Medication

The most common myth about psychiatric medication is that psychiatric drugs are used to sedate the mentally ill and put them to sleep (hence the term tranquilizers). As if that is the only purpose of the treatment, whether someone is depressed or insane (e.g. schizophrenic). In fact, people commonly use sleeping pills when they are upset, and this is a bad practice.

Many psychiatric medicines are sedating, but that is their side effect and not the therapeutic one. Anti-depressant drugs can improve sleep problems that are often associated with depression. This may be desirable but is not the sole or primary purpose of treatment.
Various psychiatric drugs are used with specific treatment goals in mind. A broad classification is as follows.

Anti-depressants: There are several types of anti-depressants available these days. Older ones are “tricyclics” while “selective serotonin reuptake inhibitors” are newer, which are well tolerated and non-sedating - Prozac is the one most commonly used. There are still other types. It is important to remember that older anti-depressants are not obsolete and are used effectively in many cases.

The aim of anti-depressant treatment is to relieve or significantly improve most of the symptoms of depression described earlier. These medicines take 3-4 weeks to take effect. They should be used, at least, for six months or longer, and discontinued only after consultation with a psychiatrist. Another good rule to remember about most psychiatric medicines is to discontinue them very gradually by decreasing the dose over a period of several weeks, except for in situations when it is medically necessary.

The list of side effects is long and varies for different anti depressants. Most side effects, if they occur, are troublesome but not harmful to the brain or the body in the long run.

Anti- psychotics: These medicines are most commonly used for psychotic illnesses, which means in situations where a person loses touch with reality, talks disorderly or acts bizarrely. Most common examples are schizophrenia and mania.

As anti-depressants, anti-psychotics are of different types, some are old others are new. Most of them are equally effective but have different side effects. One relatively newer medicine, clozapine is more effective for treatment resistant cases of schizophrenia and from some preliminary study data it appears to be better for non resistant cases too. But it can have some serious side effects, if not monitored closely. There are some other newer anti-psychotics, which are very well tolerated and safe but whether they are more effective than older ones is not clear from clinical experience.

Anti-psychotics effectively relieve the symptoms of schizophrenia but complete cure is unusual. They are effective enough to significantly improve the quality of life of the patient and his/her relatives. The expected improvement is more organized thoughts and behavior, less agitation, appropriate social interactions, better self-care and improved personal hygiene.

In mania these medicines shorten the episode and completely relieve the symptoms in many.

Anti-anxiety medicines: There are different types of anti-anxiety medicines. The group most widely used all over the world is called benzodiazepines. The most common example of which is diazepam (valium).

They are useful for effective relief of anxiety and unlike anti-depressants take effect quickly (in less than an hour). The effect lasts from few hours to few days, depending on the medicine used. They are very well tolerated with few side effects. The major problem with them is that if used regularly for a long time not only are they habit-forming but also they gradually lose effect. Nevertheless, when used with doctors’ consultation and prudence they are very helpful. There are other types of anti-anxiety medicines, which are not habit forming but are less effective. Anti-depressants are also used for some anxiety disorders including panic attacks.

Mood stabilizers: Lithium and valproate are the most common ones. They are used for bipolar disorder. The aim of treatment, by regular use of these medicines is to prevent episodes of this illness. Even if manic and depressive episodes occur, they are short in duration and less severe in intensity.