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Posts Tagged ‘
medications ’
Introduction
Nineteen million (or eight percent) of Americans could benefit from treatment for “an alcohol problem.” Although 2.4 million people are diagnosed with alcoholism, only 139,000 of them receive treatment with medications.
The most common form of treatment for alcoholism consists of group and/or individual therapy, including community self-help programs. Treatment can often be time consuming. For example, individuals are often encouraged to go to 90 meetings in 90 days or they are involved in structured group therapy three to five days per week at two to three hours per day. Often, people want to know, "Isn’t there a pill that can fix the addiction to alcohol?" Unfortunately, there is not a pill that can cure the addiction, but there are medications that can perhaps make it easier to effectively participate in treatment.
The Food and Drug Administration (FDA) has approved only three drugs in the past 55 years to treat alcoholism. Each of these drugs acts differently in the body to interrupt the addiction process. They are Antabuse, ReVia, and Campral.
For those with an alcohol problem, the oldest medication thought to “cure” the disease is Antabuse (disulfiram). Wyeth-Ayerst Laboratories Division first marketed Antabuse in 1948. This drug causes many unpleasant effects when the individual consumes alcohol, even in small amounts. The effects can range from facial flushing, headache and mild nausea to severe vomiting and increased blood pressure and heart rate.
The expectation is that as a person associates these negative symptoms with drinking, the individual will be less likely to want to drink another time. Usually, the threat of becoming ill after a drink of alcohol will deter most motivated people. However, the effectiveness of the drug depends mostly on the individual’s motivation for remaining abstinent.
While Antabuse will build up in the person’s system those who choose to resume drinking will simply stop taking the medication for a few days prior to consuming alcohol.
Another problem is that people have reported experiencing very mild reactions with the use of mouthwash that has a percentage of alcohol in it, foods with vinegar like salad dressings and ketchup, and certain colognes and aftershave. Your doctor should talk to you about what is best to avoid and what to experiment with in terms of over-the-counter products and medicines.
Antabuse should not be prescribed for people with cirrhosis or other chronic medical conditions, including heart disease or diabetes. Let your doctor make this decision. This drug should also not be prescribed for people over 60 years of age. Severe reactions to Antabuse have included heart attacks, and some cases have even resulted in death.
The FDA approved the use of ReVia (naltrexone) in December 1994 for the treatment of alcoholism. It was initially marketed by DuPont Merck Pharmaceutical company for treating narcotic dependency. ReVia blocks the parts of the brain that experience pleasure from drug/alcohol use.
Studies began to show that when used to assist with treating alcoholism, the drug helped to decrease cravings and relapse when it was used over a period of three to six months. The success of the drug, however, is likely dependent on a person's simultaneous involvement in a structured treatment program that can educate them on addiction, recovery, and relapse prevention behaviors.
The studies on ReVia and alcoholism treatment all occurred in settings that combined psychotherapy and psycho-education with the medication. Therefore, the FDA approved ReVia for alcoholism only as an adjunct to traditional supportive therapy. According to the FDA, “This drug is non-addictive but can cause liver toxicity if prescribed at doses higher than recommended.
ReVia is not recommended for people with active hepatitis and other liver diseases (www.fda.gov).” Side effects include nausea, headache, dizziness, fatigue, and sometimes vomiting and insomnia. This is a daily medication to be taken orally; however, a long-acting injection is being developed.
Campral (acamprosate) is the newest drug approved by the FDA to assist with alcohol abstinence. It was approved in July 2004 for marketing and distribution by Forest Pharmaceuticals, Inc. Though the exact workings of the drug are not understood, it is believed that Campral can restore imbalanced brain chemicals to a normal balance, thereby reducing cravings and thus relapses.
Campral is prescribed once someone has made the decision to remain abstinent and he/she is currently alcohol-free. The medication is most effective when combined with a structured treatment program that can teach relapse prevention skills, or provides social support, such as community self-help groups.
Campral has been used in Europe for over 10 years and has been shown to be useful for individuals with mild to moderate liver problems. Side effects have been reported as diarrhea, fatigue, nausea, gas, and itching. The most common side effect, diarrhea, usually resolves with time.
