Saturday, March 17, 2007

About Depression

Psychopharmacology, the treatment of psychiatric disorders and emotional distress with medication, has developed over the last fifty years, as our understanding of the workings of the brain has increased in sophistication. When medication is prescribed for mental and emotional illness, the most frequent goal is to restore the chemical balance within the brain, thereby restoring equilibrium to the entire system. Certain drugs function to address certain symptoms, such as when sedatives are prescribed for insomnia. Medications can work to slow disease processes, such as when anti-oxidants are used to treat Alzheimer's. Still other drugs control cravings and curb other problematic behaviors, such as when Naltoxone is taken to control alcoholism.

In many instances, medications are essential. If you suffer from mania, a major depression, or a paranoid disorder, medications may actually be able to restore you to your normal self. For other conditions, such as schizophrenia, medications control and modify symptoms to the degree that a person can stay in his community. Medications also ease the more distressing symptoms, allowing a person to engage in a therapeutic relationship and re-engage in the activities of her daily life. Sometimes a drug is a useful additional measure during particularly stressful times, perhaps in the initial stage of treatment or at a time of crisis. Those patients with thought disorders or hallucinatory experiences can be maintained only with appropriate antipsychotic medications.

It is not entirely clear why psychotropic medications work; yet, it appears that they reestablish balance within the chemistry of the brain. Behavior is determined through messages transmitted within the brain from one nerve cell to another through various chemicals. These chemicals are called neurotransmitters. Through the millions of nerve cells within the brain, chemicals trigger memories, sleep patterns, perceptions, feelings, moods and thoughts. The electric current that carries the messages are received by nerve ends, called synapses, which then release the neurotransmitter. These chemicals, in turn, propagate the message by stimulating the next nerves in line to send on the electrical message. Once used , the neurotransmitter chemical is returned and stored in the nerve end. This recycling process is called reuptake. When this signaling process goes askew, the effects are seen in a person's behavior and experienced in his emotions, perceptions, sensations, and ideas.

Although there are numerous chemicals that perform vital functions within the brain, three basic chemicals, or neurotransmitters, seem most critical in regulating this process and maintaining balance: serotonin, which is related to anxiety, depression, and aggression; dopamine, which affects reality perception and pleasurable experiences; and norepinephrine, which affects attention, concentration, and mood.

Medication is most helpful when there is clear disorder or, sometimes, a specific target symptom for a particular drug. Usually, a pattern of symptoms point to a specific chemical imbalance. Whenever an imbalance appears evident through a person's disordered behavior and emotional state, medication centers on modifying the strength of the signal or readjusting the balance among them. In psychopharmacology, the relationship looks as follows:

  • A group of drugs called selective serotonin reuptake inhibitors, or SSRIs addresses serotonin; the most widely known are fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Seroxat,Paxil),fluvoxamine(Faverin,Luvox).
  • Neuroleptics affect dopamine; the most commonly prescribed are fluphenazine (Prolixin), haloperidol (Haldol), chlorpromazine (Thorazine), and thioridazine (Mellaril).
  • There are many tricyclic antidepressants, or TCAs, which are typically prescribed to address both norepinephrine and serotonin; among the best known are imipramine (Tofranil), amitriptyline (Tryptanol,Elavil), desipramine (Norpramin), and nortriptyline (Nortrilen,Pamelor).
  • Atypical antipsychotics affect serotonin and dopamine; the most commonly prescribed are risperidone (Risperdal), clozapine (Clozaril), and olanzapine (Zyprexa).
  • Monamine oxidase inhibitors or MAOIs are prescribed to affected all three; the most commonly prescribed are phenelzine (Nardil) and tranylcypromine (Parnate).
  • Lithium carbonate is a naturally occurring salt that controls mood disorders by directly affecting internal nerve cell processes in all the neurotransmitter systems.
  • Anticonvulsants, such as valproic acid (Depakote) and carbamazepine (Tegretol), are also used for mood and aggressive disorders. Just how they work on neurotransmitters is not known, however.
  • Benzodiazepines affect another neurotransmitter system, GABA, which is involved in anxiety, alertness, and sleep. These include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium).
Usually, these drugs either increase the availability of these chemical and strengthen their messages, or decrease the availability of the chemicals, and weaken the signal.

The treatment of mental illness with medication can be complicated because the brain is a complex organ. Mental illness or emotional disorders are likewise complicated; often more than one condition exists simultaneously. Add to this the fact that each individual is unique and complex in his own way. As a result, it is often the case that finding the right medication and the right dosage is a painstaking process.

Usually, the process begins with a medical consultation. It is best if psychotropic medications are prescribed by a psychiatrist or psychopharmacologist, although many times, a general practitioner will write the prescription.

During the consultation, the physician will specify what disorder and which symptoms are to be addressed by the medication, and what the patient can expect in terms of benefits and side-effects. In addition, he will discuss how long treatment should last, what sort of follow-up will be given, and at what point or under what conditions medication will be adjusted or discontinued.

Before prescribing a specific medication, the physician will take a careful history, including information about previous physical illnesses or allergies, and any previous drug experience. The patient's physical health will be reviewed and a baseline mental status examination will be performed, against which progress will be measured. After the course of medication therapy has begun, the prescriber will review reaction and progress on a regular basis, making adjustments whenever necessary.

Of course, not all disorders should be treated with medications. For some patients, psychotherapy alone is sufficient to address their distress. For many, though, medications are the mainstay of treatment. Frequently, the combination of therapy and medication, at least initially, can mean the difference between living in this world or living trapped inside a psychiatric disorder.