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To Take, or Not To Take: That is the Question… Medications for Psychiatric Illness

My psychiatrist wants me to take this medication. What should I do?

The term psychotropic, a way to describe medications used for the treatment of mental conditions, means that the medication affects or alters the activity of the brain. While the words affect and alter tend to have a negative connotation, the changes that occur in the brain from its exposure to these medications can have beneficial and long-lasting effects on your mental condition. They are used to treat mood, anxiety, psychosis, and many other psychiatric disorders.

Being honest with your psychiatrist about your symptoms is extremely important. While your primary doctor may diagnose your high blood pressure or diabetes by checking your blood pressure or blood sugar levels, psychiatry is limited in the amount of actual tests that we can perform. Some reversible causes of depression may be detected in the blood (for example, certain vitamin deficiencies or thyroid dysfunction) but the bulk of the diagnoses made in psychiatry require a careful examination of your clinical symptoms by a trained mental health professional. Being frank and open about your symptoms will allow your psychiatrist to diagnose you with the correct mental health condition and prescribe you the right course of treatment.

All medications, regardless of the condition they are intended to treat, are foreign substances to your body. This means that side effects may occur. Prior to starting a new medication, it is important to have a discussion with your psychiatrist about the most common side effects of the proposed treatment. Some may be slightly bothersome but temporary; your body’s reaction to the new substance flowing through your system. Other adverse effects may be longer-lasting and may lead to permanent changes.

Most psychotropic medications, like those used to treat depression and anxiety, are what we call “maintenance medications.” They do not work like the Tylenol or Motrin that you reach for when you have a headache and expect to relieve your pain within an hour or two. Maintenance medications must be taken on a daily basis, preferably around the same time every day, and as prescribed by your doctor. Over the first weeks of treatment, the medication will slowly build up to a therapeutic level in your bloodstream, allowing it to reach its full potential. Your doctor may choose to “start low and go slow” with the dose, letting the medication reach that therapeutic or effective level over some time. This approach will minimize possible adverse effects and ensure you end up on the right dose. In other words, the medication may take some time to fully work but it will prevent you from taking more medication than needed in the long term.

Taking your psychotropic medication on a consistent basis will allow you to improve sooner. Taking these types of medication “only when I am down or anxious” or “as needed” may not only prolong the duration of your symptoms but may also cause you to experience side effects from the constant re-exposure to the medication. And just because you are feeling better does not mean it is time to stop the medication. I always tell my patients to treat the psychotropic medication I prescribe as they would an antibiotic. What does your primary doctor tell you?: “Finish all your antibiotics as prescribed.” Prematurely ending a course of treatment with psychotropic medications may lead to inadequate treatment response, return of your symptoms, and even withdrawal symptoms from abruptly stopping the medication.

Your psychiatrist may decide to continue your medication for depression or anxiety some months past your return to baseline. This will guarantee that the brain chemistry imbalance causing your condition is adequately managed and addressed. Your doctor may then slowly decrease the dose, monitoring you for continued stability and any possible withdrawal symptoms. Other medications, for example those used for psychosis in schizophrenia or for mood stabilization in bipolar disorder, may require long-term treatment.

And what are withdrawal symptoms? Does this mean I am addicted to the medication? Remember, psychotropic medications alter the functioning of your brain with the goal of improving whatever symptoms that are affecting you. Addiction does occur with some psychiatric medications, especially with benzos like Valium and Xanax used for the treatment of anxiety. But other medications, like antidepressants, require a dose decrease prior to discontinuation to make certain those areas of your body that were sensitized by the medication are slowly “weaned” off it.

Finally, psychotropic medications are not for everyone. Your psychiatrist may decide that a course of psychotherapy and/or counseling may be more appropriate at first. Your doctor may also prescribe medication in conjunction with psychotherapy. Whatever the decision, remember that it will be based on the information gathered along your treatment. And in the case of your relationship with your psychiatrist… Honesty IS the best policy!

