Medication treatment

One concern that patients mention frequently is the confusion and worry about taking certain medications that fall into a class that sounds scary.

For instance, people with treatment-resistant depressive illnesses, as well as people with treatment-resistant anxiety disorders, may benefit from adding antipsychotic medications to their medication regimen.

At first blush, that wouldn’t seem to make any sense and could cause serious concern that I believe they have a psychotic disorder. However, as is the case in general medicine, our medications tend to be classified into whatever class they were first approved for, regardless of their mechanism of action and regardless of what later research shows they can effectively treat.

We ran into this with a blood pressure medication, propranolol, many decades ago. We have found that the mechanism of action, which is called a beta blocker, can reduce blood pressure and also can slow heart rate as well as stabilize nerve cells. We use this medicine, in much lower doses than we use to treat high blood pressure, to treat various tremors as well as some forms of stage fright.

We have found that certain older antidepressants, called tricyclics (because they have three benzene rings in their chemical formula), are also helpful to treat bedwetting and certain pain syndromes.

We have found that some antidepressants are effective in treating diabetic peripheral neuropathies.

An antidepressant, Effexor, has been shown to be effective in treating certain menopausal symptoms.

Some medications used to treat epilepsy are first-line treatments for bipolar disorder.

So that now brings me back to antipsychotics. They are classified as dopamine blockers, meaning that they block the nerve cell receptors that fit the dopamine neurotransmitter in various areas of the brain. This helps relieve psychotic symptoms of schizophrenia.

We have also found over the last 20 years that these medications, in lower doses, are very effective when combined with antidepressants to help treat residual symptoms of depressive and anxiety disorders.

In my practice, I have seen many patients respond very well to the addition of an antipsychotic medication to their antidepressant medicine and achieve full remission from their depression, even though they had no symptoms or any indications of any psychotic illness.

The same is true for some severe anxiety disorders, such as obsessive-compulsive disorder. The addition of an antipsychotic may help substantially with their internal obsessional thoughts.

So, if you or a loved one has a difficult-to-treat condition and their psychiatrist recommends adding an antipsychotic, instead of worrying, I would more likely recommend showing appreciation that they are up-to-date with current treatment modalities for some of our most difficult illnesses.

The brain is the most complex organ of the human body, and we work very hard to help treat the disorders that afflict that organ and the rest of the person. It’s time-consuming and challenging and requires meticulous care.

The results are worth it!

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.

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