All prescription drugs need labels before they leave the pharmacy. The people taking the medications do not.
So said Beverly Crockett, registered nurse and psychiatric nurse educator for the Louis de la Parte Florida Mental Health Institute at USF.
In the last 15 years, there has been a large increase in the number of people taking medications for mental illness. This is due to people being more accepting of mental illness, the availability of more medications and the ability of general practitioners to prescribe these drugs.
“People’s attitude toward mental health has changed,” said Denny Bennett, a pharmacist who works for Walgreens.
Crockett educates medical professionals on psychiatric medications. She said a person with a mental illness is often stereotyped into one large mass called “the mentally ill.” This calls to mind images of people who are violent or are having hallucinations, as depicted in movies or on television. Really, that person is no different than someone who has any medical condition, Crockett said.
“When someone breaks an arm, it’s something you can see. With a mental illness, it’s not so,” Crockett said.
It makes a mental illness harder to understand.
But people seem to be understanding it more and more. According to Bennett, looking at mental illness as a chemical imbalance has allowed people to be more open.
Crockett said the old label discourages people from getting the help they need. That help starts with a medical evaluation.
“The best thing to do would be to at least consider setting up an appointment with a psychiatrist or a mental health center. It can start with a primary care physician. The first step is to be evaluated,” Crockett said.
Part of the increase in people taking prescription medication is due to a recent shift in who is prescribing what, according to Bennett.
In the past, only psychiatrists could prescribe these drugs. Now primary care physicians, nurse practitioners and physician’s assistants can write many of these prescriptions.
Along with their accompanying advertisements, many new medications have entered the market. These medications, known as “new generation” medications, often offer more benefit than older psychiatric medications with a lower incidence of side effects.
“The role of medication is really to help someone to manage the symptoms of their mental illness,” Crockett said.
In Crockett’s educational materials, she lists six different categories of medications used to treat psychiatric disorders.
These are antidepressants, for the treatment of depression and other disorders (Elavil, Prozac); mood stabilizers, for the treatment of bipolar disorder and schizoeffective disorder (lithium, Tegretol); antipsychotics, for the treatment of schizophrenia, bipolar disorder and major depression (Thorazine, Haldol); antianxiety, for the treatment of antianxiety disorder and panic disorder (Xanax, Ativan); and psychostimulants, for the treatment of narcolepsy, Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder (Ritalin, Dexadrine, Adderall, Concerta); and antiparkinsonian for the treatment of the side effects of antipsychotic medications.
“A really good way to look at medications is to look at the symptoms they treat,” Crockett said.
For example, someone with major depression might be tired, not get enough sleep, over-eat, under-eat or have suicidal thoughts.
“They lose interest in what they used to be interested in,” Crockett said.
After taking the medication, they begin to feel less tired, have more energy and start to feel more like themselves, Crockett said. She said people often say that after they have been taking medication, they say things like “I didn’t realize how bad I was feeling.”
“It allows someone to be in therapy and get the most benefit out of it,” Crockett said. Crockett said she also recommends education.
“The more the person taking the medication learns about the medication and their illness, the better it is,” Crockett said.
There are some side effects to these medications. Some of the more common side effects are dry mouth, blurry vision, drowsiness, constipation, nervousness, weight gain and sexual dysfunction. Some medications have life-threatening side effects.
“They are pretty rare,” Crockett said.
For instance, lithium, which is used to treat bipolar disorder, can cause lithium toxicity, resulting in symptoms such as slurred speech, severe drowsiness, mental confusion and even coma. This is one side effect that can lead to death.
Drinking alcohol with these medications can also put people at risk, Bennett said.
People often suffer side effects when they stop taking the medications, he said. These can include shock-like symptoms or tingling sensations.
This is one reason people are often taken off their medications gradually.
Some people might be on their medication for six months, while others might take their medication for life. It depends on the illness and on the individual.
There are a few potential problems with the increase in people taking prescription drugs. One problem is that many people think that’s all they need.
Bennett said medications can’t be used to replace therapy. Bennett said that in some cases, people should think about what it is in their life that makes them unhappy.
“Medications are a crutch for people,” Bennett said, “(A) segment of the population subscribes to that.”
“Therapy in conjunction with medication is the best it can be,” Crockett said.
One potential problem with getting the appropriate help for a mental illness is cost, Bennett said. A lot of insurance companies only pay for a certain percentage of counseling or psychiatric visits. Medications cost quite a bit themselves. Most of the newer antidepressants can cost between $70 – $100. Some medications are also not covered by insurance.
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