"This is the book that should have been written years ago. It belongs on the shelf of every home, as well as every healthcare practitioner dealing with psychiatric medications. It is practical, up to date, well organized, easy to understand, and immensely useful. This, to me, is a must-have resource for today's mental health."
Daniel A. Hoffman, M.D., Neuropsychiatrist.
Medical Director, Neuro-Therapy Clinic, P.C.
Chief Medical Officer, CNS Response, Inc.
"I'm too pooped to be elegant. But, I'm not going to shut down the computer without saying a quick `thanks' for what appears to be a fantastic piece of work ... I HAVE to go to bed, but I could probably stay up just going from one page to the next."
Peter S, Child and Adolescent Psychiatrist
"I just wanted to write to thank you for all the effort you put in to writing your book on psychiatric medicines. I read widely, and your book is beyond doubt the best resource on the subject I have ever come across. Many thanks!"
Bill T, in the UK
"I am now reading your Medicines for Mental Health ... I just wanted to commend you on your exceptional writing skills. What a pleasure to read. Thank you!"
Vicky M
"[Y]ou're awesome ... You will never know how much your [advice] helped."
Rick W
Medicines for Mental Health
The Ultimate Guide to
Psychiatric Medication
Second Edition
Kevin Thompson, Ph.D.
www.mentalmeds.org
This book is intended to be a useful summary of information regarding treatments for mental illness. Although every effort has been made to provide accurate information, the author and publisher make no warranties that this book is free from error. Nor should the content of this book be construed as medical advice, as it does not recommend any medication, or combination thereof, for any medical problem. The purpose of this book is to provide information for use by patients and physicians in understanding, and selecting, treatments for the patient's illness. Self-medication by patients is not recommended, and the author denies all liability for any damage flowing, directly or indirectly, from actions taken based on information contained herein.
Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication. Second Edition. Copyright © 2007 by Kevin Thompson, Ph.D. (previously writing as Nom dePlume, Ph.D.).
All rights reserved. This book may not be reproduced in part or in whole without written permission of the author, except in the case of brief quotations used in reviews.
ISBN 1-4196-6954-0
Library of Congress Control Number: 2007903916
Publisher: BookSurge Publishing
North Charleston, South Carolina
Cover design by Kathrine Rend, Rend Graphics & Photography
This book is dedicated to
My wife and daughter, who fill my life with joy and meaning
The many good people, in discussion forums and elsewhere, who have
contributed their insight and feedback over the years
The doctors, nurses, therapists, and other healers
who dedicate their lives to helping those in need of healing
The scientists, researchers, engineers, and other workers
(from the administrative assistants and shipping clerks
up through the CEOs and venture capitalists),
whose ceaseless labor over decades has made it possible
for pharmaceutical companies to provide the medications
that we have come to take for granted
Contents
1 Introduction
1.1 Sources
1.2 Answers to Common Questions about this Book
1.3 The Chemicals at the Heart of the Brain
1.3.1 Dopamine
1.3.2 Gamma-Aminobutyric Acid (GABA)
1.3.3 Glutamate
1.3.4 Norepinephrine
1.3.5 Serotonin
1.4 The Bad Things that Happen with Good Medications
1.4.1 Side Effects and Withdrawal Effects
1.4.2 When Antidepressants Drive You Crazy
1.4.2.1 Mania
1.4.2.2 Suicide
1.4.2.3 Anxiety
1.4.2.4 Emotional Flattening
1.5 Important: Hormones and Endocrine Disorders
1.6 Diagnosis and Treatment of Mental Illness
1.7 Standard Treatments for Mental Illness
1.7.1 Therapy
1.7.2 Electro-Convulsive Therapy (ECT)
1.7.3 Medication
1.8 Looking to the Future
1.8.1 Correlation Methods