In all cases, a primary care physician or psychiatrist can prescribe and monitor the medications. Also, in all cases the recommendation is to use medication as a part of a comprehensive plan for treating addiction. The person with an alcohol problem should be willing to participate in some sort of supportive treatment program, ranging from community self-help groups like Alcoholics Anonymous / Narcotics Anonymous, Rational Recovery, etc, to a structured treatment program involving a combination of group and individual therapy and education. Recovering from addiction involves a lifestyle change. The medications can only assist in making the changes easier by reducing cravings and/or drinking behaviors so that you can focus on recovery.
Sources and Recommended Websites:
www.addictionrecoveryguide.org
www.fda.gov
www.medscape.com
www.niaaa.nih.gov
www.nida.nih.gov
Forest Pharmaceuticals, Inc. Campral Brochure. 2005.
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Tags: alcohol, alcoholism, Antabuse, Campral, drawbacks, Laura Buck, medications, resources, ReVia, side effects, therapy
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NOTE: The author is a licensed, clinical social worker who provides outpatient behavioral medicine services for children, adolescents, and adults.
Some of the most frequent questions I am asked by clients involve the use of antidepressant medications. Clients often either think that antidepressants don’t really work (“They just give those pills to anybody!”), that they should be able to feel better without any medication (“I don’t need a pill to feel OK!”), or that antidepressant medications are somehow dangerous and/or addictive.
While not everyone needs or would benefit from antidepressant medication, some individuals have depressions that will only respond to medication. The benefits of appropriately treating these depressions far outweigh any potential risks. The key lies in being able to identify who needs treatment with medication and who does not.
Recent years have seen remarkable breakthroughs in the science of psychopharmacology – the use of medications in the treatment of mental and emotional disorders. These advances are especially evident in the treatment of depression. However, the effectiveness of antidepressant medication depends on the specific type of depression and symptoms experienced.
Many individuals will experience what's generally thought of as a reactive depression at some point in their lives. This type of depression is a direct response to something that is obviously causing stress in a person's life. The depression can range in intensity from mild to severe, but basic physical functions such as sleep and energy levels remain relatively unaffected.
Others may experience a biological depression. With this type of depression there is obvious stressful or worrisome situation that can be identified as the cause of the person’s depression. This type of depression can result from medical illnesses, female hormonal fluctuations, medication and recreational drug use, or biochemical imbalances in the brain, which cause physiological symptoms.
These conditions can cause actual chemical changes in the brain, which affect specific areas of physiological function such as sleep cycles, appetite, energy levels, concentration/distractibility, and short-term memory. Attempting to “talk” or simply “will” these symptoms away is as incomplete a treatment as is attempting to control diabetes or high blood pressure without medication.
However, most depressed people suffer from a mixed depression. A mixed depression starts as a reactive depression. However, the person may soon develop the kind of physiological symptoms seen in biological depressions.
There have been significant advances made in recent years regarding antidepressant medications, and there are several effective and relatively safe alternatives available. All antidepressants work by altering levels of neurochemicals in the brain, but different "families" of medications act in different ways. (These medications are only available with a doctor's prescription.) Generally, the antidepressants affect one or more of the primary chemicals in the brain believed to be related to the symptoms of depression. These brain chemicals include norepinephrine, serotonin, monoamine oxidase, and dopamine.
One of the newer categories of antidepressants called selective serotonin reuptake inhibitors, or SSRI’s for short, have been widely used due to their relatively mild side effects and few drug interactions. The most common side effects of these drugs are nausea and an upset stomach, sleepiness, and problems with sexual function. However, these effects are generally mild and short-lived. None of the antidepressants are addictive, although there has been evidence of some people who abruptly stop taking their SSRI's rather than tapering off them experiencing some negative side effects for a relative short period of time (a few days).
A physician will prescribe an antidepressant based on a person's physiological symptoms. While antidepressant medication can be very successful in treating the physiological symptoms of a depression, it does not address any underlying sadness or sense of loss. For those symptoms, psychotherapy is the treatment of choice.
