I’ve compiled a list of questions that I receive over and over again in the seminars and trainings I conduct, as well as in my clinical practice. Here’s hoping my answers help you if you use any of these medications or are a clinician counseling clients.
Q. Why do so many antidepressants seem to cause sexual dysfunction?
A. In addition to its antidepressant effects, serotonin is a rather powerful vasoconstrictor. It can restrict blood flow to sexual organs and negatively impact sexual performance, libido, and the ability to reach orgasm.
Q. What is the safety profile of the SSRIs?
A. From a “potential for overdose” perspective, they are actually incredibly safe. Death by SSRI overdose, according to some published reports, occurs in only about two out of every one million users.
Q. Are reports regarding “sleepwalking,” “sleep eating,” and “sleep-driving” with the sleeping pill Ambien true?
A. Yes, but the number of reported cases is still small. Nevertheless, some people using Ambien report objective evidence of having engaged in these behaviors with no recollection the next day of having done so.
Q. In relationship to OCD, what is “PANDAS?”
A. PANDAS are the acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. This is actually a subtype of pediatric OCD triggered by strep throat, in which the body’s own immune cells attack the basal ganglia within the brain rather than the strep. PANDAS OCD is usually consistent with the sudden onset of OCD symptoms, so if symptoms come on rather suddenly in a child typically between the ages of 4-10, PANDAS should be investigated.
Q. Why do so many psychotropic medications seem to cause weight gain?
A. Psychiatric medications that are linked to weight gain typically slow down the metabolism of carbohydrates 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. Will consuming alcohol prevent or diminish the potential positive effects of an antidepressant?
A. Given the complexity of individual biochemistry, the answer to this question is difficult to nail down, but it certainly depends on the quantity and frequency of alcohol use. A few studies indicate that any amount of alcohol— even just one alcoholic beverage—can lead to a diminished antidepressant response. I routinely recommend to those using antidepressants that they consume no more than two alcoholic beverages a week.
Q. Should adults take ADHD drugs?
A. Absolutely adults should take them. Seventy percent of those diagnosed with ADHD in childhood or adolescence go on to experience symptoms in adulthood. If untreated, these adults will struggle with distractibility and inattention throughout their entire lives, to some extent.
Q. Is bipolar disorder more difficult to diagnose in children than in adults?
A. Yes, bipolar disorder is actually very hard to diagnose in children, mostly because of the high incidence of multiple co-existing disorders with symptom overlap seen in children. The prime example of a coexisting condition with symptom overlap is ADHD. Two of the symptoms presumed to be evidence of a mood disorder (bipolar)—irritability and hyperactivity—are also key criteria for an ADHD diagnosis. Another issue complicating the diagnosis of bipolar disorder in children is that no consensus exists on how to measure symptom severity. If a child is perceived as disruptive, it could be that their behavior deviates wildly from the mean, or it could be that the diagnosing clinician is overly intolerant of unruly behavior.
Q. Does one particular antidepressant work best for someone just starting out?
A. No. Antidepressant selection for the first-timer is based on how the person’s depression presents, whether any co-occurring disorders are present and family history.
Q. Why do placebos work?
A. They work because the hope and confidence they create make it more likely that something will go better.
Q. Does bipolar depression differ from unipolar depression?
A. Yes, but only a little. Bipolar depressive episodes occur earlier in life and more frequently. However, both unipolar and bipolar depressions appear essentially the same on functional brain imaging.
Q. Does OCD respond to medication?
A. Medication tends to deliver paltry results in managing OCD. Exposure and response prevention techniques work best. Over 85 percent of those who stick with these techniques and practice regularly improve.
Q. What is Suboxone?
A. Suboxone is used to treat opioid dependence. It combines buprenorphine (a partial opioid activator) with naloxone (an opioid blocker).
Q. What is the highest aim for psychotropic medications?
A. Psychotropic medications perform at their best when they improve functioning, not feelings.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.