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

PTSD and Response to Traumatic Events in the Aftermath of the Boston Marathon Bombings, Sandy Hook and Other Recent Tragedies

Following recent traumatic events, such as the Boston Marathon bombings, the Sandy Hook massacre in Newtown, Connecticut, and other tragedies in the United States and around the world, it is imperative to address the importance of early recognition and treatment of acute and posttraumatic stress disorders.

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) may arise after direct exposure to a traumatic event, actual or threatened death of a family member or close friend, or repeated exposure to details about a traumatic event (1). Symptoms of ASD and PTSD are fairly similar and the distinction is largely based on the time frame to the beginning and duration of symptoms. Symptoms related to ASD last up to four weeks and must arise within one month of exposure to the traumatic event. In PTSD, the duration of symptoms is beyond 30 days. While your repeated exposure to details of a traumatic event from media coverage is not considered a cause of ASD and PTSD, the impact of graphic and violent images may affect people in different ways and may lead to temporary mood changes or worsen any pre-existing depressive or anxiety disorders.

The lifetime prevalence of PTSD in the United States adult population is estimated to be 6.8% (2). Women may be up to three times more likely to develop PTSD than men. Risk factors to develop PTSD, in addition to exposure to a traumatic event, include: being a female, having other mental illnesses (like depression and anxiety), having a family history of psychiatric illness, being a victim of abuse, or having a poor support system.

The following are key symptoms of PTSD but this condition may affect you in many different ways. Symptoms may also become severe enough to the point that they affect your day-to-day life and functioning.

Flashbacks or intrusive thoughts about the trauma

Nightmares or recurring dreams (about the trauma or with related themes)

Avoidance of memories or outside cues that remind you of the trauma (for example: blocking memories, avoiding conversations about the trauma, or driving the long way home to avoid the intersection where your car accident occurred)

Anxiety

Being easily frightened or startled

Sleep problems

Difficulty concentrating

Irritability or anger

Survivor’s guilt

Social isolation

Depression

Loss of interest in pleasurable activities

Feelings of detachment or numbness

Inability to fully express your emotions

Mistrust of others

Thoughts of suicide or suicide attempts

Early intervention following a traumatic event is important. For some people, talking about it with a family member or friend (“getting it off your chest”) may be enough. Others may need longer treatment with therapy and even medication.

Talk about your feelings: How safe do I feel? How has the trauma affected me? Am I afraid to leave the house? Am I self-medicating with drugs or alcohol? Why is my family so worried? What can I do?

The National Suicide Prevention Lifeline (1-800-273-TALK or 1-800-273-8255) is an excellent source of support. It is for people in crisis, not just if you are thinking of ending your life. When you dial Lifeline, your call is routed to the crisis center closest to your location. The call is free and confidential. Someone will be there to listen to you and to provide you with information on mental health services in your community.

Remember, there is no shame in seeking help. We all need a little push every now and then.

Be Smart. Be Safe. Be Healthy. Be Strong.

Until next time!

Dr. Felix

Trastorno de Estrés Postraumático a Consecuencia del Atentado del Maratón de Boston, Sandy Hook y Otras Tragedias Recientes

Después de acontecimientos recientes, como el atentado del Maratón de Boston, la masacre de Sandy Hook en Newtown, Connecticut, y otras tragedias en los Estados Unidos y alrededor del mundo, es imprescindible abordar la importancia de la detección temprana y el tratamiento de los trastornos de estrés agudo y postraumático.

El trastorno de estrés agudo y el trastorno de estrés postraumático pueden surgir después de la exposición directa a un acontecimiento traumático, muerte o amenaza de muerte de un familiar o amigo cercano, o la exposición repetida a los detalles de un evento traumático (1). Los síntomas del trastorno de estrés agudo y el trastorno de estrés postraumático son bastante similares y la distinción se basa en el tiempo transcurrido al inicio de los síntomas y a su duración. Los síntomas del trastorno de estrés agudo duran hasta cuatro semanas y deben surgir dentro de un mes después de la exposición al evento traumático. En el trastorno de estrés postraumático, la duración de los síntomas continúa más allá de 30 días. Mientras que tu exposición repetida a los detalles de un evento traumático difundidos en los medios de comunicación no se considera una de las causas de estos desordenes de estrés, el impacto de las imágenes gráficas y violentas puede afectar a personas de diferentes maneras y puede conducir a cambios temporeros de humor o empeorar algún trastorno depresivo o de ansiedad anteriormente diagnosticado.

