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Many behavioral health professionals do not prescribe drugs—you need a medical degree to prescribe.
But in order to develop effective treatment plans, practitioners should be aware when clients are using medications to treat anxiety, depression, and other mental health conditions.
This involves learning to untangle the marketing claims of the pharmaceutical companies from the real benefits and drawbacks of particular drugs.
What do we need to know about the impact of certain medications?
How do these drugs intersect with other treatment strategies?
And what’s with the novel‑length package inserts?
Psychopharmacology Basics
In the online Consortium on‑demand training series Psychopharmacology: Truth, Recovery, and Wellness, Dr. Charles Atkins demystifies the topic of psychopharmacology, providing a plain‑language overview of “psych meds” for clinicians.
Atkins was a board‑certified psychiatrist and the author of the medical thriller Elixir. His course includes a full disclosure that it includes interventions and modalities that are outside the authorized practice of mental health professionals.
His training covers what practitioners should know about these medications: how they work in the body, how to understand the claims made by pharmaceutical companies, and what clients can expect when they are prescribed a medication.
The course also explores the issue of adherence, personal choice, respect for personal priorities, and medication errors.
“Big Pharma” and Prescribers
There is no doubt that there is big money in pharmaceuticals. The companies are sometimes called “Big Pharma” because they spend billions every year advertising and promoting medications to prescribers and consumers. They also have lobbyists protecting their interests with legislation and federal regulatory bodies.
Atkins approaches the motives of these companies with a healthy dose of skepticism, asking “Which is more profitable: a cure or a treatment?”
He suggests looking at a peer‑reviewed journal to see just how many advertisements there are for pharmaceuticals.
He also points out that many solutions to behavioral health issues lie outside the pill bottle.
Wellness Basics
As part of a holistic way of looking at mental health, Atkins lists the following dimensions of wellness:
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Sleep
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Nutrition
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Exercise
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Social connections
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Meaningful pursuits
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Mental flexibility
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Humor
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Good hygiene
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Daily maintenance
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Repair and healing of the body, mind, and spirit
These are good reminders that pharmaceuticals are only a small part of what contributes to general wellness.
Safe Use of Pharmaceuticals
The Institute of Medicine reports that between 44,000 and 98,000 Americans die each year from medical errors. Some of those deaths are due to medication errors. There are ways to reduce these kinds of mistakes.
People who are prescribed drugs need to follow up regularly with doctors, including annual physicals and specialized care. They need to get blood work and lab tests done. And it’s important for care to be coordinated, so everyone’s on the same page with the treatment plan.
Patients can do their part by making sure they track pills with a pill tracker and verify drugs with health care professionals or pharmacists.
There are apps out there that can help identify pills, like AARP’s Pill Identifier.
It’s also a good idea for patients and behavioral health professionals to study the abbreviations you see on prescriptions. Here are a few common ones.
- Mg=milligram
- IU=International Unit
- QD=daily
- BID=twice a day
- TID=three times a day
- PRN=as needed
Reading the Fine Print
The tiny‑print package inserts for drugs are some of the most confusing pieces of literature you’ll encounter. For example, the package insert for the antidepressant Trintellix (vortioxetine) is 32 pages long. The ADHD stimulant Vyvanse (lisdexamfetamine dimesylate) is 39 pages.
Aside from taking out a magnifying glass and poring over the whole thing, what do behavioral health professionals and patients need to know?
Some of the most important information has to do with side effects, or adverse reactions. The package insert should have a table that compares the drug group to the placebo group from a clinical trial.
We’ve all seen the TV ads for various drugs where the narrator reads off a long list of possible side effects (usually while scrolling images of some amazing scenery). The package insert has that same information in a less‑glamorous form.
How Do They Know a Drug Works?
There are two main types of studies. The ones to trust are clinical investigations called placebo‑controlled double‑blind studies. These are the scientific “gold standard,” according to Atkins, and the ones that the companies use to obtain approval from the Food and Drug Administration (FDA).
Other types of studies, called open label or unblinded, are generally not as effective in determining if a drug actually works.
Classes of Psych Drugs
This article in Psychology Today gives a good overview of the major classification of psychotropic drugs, examples, and what conditions they are prescribed for.
- Antidepressants (escitalopram/Lexapro) are prescribed for depression, low energy, and insomnia.
- Antipsychotics (aripiprazole/Abilify and quetiapine/Seroquel) are prescribed for significant thinking disorders like psychosis and delusions. They are also used to stabilize mood.
- Mood stabilizers (valproic acid/Depakote and lithium) even out mood swings.
- Anxiolytics (lorazepam/Ativan) reduce anxiety.
- Hypnotics (zolpidem/Ambien) help people sleep.
- Psychostimulants (methylphenidate/Ritalin) are used to treat attention problems.
Understanding Antidepressants
Let’s take a closer look at antidepressants because their prescription is so common.
According to the Centers for Disease Control (CDC), one in 10 Americans aged 12 and over take antidepressant medications. Non‑Hispanic white people are the most likely to take them, and more females than males do.
When people are experiencing depression, they have symptoms that affect their emotions, thinking, energy level, sleep, and appetite. Psychology Today lists the following symptoms of depression:
- Sadness
- Loss of ability to feel interest or pleasure in everyday events
- Low self‑esteem and worthlessness
- Social withdrawal
- Irritability
- Excessive guilt
- Indecisiveness
- Energy, appetite, or sleep disturbances
Alarmingly, about two‑thirds of people with depression contemplate suicide, and 10% to 15% die from suicide.
Treatment for depression often involves psychotherapy, antidepressants, or a combination of the two.
The common antidepressants (Prozac, Zoloft, Lexapro, Effexor, Celexa, and Remeron) take about two to four weeks to start making changes in a person’s depression. They work by raising levels of the brain neurotransmitter serotonin. They bind to the brain’s receptors, which can help resolve some of the emotional distress.
But antidepressants don’t work for everyone, and they work better in conjunction with other forms of treatment.
Tips for Non‑Prescribers
Non‑prescribers like social workers, family therapists, and counselors are not the people who diagnose mental health conditions that require medications. They also aren’t the ones who can help if someone is having an adverse reaction. But non‑prescribers do play an important role in helping clients get attention if they are experiencing a problem.
Sometimes case managers, recovery specialists, or family members will reach out and say that a client looks or sounds unwell. Other times clients will say they don’t feel right, or say they had to visit the emergency room.
In the therapy room, you may notice differences in cognitive functioning, new symptoms, or changes in consciousness, as when they nod off or seem hyper or anxious.
You can help put them in touch with a medical professional who can prescribe, adjust, or switch them from one drug to another.
Knowledge Is Power
Pharmaceuticals can help people manage depression, anxiety, psychosis, and other serious mental health issues. But they’re not the only approach that works.
Even when you’re not the person doing the prescribing, it helps to understand some of the basic functions of psychotropic drugs, and to help clients grasp the importance of following their doctor and pharmacist’s instructions if they are taking medications.
When everyone is communicating and coordinating the approach to helping people, outcomes improve, and the result is greater overall wellness.
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