To medicate or not?

There a a lot of people who don’t believe in medicating mental illness, in the hopes that a healthier lifestyle and perhaps herbal or nutritional supplements can work equally as well.  I believe this to be true in mild cases of for example depression (mild), but I also believe strongly that if you are not able to function normally you should seek medical (chemical) assistance, in conjunction with a healthy lifestyle, various supplements and psychological assistance (counselling).  I don’t believe you should attack it purely one way – try a number of things and find a combination that works well for you.

So besides trying to eat well and sleep well and exercise regularly, what medication am I on?

Escitalopram 20mg 2 in the morning

Escitalopram (Lexapro, Esipram) for generalised anxiety disorder and social anxiety disorder (social phobia)

  • Escitalopram is the first PBS-subsidised selective serotonin reuptake inhibitor (SSRI) for moderate to severe generalised anxiety disorder (GAD) and moderate to severe social anxiety disorder (SAD/social phobia).
  • GAD is excessive and uncontrolled worry about a number of events on most days for at least 6 months. SAD is fear and avoidance of social or performance situations.
  • The PBS listing of escitalopram does not cover mild anxiety states for which other forms of treatment are more appropriate.
  • Offer non-pharmacological therapies to all people with GAD and SAD, as these therapies can be effective.
  • Patients prescribed escitalopram on the PBS must have failed non-pharmacological therapies and have a GP Mental Health Care Plan, or have been assessed by a psychiatrist.
  • Start at a low dose and increase gradually over 2–4 weeks, if required.
  • Monitor patients carefully in the first few weeks of treatment for a transient worsening of symptoms.
  • GAD and SAD are chronic disorders. Patients who respond to escitalopram should continue treatment for at least 6 months.
  • Refer patients with refractory GAD or SAD to a specialist mental health service.

Place in Treatment:

Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and the active isomer of citalopram. SSRIs are a recommended initial pharmacological option for long-term treatment of anxiety disorders.3,4 Other antidepressants are indicated for GAD and SAD but are not PBS subsidised for these indications. Paroxetine and venlafaxine are TGA approved for both disorders, and sertraline for SAD.5

Evidence for the efficacy of escitalopram is limited to patients with a primary diagnosis of moderate to severe GAD or moderate to severe generalised SAD, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders — 4th edition (DSM-IV) (see Box 1). It does not relate to mildly anxious patients, for whom other forms of treatment are more appropriate.

Box 1: Generalised anxiety disorder (GAD) and social anxiety disorder (SAD, or social phobia)

Generalised anxiety disorder (GAD)Excessive and inappropriate anxiety and worry about several events or activities, more days than not, lasting at least 6 months.

Additional symptoms must include at least three of the following:

  • restlessness
  • easily fatigued
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance.6
Social anxiety disorder (SAD/social phobia)Marked, persistent and unreasonable fear of scrutiny by others and avoidance of social or performance situations in which embarrassment may occur.

Feared situations are usually avoided or endured with intense anxiety and distress.6

In severe cases, SAD causes significant interference with occupational, academic and social functioning and interpersonal relationships.

Two distinct subtypes of SAD exist:

  • generalised SAD (fear and avoidance of most performance and social situations) and
  • non-generalised SAD (fear of particular performance situations as well as several but not all social situations).6

Escitalopram was shown in trials to be more effective than placebo in reducing anxiety in more severe forms of GAD and SAD. There is no evidence that it is more effective than other SSRIs in these indications.

Psychological therapies, including cognitive behavioural therapy (CBT), are also an effective initial option for anxiety disorders.3,4,7–9 Consider escitalopram in conjunction with a structured plan of care for people with moderate to severe GAD or SAD who fail to respond to non-pharmacological therapies alone.

I take Escitalopram for my Obsessive Compulsive tendancies (Generalised Anxiety Disorder) and also for my mild Social Anxiety Disorder.  In fact it is not an issue for me very often anymore now that I am medicated.  The Obsessive Compulsiveness is still a real problem for me however, but I manage it as best I can and the meds help.

Lithium 450mg 1 in the morning 1 at night

Information specific to: Lithium carbonate 200mg modified-release tablets when used in Depression.

Lithium Carbonate (Lith-ee-um car-bon-ate) is a medicine which is used in depression, mania, bipolar disorder, self-harming behaviour and treating aggressive behaviour.

The information in this Medicine Guide for lithium carbonate varies according to the condition being treated and the particular preparation used.