1.8.1.1 The Referenced EEG Method (rEEG)
1.8.1.2 Neurotransmitter Assessment
1.8.1.3 Comparison of rEEG and Neurotransmitter Assessment
1.8.2 Neurotherapy
1.8.2.1 Chiropractic Neurology
1.8.2.2 Neurofeedback
1.8.3 Conclusion
1.9 Advice for the Patient (and Impatient)
2 Depression
2.1 Causes of Depression
2.2 Treatments for Depression
2.2.1 Vagus-Nerve Stimulation (VNS)
2.2.2 Transcranial Magnetic Stimulation (TMS)
2.2.3 Deep Brain Stimulation (DBS)
2.2.4 Antidepressant Medication
2.3 Non-Prescription Antidepressants
2.3.1 Serotonin Precursors
2.3.1.1 Mechanism
2.3.1.2 Benefits
2.3.1.3 Principal Drawbacks
2.3.1.4 Medications
2.3.1.5 Brand Names
2.3.2 St. John's Wort
2.3.2.1 Mechanism
2.3.2.2 Benefits
2.3.2.3 Principal Drawbacks
2.3.2.4 Medications
2.3.2.5 Brand Names
2.3.3 SAM-e
2.3.3.1 Mechanism
2.3.3.2 Benefits
2.3.3.3 Principal Drawbacks
2.3.3.4 Medications
2.3.3.5 Brand Names
2.4 Monoamine Oxidase Inhibitors (MAOI)
2.4.1 Mechanism
2.4.2 Reversible MAO-A Inhibitor (MAO-RA)
2.4.2.1 Benefits
2.4.2.2 Principal Drawbacks
2.4.2.3 Medications
2.4.2.4 Brand Names
2.4.3 Irreversible MAO-B Inhibitor (MAO-IB)
2.4.3.1 Benefits
2.4.3.2 Principal Drawbacks
2.4.3.3 Medications
2.4.3.4 Brand Names
2.4.4 Irreversible MAO-A and MAO-B Inhibitor (MAO-IA,IB)
2.4.4.1 Benefits
2.4.4.2 Principal Drawbacks
2.4.4.3 Medications
2.4.4.4 Brand Names
2.5 Reuptake Inhibitors
2.5.1 Mechanism
2.5.2 Tricyclic/Tetracyclic Antidepressants (TCA)
2.5.2.1 Mechanism
2.5.2.2 Benefits
2.5.2.3 Principal Drawbacks
2.5.2.4 Medications
2.5.2.5 Brand Names
2.5.3 Selective Serotonin Reuptake Inhibitors (SSRI)
2.5.3.1 Mechanism
2.5.3.2 Benefits
2.5.3.3 Principal Drawbacks
2.5.3.4 Medications
2.5.3.5 Brand Names
2.5.4 Serotonin Antagonist/Reuptake Inhibitors (SARI)
2.5.4.1 Mechanism
2.5.4.2 Benefits
2.5.4.3 Principal Drawbacks
2.5.4.4 Medications
2.5.4.5 Brand Names
2.5.5 Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)
2.5.5.1 Mechanism
2.5.5.2 Benefits
2.5.5.3 Principal Drawbacks
2.5.5.4 Medications
2.5.5.5 Brand Names
2.5.6 Norepinephrine Reuptake Inhibitors (NRI)
2.5.6.1 Mechanism
2.5.6.2 Benefits
2.5.6.3 Principal Drawbacks
2.5.6.4 Medications
2.5.6.5 Brand Names
2.5.7 Norepinephrine/Dopamine Reuptake Inhibitors (NDRI)
2.5.7.1 Mechanism
2.5.7.2 Benefits
2.5.7.3 Principal Drawbacks
2.5.7.4 Medications
2.5.7.5 Brand Names
2.5.8 Noradrenergic/Specific Serotonergic Antidepressants (NaSSA)
2.5.8.1 Mechanism
2.5.8.2 Benefits
2.5.8.3 Principal Drawbacks
2.5.8.4 Medications
2.5.8.5 Brand Names
2.5.9 Serotonin Reuptake Accelerators (SRA)
2.5.9.1 Mechanism
2.5.9.2 Benefits
2.5.9.3 Principal Drawbacks
2.5.9.4 Medications
2.5.9.5 Brand Names
2.5.10 Dopamine Reuptake Inhibitors (DRI)
2.5.10.1 Mechanism
2.5.10.2 Benefits
2.5.10.3 Principal Drawbacks
2.5.10.4 Medications
2.5.10.5 Brand Names
2.6 Medications for Bipolar Disorder
2.7 Dopamine Agonists (DA)
2.7.1 Mechanism
2.7.2 Benefits
2.7.3 Principal Drawbacks
2.7.4 Medications
2.7.5 Brand Names
2.8 Stimulants
2.8.1 Mechanism
2.8.2 Benefits
2.8.3 Principal Drawbacks
2.8.4 Medications
2.8.5 Brand Names
3 Bipolar Disorder
3.1 Causes of Bipolar Disorder
3.2 The Role of Gamma-Aminobutyric Acid (GABA)
3.3 Treatments for Bipolar Disorder
3.4 Lithium
3.4.1 Mechanism
3.4.2 Benefits
3.4.3 Principal Drawbacks
3.4.4 Medications
3.4.5 Brand Names
3.5 Valproate
3.5.1 Mechanism
3.5.2 Benefits
3.5.3 Principal Drawbacks
3.5.4 Medications
3.5.5 Brand Names
3.6 Enzyme-Inducing Anti-Epileptic Drug (EIAED)
3.6.1 Mechanism
3.6.2 Benefits
3.6.3 Principal Drawbacks
3.6.4 Medications
3.6.5 Brand Names
3.7 GABA Analogs (GA)
3.7.1 Mechanism
3.7.2 Benefits
3.7.3 Principal Drawbacks
3.7.4 Medications
3.7.5 Brand Names
3.8 Miscellaneous Anticonvulsants
3.8.1 Mechanism
3.8.2 Benefits
3.8.3 Principal Drawbacks
3.8.4 Medications
3.8.5 Brand Names
3.9 Benzodiazepines
3.9.1 Mechanism
3.9.2 Benefits
3.9.3 Principal Drawbacks
3.9.4 Medications
3.9.5 Brand Names
3.10 Antipsychotics
4 Schizophrenia and Psychosis
4.1 Causes of Schizophrenia and Psychosis
4.1.1 The Dopamine Hypothesis
