in direct contact with each other and have a tiny gap between them. When electricity reaches the very end of the first neuron, it releases chemicals; shown as red dots in the picture. The chemicals then swim across and sit on the surface of the second neuron and spark electricity there. This is not the end of the story though. Neurons do not waste chemicals and recycle them back. In other words, the chemicals are taken back to the first neuron as soon as they finish their job. We call this re-uptake.

Serotonin is one of the chemicals that the brain works with. There is a theory that depression is related to an imbalance of serotonin activity in brain. Antidepressant pills try to restore the serotonin activity back to normal. One way of doing this is to tell neurons to not take serotonin back quickly and to leave it out there a bit longer. As you can imagine, this will make serotonin more available to neurons. This type of antidepressants is called Serotonin Specific Reuptake Inhibitor (SSRI) because they specifically prevent re-uptake of serotonin and hence make it more available in synapses. SSRI is the most common type of antidepressant that we use these days.

Although SSRI antidepressants primarily work on Serotonin in brain, many scientists believe that their effect is actually much more complicated than simply tweaking Serotonin up and down. They believe that antidepressants cause a domino reaction in the brain that eventually leads to feeling less depressed.

Is medication dangerous?

Is medication dangerous? Well, I believe you can ask the same question about any form of technology that we commonly use. It’s like asking whether cars are dangerous. The answer is that it really depends! Cars are reasonably safe if you know how to drive them; and they are extremely helpful if you drive them very carefully.

Won’t you take an antibiotic if you have severe chest infection that is damaging your lungs? Would you refuse to take a diabetes medication if your blood sugar is high, knowing that it will inevitably damage your blood vessels and cause severe heart conditions and blindness? Finally, won’t you take a medication that can help you snap out of depression, even though that depression is ruining your life, career, and relationship?

I have been a doctor for twenty odd years, but medications have not ceased to amaze me over and over. I have seen medications that have made marked improvement to people’s lives while sometimes they have caused serious unwanted consequences. There are a few risks with medications that I would like to highlight below:

Pregnancy & Breast-Feeding:

Most medications should not be used during pregnancy or breast-feeding. I strongly advise you to discuss this with your doctor. Baby’s organs are mostly formed in the first three months of pregnancy. Therefore, it’s crucial not to expose them to medication during the first trimester. This means that ladies should use prevention and pre-plan for pregnancy if they are on medication. Otherwise, you might have already exposed your baby to medication by the time that you find out about your pregnancy.

Dependency:

Most medications are not addictive, but some of them are, and you may get hooked on them if you take them regularly for a while. For example, anti-anxiety medications known as benzodiazepines are addictive. Examples are Valium, Murelax, Xanax, and Kalma. Please ask your doctor whether a medication is addictive before taking it.

Side-Effects:

Medications may cause side effects. For example, some medications may cause sedation or weight gain. An ideal medication is the one that helps you significantly without causing unwanted side-effects. You and your doctor should discuss available medications and choose the one that is best for you and your condition. You can learn about any given medication by reading Consumer Medicines Information. To read more, please click Here.

Tips on how to handle medications

Keep medications safe!

Please keep medications out of the reach of children. Moreover, adults may rarely overdose on medication intentionally or unintentionally. If you and your doctor are concerned about this, then you may ask your partner or friend to keep the medication safe. This is particularly important if you drink alcohol excessively, if you tend to double the dose due to forgetfulness, or if you have suicidal ideas.

Avoid forgetting medication!

Most medications should be taken regularly in order to be effective. It’s usually helpful if you link taking medication with your daily routines or if you put them somewhere that will catch your eyes. For example, you can place your medication on the kitchen bench so that it will catch your eyes whenever you go there for breakfast. If you take a few medications, then you may buy a Dosette box to keep yourself organised. You can buy them from your local chemist.

Be smart about unwanted medications!

You can take your old, unwanted medications back to the local chemist for proper disposal. But I recommend keeping medication boxes. Medication boxes contain valuable information about you and your medication. You can flatten the boxes and keep them in a bag or an envelope. Then you will have your medication history all at home. It is extremely important for your doctor to know your medication history, e.g. which medication was effective or which one caused side effects. I keep a copy of my clients’ scripts on my computer system, but I have often found it difficult to chase up medication histories of new clients.

Choose generic or brand!

Chemists often ask you whether you want the original medication or something similar. The reality is that the very same medication is produced by different companies under different brand names. For example, the antidepressant, Sertraline was originally produced as Zoloft. Pharmaceutical companies have a patent to make medications exclusively for ten years. After ten years, other companies can produce the same medication under different names. Therefore, we now have other brands of Sertraline such as Xydep, Eleva, Sertra, Setrona, etc. In general, I recommend going with the most affordable brand because they have the same active ingredient. Rarely, you may find that a particular brand agrees with you most. Obviously, you will then stick with that particular brand and will not swap it with alternatives.

What types of medication do exist?

Medications in psychiatry are clustered into a few broad categories. The most popular categories are Antidepressants, Anxiolytics, Mood Stabilisers, and Antipsychotics. Medications and their names are very confusing for consumers. In the following sections, I will refer to medications by their active ingredients and will mention the original brands next to them in parentheses. You can click on the brand name to read about the medication.

Antidepressants:

Antidepressants undoubtedly work. The largest-ever study looked at data from 552 clinical trials and showed that antidepressants are more effective than placebo in treating acute depression in adults. The result of this study is published in one of the most prestigious medical journals, Lancet in 2018 .

