Q. Why do so many psychotropic medications seem to cause weight gain?
A. Psychiatric medications which are linked to weight gain typically slow down the metabolism of carbohydrate and fat. Also, some psychotropics, such as the antipsychotics Clozaril and Zyprexa, interfere with satiety. People taking these medications often continue to eat and eat – particularly sugars – without feeling full.
Q. Is Deplin an antidepressant?
A. No. Deplin is actually a folic acid derivative, specifically a methylfolate preparation. Depressed patients consistently have lower serum folate concentrations. Deplin helps normalize amounts of the neurotransmitters norpinephrine, serotonin and dopamine by aiding in the creation of these vitally needed neurotransmitters. Deplin is sometimes employed as an augmenting agent in those experiencing a suboptimum response to traditional antidepressants.
Q. What’s the chance that there will be some untoward and unintended consequences between alcohol and antidepressants?
A. This largely depends on the actions of the antidepressant prescribed, particularly the drug’s capacity for producing sedation. There is much less concern about additive sedation if alcohol is ingested in combination with a non-sedating antidepressant. On the other hand, combining alcohol with a sedating antidepressant may lead the individual to become more intoxicated than would otherwise be anticipated.
Q. How long does it take for Zoloft, Paxil, Effexor and Wellbutrin to take effect?
A. At least 50 percent of those who will eventually respond to the above mentioned antidepressants will begin to demonstrate improvement within one or two weeks of treatment initiation. Users most often report an increase in energy, productivity, a decrease in sensitivity (particularly to inappropriate comments from others) and anger. Remission of mood symptoms is tougher. Because depression is neurotoxic, this may span over an 8-12 week period.
Q. What Questions Should Clients Ask When Having a Psychiatric Medication Evaluation?
A. Many clients develop “white-coat brain lock” when it comes to asking questions – particularly on the first visit – because one of the most prevalent communication gaps is between doctors and patients.
On a 3×5 index card, have your client write down the following five questions and recommend that they ask these after the doctor has completed the initial assessment and has evaluated the client’s history and presenting symptoms:
- “What do you think is wrong with me?”
- “What might be causing this?”
- “What else could it be?”
- “Is there more than one treatment for my disorder?”
- “Would you please tell me about the medication(s) you’re prescribing for me?”
The average length of a general practice physician office visit nowadays is seven (7) minutes, so these questions often go unanswered due to the flurry of activity in doctor’s offices. Clients have to empower themselves to maximize the benefits of office visits. And an empowered client is usually a compliant client.
Q. When diagnosing depression in a client, how concerned should I be about identifying specific depression subtypes?
A. The important issue here is whether labeling a depression by subtype assists the clinician in treating the client more effectively. With few exceptions, the answer is NO. Subtypes are generally poor predictors of treatment response. There are some exceptions however. Seasonal Affective Disorder may respond to light therapy as well as antidepressants, and psychotic depressions all but always require antidepressant treatment augmented with antipsychotics.
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Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.