Your medicine

Lithium Carbonate is used to treat a number of mental health problems that are thought to be due to a chemical imbalance in the brain. Lithium Carbonate affects the levels and activity of certain chemicals in the brain. Lithium Carbonate is used to treat mania, bipolar disorder, aggressive or self-harming behaviour. It is also given to people with certain types of depression when their previous treatments for depression have not been successful.

It is very important that you take the correct dose of . This is to make sure that the level of lithium in your blood is not too low or too high. Very high blood levels may lead to lithium toxicity. Levels of lithium in the blood can be altered by dieting or changes in your diet, fluid or salt intake; certain medicines, infections; or by changing brands. It is important you tell your prescriber or medical team if there are any changes in your circumstances that could affect levels of lithium as your dose may need to be adjusted.

Your prescriber will regularly monitor levels of lithium in your blood during treatment with Lithium Carbonate. They will also advise you of the symptoms you need to look out for, if levels of in the blood are high. If you develop any signs and symptoms of lithium toxicity, you must immediately seek medical advice. For more information about lithium toxicity and blood tests ask your prescriber or a member of your medical team.

During treatment with Lithium Carbonate it is important that you are well hydrated. You need to make sure that you are drinking enough fluid especially in situations where you could become dehydrated such as in hot weather or if you have an infection. Make sure you tell your prescriber if you have an infection. Your prescriber may need to adjust your dose or decide to temporarily stop your treatment with Lithium Carbonate.

Other information about Lithium Carbonate:

  • your prescriber will try to find the lowest dose of your medicine which can control your condition
  • if changing to a different brand or form of lithium, your dose may need adjusting. Your prescriber will monitor the levels of lithium in your blood and make dose adjustments

Do not share your medicine with other people. It may not be suitable for them and may harm them.

The pharmacy label on your medicine tells you how much medicine you should take. It also tells you how often you should take your medicine. This is the dose that you and your prescriber have agreed you should take. You should not change the dose of your medicine unless you are told to do so by your prescriber.

If you feel that the medicine is making you unwell or you do not think it is working, then talk to your prescriber.

My psychiatrist explained the use of Lithium to me like this : lithium amplifies the effects of other medications, especially anti-depressants and anti-mania medications.  I have to have my Lithium levels checked every 2 to 3 months which is annoying but the medication definitely helps, I am far more stable on it than before I began taking it, so I’m happy to continue on it.

Risperidone 2mg 1 at night

Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

I think it is fairly evident why I am on risperidone.  Occasionally if I am REALLY manic my doctor will increase the dosage for a while until I calm down, but generally I find 2mg/day is sufficient.

Nortriptyline 25mg 2 at night

Nortriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). Serotonin and noradrenaline are neurotransmitters — chemicals that relay signals between the cells in your brain. TCAs increase the amount of these two neurotransmitters in your brain, and this is how nortriptyline is thought to improve the symptoms of depression.

Nortriptyline is my basic anti-depressant.  I think of it as my rock.  Excellent anti-depressant that I wish I had have found much earlier than I did.  All’s well that ends well though so I will be staying on this one for well maybe ever.

Olanzapine 10mg 1 in the morning and 1 at night – if/when I am manic

Olanzapine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) in adults and teenagers 13 years of age and older. Olanzapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

I think of Olanzapine as my Respiridone Amplifier – it does a very similar job to Respiridone and I only take it when I am manic.  Usually just one per day but if it is ongoing sometimes 2 per day.

Side Effects of my Medication

The MAJOR side effect for almost every medication that I am on is weight gain, it hits you two ways – firstly it slows your metabolism and secondly it increases your appetite.  So it is extremely hard to manage my weight on these medications.  The single hardest part of managing my illness is my low self esteem that comes from the fact that I am no longer a thin person.  This feeds into my depression and it is a very difficult cycle of obsessive thinking to control.   In fact I’m obsessing now so I’ll stop talking about it.

There are other side effects but they are mild – a little nausea occasionally, drowsiness in general etc.  But the worst is what happens if you forget to take your medication.  If I forget I get the shakes really badly, I can’t think straight, I am wide awake and restless and just generally irritable.  It is so intense that I rarely forget to take them because I dread the side effects so much!

So that pretty much sums up my medication.  I sourced a lot of the info above from government and health websites.  Don’t take what is written here as gospel.  Always source your own information from a qualified health professional (most likely a psychiatrist).

Over and out

Em.

6 thoughts on “To medicate or not?

  1. Stacey cruse December 22, 2013 / 6:29 pm

    As you said earlier some people don’t believe in taking medications, I have to say at first I was scared when I was prescribed with medications but this day on I believe it was the best thing I’ve done, it had helped me to lead a normal life style without having to worry about anything or go through panic attacks.

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