Antidepressants are not just effective in depression and are also used for treatment of Anxiety, PTSD, and OCD. There are different types of antidepressants. I have already mentioned a particular type of antidepressants called Serotonin Specific Reuptake Inhibitor (SSRI) which specifically works on a brain chemical, Serotonin. They include Sertraline (Zoloft), Escitalopram (Lexapro), Citalopram (Cipramil), Paroxetine (Aropax), Fluvaxamine (Luvox), and Fluoxetine (Prozac).

There is another type of antidepressants that works on two chemicals in the brain, Serotonin and Norepinephrine. These antidepressants are called Serotonin Norepinephrine Re-uptake Inhibitor (SNRI). The common examples are Venlafaxine (Efexor), Desvenlafaxine (Pristiq), and Duloxetine (Cymbalta).

Antidepressants are not limited to these two types. There are plenty of other antidepressants. Examples are as the followings: Mirtazapine (Avanza), Agomelatine (Valdoxan), Vortioxetine (Brintellix), Reboxetine (Edronax), Moclobemide (Aurorix), Amitriptyline (Endep), Nortriptyline (Allegron), Clomipramine (Anafranil), Mianserin (Lumin), Doxepin (Deptran), Dothiepin (Dothep), Tranylcypromine (Parnate), Phenelzine (Nardil), and Esketamine (Spravato).

Anxiolytics:

There are plenty of medications with anti-anxiety effects. Alcohol and cigarettes are the two legal drugs that are commonly used for reducing anxiety, not that I recommend either. Some over-the-counter medications are also relaxing. In terms of prescribed medications, antidepressants are usually the best medication for treating relentless, debilitating anxiety. Beta-blockers are medications that reduce the effect of anxiety on your body. An example is Propranolol (Deralin), which reduces shaking and sweating in people with social phobia.

Benzodiazepines are strong anti-anxiety medications but they are typically used for a short period of time because of their addictive property. They generally tend to calm a person with lower doses and help them to sleep with higher doses. They include Diazepam (Valium), Oxazepam (Serepax), Temazepam (Normison), Nitrazepam (Mogadon), Bromazepam (Lexotan), Lorazepam (Ativan), Clonazepam (Paxam), and Alprazolam (Kalma). The last one is the most addictive and can only be prescribed for panic disorder that cannot be treated with other medications.

Mood stabilisers:

As the name implies, mood stabilisers are used to stabilise mood and prevent extreme mood swings. They are typically used in bipolar disorder. They are also sometimes added to other medications to boost their effect. The most common mood stabilisers are Lithium (Lithicarb), Sodium Valproate (Epilim), Carbamazepine (Tegretol), and Lamotrigine (Lamictal).

Lithium is a natural salt and the standard treatment of severe bipolar illness. Lithium should be monitored closely. Your doctor will request blood tests every six months to determine the blood level of lithium and to rule out any adverse effect. While taking lithium, you need to drink a lot of water, and you should limit using table salt and coffee.

Antipsychotics:

Antipsychotics are typically used for treatment of psychosis. They are also used for other purposes. Some antipsychotics are used for stabilising mood. Low doses of antipsychotics are used as an anxiolytic. Moreover, they are sometimes added to other medications to boost their effect. The most common antipsychotics are Risperidone (Risperdal), Paliperidone (Invega), Ziprasidone (Zeldox), Olanzapine (Zyprexa), Quetiapine (Seroquel), Amisulpride (Solian), Aripiprazole (Abilify), Asenapine (Saphris), Lurasidone (Latuda), Brexpiprazole (Rexulti) and Cariprazine (Reagila).

Clozapine (Clopine) is probably the most effective antipsychotic ever. However, this medication is not commonly used and is kept as a last resort when psychosis is not manageable with other antipsychotics. Clozapine should be closely monitored for unwanted side effects. This includes a blood test every month.

Stimulants:

Stimulants are typically used for treatment of Attention Deficit Hyperactivity Disorder (ADHD) and some sleep issues such as Narcolepsy. On rare occasions, they are added to antidepressants if depression is treatment-resistant and does not improve with antidepressants alone. These medications can enhance alertness, improve attention, and reduce fidgetiness. The most common stimulants include the followings: Methylphenidate (Ritalin, Ritalin LA, and Concerta), Dexamfetamine (Dexmine), Lisdexamfetamine (Vyvanse), Modafinil (APO-Modafinil), and Armodafinil (Nuvigil).

Other types of biological treatment

There are biological treatments other than medication. Transcranial Magnetic Stimulation (TMS) has been used in depressed patients who have not responded to medications. In this treatment, the front of the brain is stimulated by a magnetic field. It may sound odd and extreme, but it's a non-invasive treatment, and is usually safe and well-tolerated.

Electroshock Therapy (ECT) is an old treatment and is infamous for causing side effects. In ECT, a person is put to sleep and then the brain is stimulated by a small electric current. ECT is not commonly used and is kept as the very last resort. This is when other treatments have failed and doctors fear for a person’s life; e.g. when a person is about to die because she or he does not eat and drink anymore due to severe depression or psychosis.

Other biological treatments include Vegal Nerve Stimulation (VNS) and Light Therapy. In Light Therapy, for example, a person is exposed to very bright light for half an hour a day. This method was introduced after an observation that some people get depressed in colder seasons when there is not enough daylight.

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