La prevalencia del trastorno de estrés postraumático en la población adulta de los Estados Unidos se estima en 6.8% (2). Las mujeres pueden estar hasta tres veces más propensas a desarrollar este trastorno en comparación a los hombres. Los factores de riesgo para desarrollar el trastorno de estrés postraumático, además de la exposición a un evento traumático, son: ser mujer, tener otras enfermedades mentales (como la depresión y la ansiedad), tener un historial familiar de enfermedad psiquiátrica, haber sido víctima de abuso, o tener un pobre sistema de apoyo.

Los siguientes son los síntomas principales del trastorno de estrés postraumático, pero esta condición te puede afectar de muchas diferentes maneras. Los síntomas también pueden ser lo suficientemente graves como para afectar tu vida y funcionamiento diario.

Imágenes impactantes (“flashbacks”) o pensamientos intrusivos sobre el trauma

Pesadillas o sueños recurrentes sobre el trauma o temas relacionados

Evitar recuerdos o señales externas que te recuerden el trauma (por ejemplo, la represión de memorias, el evitar conversaciones sobre el trauma, o conducir el camino mas largo de regreso a casa para evitar la intersección donde se produjo tu accidente de automóvil)

Ansiedad

Asustarte fácilmente

Problemas del sueño

Dificultar a concentrarte

Irritabilidad o enojo

Sentimientos de culpabilidad como sobreviviente del trauma

Aislamiento social

Depresión

Pérdida de interés en actividades placenteras

Sentimientos de desapego o entumecimiento emocional

Incapacidad para expresar plenamente tus emociones

Desconfianza de los demás

Pensamientos de suicidio o intentos de suicidio

La intervención temprana después de un evento traumático es importante. Para algunas personas, hablar del trauma con un familiar o amigo (“sacárselo del pecho”) puede ser suficiente. Otras personas pueden necesitar tratamiento más prolongado con terapia e incluso medicamentos.

Habla de tus sentimientos: ¿Qué tan seguro me siento? ¿Cómo me ha afectado el trauma? ¿Tengo miedo de salir de casa? ¿Me estoy automedicando con drogas o alcohol? ¿Por qué mi familia está tan preocupada? ¿Qué puedo hacer?

La Red Nacional de Prevención del Suicidio (1-888-628-9454) es una excelente fuente de apoyo. Es para personas en crisis, no sólo si estás pensando en terminar tu vida. Cuando llamas a la Red, tu llamada será dirigida al centro de crisis más cercano a ti. La llamada es gratuita y confidencial. Un profesional de la salud mental estará disponible para escucharte y ofrecerte información acerca de servicios de salud mental en tu comunidad.

Recuerda, no hay vergüenza en pedir ayuda. Todos necesitamos un pequeño empujón de vez en cuando.

Se Inteligente. Se Precavido. Se Saludable. Se Fuerte.

¡Hasta la proxima!

Dr. Félix

 

Welcome to My Blog!

Hello Dear Reader:

Welcome to my blog!

I plan to address mental health issues: from stigma to advocacy, from medications to therapy, from conventional to alternative, from funny to serious, from hot topics to current events.

I hope you will find the content of my blog useful and educational.

Off to write I go!

Dr. Felix

¡Bienvenido a mi Blog!

Hola Estimado Lector:

¡Bienvenido a mi blog!

Tengo la intención de abordar temas de salud mental: del estigma al asesoramiento, de los medicamentos a la terapia, de lo convencional a lo alternativo, de lo serio a lo divertido, de temas calientes a acontecimientos de actualidad.

Espero encuentres el contenido de mi blog útil y educativo.

¡A escribir voy!

Dr. Félix