4.1.2 The Four Dopamine Pathways
4.1.2.1 The Mesolimbic Dopamine Pathway
4.1.2.2 The Mesocortical Dopamine Pathway
4.1.2.3 The Nigrostriatal Dopamine Pathway
4.1.2.4 The Tuberoinfundibular Dopamine Pathway
4.2 Treatments for Schizophrenia
4.3 The Dangers of Antipsychotic Medications
4.3.1 Tardive Dyskinesia
4.3.2 Diabetes
4.3.3 Neuroleptic Malignant Syndrome
4.3.4 QT Prolongation
4.4 Typical Antipsychotics
4.4.1 Mechanism
4.4.2 Benefits
4.4.3 Principal Drawbacks
4.4.4 Medications
4.4.5 Brand Names
4.5 Atypical Antipsychotics
4.5.1 Mechanism
4.5.2 Benefits
4.5.3 Principal Drawbacks
4.5.4 Medications
4.5.5 Brand Names
5 Sexual Dysfunction
5.1 Solutions for Sexual Dysfunction in General
5.1.1 Treating Sexual Arousal Disorders
5.1.1.1 PDE5 Inhibitors
5.1.1.2 PGE1 Vasodilators
5.1.1.3 Apomorphine
5.1.1.4 Yohimbine
5.1.2 Treating Sexual Desire Disorders
5.1.2.1 Hormone Therapy
5.1.2.2 Dopaminergic Medications
5.1.2.2.1 Bupropion (Wellbutrin)
5.1.2.2.2 Dopamine Agonists
5.1.2.2.3 Selegiline
5.1.2.3 Partial Serotonin Agonists
5.2 Antidepressant-Induced Sexual Dysfunction
5.3 Solutions for Dysfunction Caused by Antidepressants
5.3.1 Dose Time Change
5.3.2 Drug Holidays
5.3.3 Dose Reduction
5.3.4 Medication Change
5.3.5 Temporary Augmentation with a Serotonin Antagonist
5.3.6 Cholinergic Enhancers
5.3.7 Other Augmentations
5.4 Solutions for Problems Caused by Antipsychotics
5.5 Conclusion
6 Glossary
7 Medication Index
Preface
This book is for people who have a mental illness, or know someone who has a mental illness, and want to know about the types of treatment that are available. If you are one of these people, then read on. You will find more useful information here than you are likely to find anywhere else.
This book is also for medical practitioners and interested laypeople who may not specialize in psychiatric medications, but would like to have a good reference that covers the breadth of available treatments, at a useful depth. If you are a psychologist, therapist, general practioner, nurse, acupuncturist, chiropractor, or anyone else who works with patients who take these medications, you, too, will find more useful information here than you are likely to find anywhere else.
No book of this size can contain all useful information about treatments for mental illness. This is why I have created the companion Web site, Medicine for Mental Health, at www.mentalmeds.org. The book packs a great deal of information about how these treatments work, including information on over 100 medications, into a volume of modest size. It does so at the cost of being unable to provide detailed information about every single drug. The Web site picks up where the book leaves off, and provides the highly detailed information about each drug. Together, the book and the Web site accomplish the difficult task of making these medications understandable, providing the details on demand, and opening up an entire world of additional resources to those in need.
Welcome. Welcome to help, and welcome to hope. Welcome to Medicines for Mental Health.
Feedback and Advice
I hope you will find this book useful, and I would like to hear your thoughts about improvements. Please send your comments to
meds@mentalmeds.org.
I appreciate all messages, but the volume I receive makes it impossible, at times, to reply to every one of them. A more effective way to seek advice is to post questions on public discussion forums over the Internet. Many such forums exist. Here is a brief list of groups that I find informative, and in which I often participate (under the pen-name of Nom dePlume):
- alt.support.depression.medication
- Medication for depression.
- alt.support.depression.manic
- Medication and advice for bipolar disorder.
- alt.support.schizophrenia
- Medication and advice for schizophrenia.
These groups can be found through any standard news reader (Usenet client) program, such as Microsoft's Outlook Express. Alternatively, they may also be found through Google Groups at groups.google.com.