So, when my clients ask me about antidepressant medications, I try to provide them with the same accurate and complete information that I would expect to receive. I also tell them that, overall, antidepressant medications are safe and effective in the treatment of the physiological symptoms of depression and, when combined with psychotherapy, can often make all the difference in the world.
###The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Tags: antidepressant, Biological, Lesa Warren, medications, Mixed Depressions, options, Reactive, social worker
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Introduction
Depressive disorders affect approximately 19 million American adults, according to the National Institute for Mental Health. If you or someone you care for is suffering from depression, there are numerous options for professional treatment and help available, and much reason for hope.
Recent headlines focusing on the incidence of postpartum depression in celebrities has helped illustrate just how difficult yet common and treatable this disease can be. Given the stigma surrounding mental illness, recognition that depression is a disease is long overdue.
Many people have internalized some amount of bias regarding depression and mental illness. Many of us consciously or subconsciously harbor the belief that the problem stems, at least partially, from some failure on the part of the individual, as if suffering from depression were a choice. This stigma often interferes with reaching out for help and prolongs suffering.
Depression is often the result of a complex interplay between brain chemistry, environmental stressors and psychological factors. Symptoms of depression may include a persistent sad mood, loss of interest in previously pleasurable activities, a change in sleeping and/or eating patterns, irritability, loss of energy, feelings of worthlessness, excessive guilt, a sense of hopelessness, difficulty concentrating and recurrent thoughts of death or suicide.
Research indicates that individuals suffering from depression show the most improvement when they receive a combination of antidepressant medication plus psychotherapy (also called "Talk Therapy").
The effectiveness of the numerous anti-depressant medications available today is well documented. Having said this, unless a persistent or dire condition exists, medication need not be the first line of treatment.
A thorough psychological assessment by a qualified mental health professional to help determine the underpinnings of an individual's depression is an appropriate place to begin. Once this has been conducted, medication should be considered as only one possible component of a comprehensive treatment plan.
There are numerous talk therapy approaches available. These treatment techniques are documented to be effective in eighty percent of cases (NIMH).
- Insight-oriented treatments, designed to explore past psychological hurt often prove eye opening, liberating, and important to the resolution of depressive feelings.
- Behavioral techniques, designed not to revisit the past but to remain focused in the present, can help identify and modify current negative thought patterns that give generate depressive feelings prevent them from ending.
- Personal therapy can help relieve depression by helping clients work through relationship issues that often contribute to depression.
- Identification and expression of anger is often a key component of treating depression. Unexpressed anger may linger and haunt people in the form of low self-esteem, feelings of helplessness and irritability.
Many therapists use a multidimensional approach to combat depression, drawing from these and other methods.
Depression is a highly treatable disease that warrants professional intervention.
Don't isolate yourself, disregard how you're feeling or blame yourself. Reach out to whomever you feel most comfortable with, whether it is a friend, family member or professional. If you are feeling suicidal, go to or call your nearest emergency room immediately. There is nothing to be ashamed of – and everything to gain!
Books:
When Words Are Not Enough, by Valerie Davis Raskin, MD New York: Broadway Books, 1997.
Mind Over Mood, by Dennis Greenberger, PhD and Christine A. Padesky, PhD, New York: The Guilford Press, 1995.
Websites:
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How many times have you walked out of the house only to immediately return, convinced that you left the iron on, or forgot to lock all the doors?
It's only normal to occasionally forget something or to worry that you neglected to do something. If, however, these worries begin to overwhelm you, or cause you to repeatedly perform certain "rituals" to help keep your anxieties at bay, you may be suffering from Obsessive Compulsive disorder (OCD).
It is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors to help rid yourself of these thoughts (compulsions). The behaviors may include constant hand washing to eradicate "germs," counting certain objects over and over to make sure you have not lost any, keeping everyday items in precise order. Unfortunately, performing these rituals brings about only temporary relief from the crippling fear and anxiety. Likewise, not performing these rituals usually spells an increase in anxiety.
With OCD, it's as if your brain gets stuck on a specific image, thought, or urge, and can't move on, like a needle on a broken LP record. Among the more common obsessions: excessive worries about dirt and germs, a fear of having harmed someone else (perhaps while pulling the car out of the driveway) even though it's unrealistic, or a fear of yielding to violent urges.
