Understanding medication for psychological difficulties
First Psychology cannot prescribe or administer any medications for any psychological difficulty. We are psychologists and psychological therapists and we work by providing talking therapies and strategies to bring about changes in behaviours or situations.
However we are well aware that many of our clients have visited their GP and may have been prescribed medications to help with their symptoms. To see psychological difficulties as purely biological is oversimplistic as each person will experience a unique set of difficulties. Medication can however help ease the symptoms of conditions such as depression so that people find it easier to function on a day-to-day basis. When making the decision to take medication, ask your GP about the type of medication they are proposing to prescribe and why it is being prescribed to you. You could ask: the name of the medication and what it is used to treat; how long you are likely to need to take it; any possible side effects and risks; how you stop taking it – are there any withdrawal symptoms; and whether it will interact with any other medications that you may need to take.
Medication for depression
It's important to understand that at present any medications available for your GP to prescribe for depression will treat the symptoms, not the depression itself. A combination of medication plus a form of therapy, such as CBT or psychotherapy, is often recommended as it has been shown to reduce the rate of relapse (this is high in people using medication only). Antidepressant medicines work on the basis that depression can be caused by low levels of particular chemicals (neurotransmitters) in the brain.
There are three main types of antidepressant:
TCAs (Tricyclic Antidepressants): These are thought to work by inhibiting the reuptake of neurotransmitters norepinaphrine, serotonin or dopamine. TCAs on the market at the present include imipramine (Tofranil), amitriptyline (Elavil, Endep, Tryptanol, Trepiline), clomipramine (Anafranil) and desipramine (Norpramine, Pertofrane). TCAs may also be prescribed to treat anxiety, ADHD and bulimia nervosa. Common side effects include dry mouth, dry nose, blurred eyes and sedation, so driving can be difficult. The toxic dose of TCAs is close to the therapeutic dose, so great care must be taken to prevent fatal poisoning.
SSRIs (Selective Seratonin Reuptake Inhibitors): These are more recently developed antidepressants and work by inhibiting the reuptake of the neurotransmitter serotonin, increasing its level in the brain. Types of SSRIs include: Fluoxetine (Prozac, Seronil, Sarafem, Fluctin), paroxetine (Paxil, Seroxat) and setraline (Zoloft, Lustral). SSRIs may take up to eight weeks to reach their full effect. Side effects including nausea, drowsiness, headaches, appetite change and some sexual difficulties may occur in the first 4 weeks as the body adapts to the drug, but these generally subside once the body has adapted to them. SSRIs may also be prescribed for obsessive compulsive disorder, panic disorders and eating disorders. Withdrawal symptoms vary depending on the medication prescribed, but can be particularly problematic with paroxetine.
MAOIs (Monoamine Oxidase Inhibitors): These act by blocking the action of an enzyme which breaks down monoamine neurotransmitters, thus raising the levels of the neurotransmitters in the brain. MAOIs are often considered if other types of antidepressants have failed. Care should be taken with diet and in taking other drugs when taking MAOIs. Tyramine, a chemical in preserved foods (e.g. pickled, dried, cured, matured) can be dangerous when taking MAOIs, as can several other drugs. Check with your doctor for more details. Common types of MAOIs include isocarboxazid (Marplan), moclobimide (Aurorix, Manerix), selegiline (Selegiline, Eldepryl) and iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida). Side effects include severe high blood pressure, particularly when dietary advice is not followed, weight gain, drowsiness and nausea. Withdrawal can be hard.
Medication for other psychological difficulties
As mentioned above, some antidepressants may be prescribed by your GP for other psychological difficulties such as anxiety disorders and eating disorders, however there are also medications used specially for those conditions.
Medication for anxiety: Tranquilizers such as Benzodiazapines may be used for short term relief of severe and disabling anxiety. Common types include Chlordiazepoxide (Librium), Diazepam (Valium, Valclair, Tensium), Clorazepate (Tranxene) and Alprazolam (Xanax). Dependence and withdrawal difficulties can be a problem with these drugs, so they are prescribed on a limited, short-term basis to minimise dependency.
Anti-psychotic medication: Anti-psychotic medications can be used either for one-off experiences of psychosis or to treat an ongoing illness. Psychotic experiences can occur in schizophrenia and manic episodes, but also in severe depression or following recreational drug use. Anti-psychotic medication is thought to work via a sedative effect, acting on the neurotransmitter Dopamine. Neuroleptics, which control the nerves, are the most common form of treatment for psychotic episodes and help to control symptoms such as hallucinations and anxiety. Some common examples include Chlorpromazine (Taractan) and Clozaril (Clozapine). Common side effects include neuromuscular difficulties, such as tremors, stiffness, restlessness and loss of movement. Anti-psychotic medication can also disrupt hormone levels, so some sexual dysfunction can occur.
We would advise you to discuss any new treatment plan requiring medication with your GP so that you understand how effective it might be as well as any possible side effects and dependency issues.
Feel free to contact us to ask about psychological therapies available at our centres.