People with OCD may recognize that their repetitive thoughts and behaviors are utterly senseless, but cannot free themselves from them. Often, they feel helpless and embarrassed and question their sanity. Others may not realize something is wrong. Actor Jack Nicholson was nominated for an Academy Award for his role as a New York writer and OCD sufferer in the 1997 film "As Good as it gets."
Experts once thought that OCD was rare, but it's now known to be more common than other mental illnesses such as schizophrenia and bipolar disorder. More than three million Americans from all walks of life have OCD.
If your parents or other relatives had OCD, the odds of you suffering are slightly higher. However, scientists have not identified any genes responsible for it. They are also divided on its origins, with some theorizing that its cause is biological, and others saying it springs from a learned behavior. Yet other experts believe it's a combination of both environmental and genetic factors.
Inadequate levels of serotonin, a chemical messenger in your brain, may also be to blame. OCD sufferers who take medicines that enhance the action of serotonin often improve greatly.
Some people who strive for perfection in all they do – maintaining an impossibly clean home, always finishing a work projects well ahead of schedule – may be considered compulsive. This is not the same as having OCD. Behaviors associated with OCD begin to interfere with everyday functioning, taking up time, and creating anxiety.
This is where a social worker can help you.. Often people plagued by recurrent thoughts and behaviors are ashamed to admit them. They fear being judged or labeled crazy if they confide, for example, that they are stuck on the same senseless thought or feel as though they must constantly scrub "germs" off a doorknob.
In a caring, non-judgmental environment, a social worker can assist you with determining whether it is indeed OCD and help you to formulate a treatment plan, possibly even referring you to a mental health professional who specializes in the disorder. While there is no specific laboratory test to confirm the disorder, a social worker can ask a series of key diagnostic questions about your obsessions.
A form of psychotherapy called cognitive behavioral therapy and antidepressant medications, often used together, are effective in treating OCD. Cognitive behavioral therapy involves retraining your thought patterns and routines so that your compulsions are no longer necessary.
Two types of antidepressants are used to treat OCD. These are: Selective Serotonin reuptake inhibitors (SSRIs) which enhance the brain's ability to use serotonin, a brain chemical that sends and receives messages and plays a crucial role in mood.
Yes. In fact, OCD usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents.
A young child with OCD, for example, may be terrified someone will enter his home at night through an unlocked door or window. While his parents sleep, the child may tiptoe around the house, checking all the doors and windows, a way of alleviating the anxiety. Fearing that he may have mistakenly unlocked a door or window in the process, he then begins checking all over again.
An older child or teenager with OCD may often worry that they will become sick with AIDS, germs, or contaminated food. To cope with these unsettling feelings, the child may develop "rituals" or behaviors or activities that they repeat, such as frequent hand washing, checking something again and again or keeping items or possessions in absolute order.
The rituals can also consist of mental acts like counting aloud, repeating words silently or avoiding certain things, like cracks on a sidewalk, or climbing over every other step in a staircase.
If your child's compulsions or obsessions interfere with her normal routine, for example, keep her from focusing in school, alienating her from her peers or hindering her from joining in on social activities, a consultation with a mental health professional is definitely in order .
Again, seeking the services of a social worker possibly even within the child's school system, is an excellent place to begin.. She will help in the diagnosis and possibly in the creation of an effective treatment plan.
Cognitive behavior therapy is considered to be especially helpful in for children and adolescents with OCD
Cognitive behavior therapy with a trained mental health professional is especially helpful, more so than antidepressant medication, which is also prescribed for children and adolescents.
Remember only a licensed physician can prescribe medication for your child's OCD.
For additional information, visit these sites:
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Introduction
If your child is suspected of having Attention-Deficit Hyperactivity Disorder (ADHD), the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/ behavioral pediatricians, behavioral neurologists, and clinical social workers. After ruling out other possible reasons for the child's behavior, the specialist checks the child's school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered.
For children with ADHD, no single treatment is the answer for every child. A child may sometimes have undesirable side effects to a medication that would make that particular treatment unacceptable. And if a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best. Each child’s needs and personal history must be carefully considered.
For decades, medications have been used to treat the symptoms of ADHD.The medications that seem to be the most effective are a class of drugs known as stimulants.
Some people get better results from one medication, some from another. It is important to work with the prescribing physician to find the right medication and the right dosage. For many people, the stimulants dramatically reduce their hyperactivity and impulsivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as that needed in handwriting and in sports.
The stimulant drugs come in long- and short-term forms. The newer sustained-release stimulants can be taken before school and are long-lasting so that the child does not need to go to the school nurse every day for a pill. The doctor can discuss with the parents the child’s needs and decide which preparation to use and whether the child needs to take the medicine during school hours only or in the evening and on weekends too.
If the child does not show symptom improvement after taking a medication for a week, the doctor may try adjusting the dosage. If there is still no improvement, the child may be switched to another medication. About one out of ten children is not helped by a stimulant medication. Other types of medication may be used if stimulants don’t work or if the ADHD occurs with another disorder. Antidepressants and other medications can help control accompanying depression or anxiety.
Several intervention approaches are available. Knowing something about the various types of interventions makes it easier for families to choose a therapist that is right for their needs.
Psychotherapy works to help people with ADHD to like and accept themselves despite their disorder. It does not address the symptoms or underlying causes of the disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior, and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change or better cope with their disorder.
Behavioral helps people develop more effective ways to work on immediate issues. Rather than helping the child understand his or her feelings and actions, it helps directly in changing their thinking and coping and thus may lead to changes in behavior. The support might be practical assistance, like help in organizing tasks or schoolwork or dealing with emotionally charged events. Or the support might be in self-monitoring one’s own behavior and giving self-praise or rewards for acting in a desired way such as controlling anger or thinking before acting.
Social skills training can also help children learn new behaviors. In social skills training, the therapist discusses and models appropriate behaviors important in developing and maintaining social relationships, like waiting for a turn, sharing toys, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to “read” other people’s facial expression and tone of voice in order to respond appropriately. Social skills training helps the child to develop better ways to play and work with other children.
Support groups help parents connect with other people who have similar problems and concerns with their ADHD children. Members of support groups often meet on a regular basis (such as monthly) to hear lectures from experts on ADHD, share frustrations and successes, and obtain referrals to qualified specialists and information about what works. There is strength in numbers, and sharing experiences with others who have similar problems helps people know that they aren’t alone. National organizations are listed at the end of this document.
Parenting skills training, offered by therapists or in special classes, gives parents tools and techniques for managing their child’s behavior. One such technique is the use of token or point systems for immediately rewarding good behavior or work. Another is the use of “time-out” or isolation to a chair or bedroom when the child becomes too unruly or out of control. During time-outs, the child is removed from the agitating situation and sits alone quietly for a short time to calm down. Parents may also be taught to give the child “quality time” each day, in which they share a pleasurable or relaxing activity. During this time together, the parent looks for opportunities to notice and point out what the child does well, and praise his or her strengths and abilities.
This system of rewards and penalties can be an effective way to modify a child’s behavior. The parents (or teacher) identify a few desirable behaviors that they want to encourage in the child—such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn’t. A reward can be small, perhaps a token that can be exchanged for special privileges, but it should be something the child wants and is eager to earn. The penalty might be removal of a token or a brief time-out. Make an effort to find your child being good . The goal, over time, is to help children learn to control their own behavior and to choose the more desired behavior. The technique works well with all children, although children with ADHD may need more frequent rewards.
In addition, parents may learn to structure situations in ways that will allow their child to succeed. This may include allowing only one or two playmates at a time, so that their child doesn’t get overstimulated. Or if their child has trouble completing tasks, they may learn to help the child divide a large task into small steps, then praise the child as each step is completed. Regardless of the specific technique parents may use to modify their child’s behavior, some general principles appear to be useful for most children with ADHD. These include providing more frequent and immediate feedback (including rewards and punishment), setting up more structure in advance of potential problem situations, and providing greater supervision and encouragement to children with ADHD in relatively unrewarding or tedious situations.
Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise, to increase their own tolerance for frustration so that they can respond more calmly to their child’s behavior.
Source: National Institute of Mental Health, www.nimh.nih.gov
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