Medication: Anti-psychotic, Anti-depressant, and Stimulant Medication: Medication: Anti-psychotic, Anti-depressant, and Stimulant Medication Ivor Weiner, Ph.D. Assistant Professor, Special Education California State University, Northridge & Director Family Focus Resource & Empowerment Center, CSUN Antelope Valley SELPA Family Conference March 10, 2007 www.ivorweiner.com www.csunfamilyfocus.com Adapted from a presentation by Weiner and Stockton (2004)


Slide2: DISCLAIMER The presenter is not a physician and the information provided in this handout and in this session is not intended as medical advice. This presentation merely presents information about medication and its intended use. All drugs, including alternatives to drugs such as vitamins or over-the-counter drugs should be administered under the supervision of a qualified physician.


Slide3: Finding the Right Mental Health or Medical Professional Differences between doctors and therapists Pediatrician Family Practice Neurologist Psychiatrist Therapist


Slide4: Some Tips for Finding the Right Professional 1) Ask for referrals from your therapist, general physician, or other treating health or mental health professional  2) Contact a professional referral service. These can be found listed under "Mental Health" in your phonebook, or under the specific heading of the type of professional for which you are searching. Professional organizations maintain referral lists of qualified therapists.


Slide5: 3) The best way to locate a therapist is through a recommendation from someone who has a problem similar to yours and has had a good experience with that particular therapist. 4) Scan the yellow pages. Look for certifications such as "Board Certified in Psychiatry" or "Board Certified in Pediatric Psychiatry." Those who specialize in Psychopharmacology may be a good choice.


Slide6: 5) Review the list of approved mental health care providers from your insurance company. 6) If you have a university within a reasonable driving distance, call their Department of Psychiatry. These psychiatrists are often on the cutting edge of research.


Slide7: 7) Try the following online databases: About Mental Health - State Mental Health Resources ADAA - Find a Professional Mental Health Net - Search for Clinicians  8) Many companies offer employee assistance programs that may be able to provide the names of psychiatrists. 9) Contact the California Psychiatric Association. 


The Human Brain: The Human Brain The human brain has 3 main neurotransmitters: serotonin, norepinephrine, and dopamine. These neurotransmitters send messages in the brain.


Psychotic Illnesses and Treatment: Psychotic Illnesses and Treatment Bipolar Disorder Dementia Schizophrenia These illnesses are treated by the use of anti-psychotic medications


How Anti-psychotic Medication Works: How Anti-psychotic Medication Works helps to correct an imbalance in the chemicals that enable to brain cells to communicate with each other contains D2 receptor blockers that interfere with dopamine, a neurotransmitter primarily associated with schizophrenia. www.healthyplace.com and (Fiorello, 2003)


The 2 Types of Anti-psychotic Medications: The 2 Types of Anti-psychotic Medications Conventional: introduced in the 1950’s, side effects included muscle stiffness, tremors, and abnormal movements. 1960’s: polypharmacy (the combination of anti-psychotic medications) was common; hoped to combat symptoms and reduce side effects. Atypical: introduced in the 1990’s, has different complex receptor activities and properties; just as effective as conventional but with less side effects. www.healthyplace.com and (Fiorello, 2003)


Conventional Anti-psychotic Medications: Conventional Anti-psychotic Medications Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Haloperidol (Haldol) Thiothixene (Navane) Trifluoperazine (Stelazine)


Conventional Anti-psychotic Medications Continued: Conventional Anti-psychotic Medications Continued Perphenazine (Trilafon) Thioridazine (Mellaril) www.about.com


Side Effects of Conventional Anti-psychotic Medications: Side Effects of Conventional Anti-psychotic Medications


Extrapyramidal (EPS) Side Effects: Extrapyramidal (EPS) Side Effects Tardive dyskinesia: a movement disorder causing uncontrollable movements of the tongue and face as well as jerking and twisting of other body parts. Neuroleptic malignant syndrome: a potentially fatal disorder involving severe muscle stiffening, fever, sweating, high blood pressure, delirium, and sometimes can induce a coma. Parkinson’s like symptoms www.webMD.com


Atypical Anti-psychotic Medications: Atypical Anti-psychotic Medications Aripiprazole (Abilify) Risperidone (Risperdal) Clozapine (Clozrail) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) www.about.com


Side Effects of Atypical Anti-Psychotic Medications: Side Effects of Atypical Anti-Psychotic Medications


EPS Side Effects of Atypcial Anti-psychotic Medications: EPS Side Effects of Atypcial Anti-psychotic Medications Only Clozapine causes an EPS effect called Agranulocytosis: a decreased number of white blood cells. As a result, people must have regular blood tests. (Lalonde, 2003) and www.webMD.com


Efficacy and Effectiveness: Efficacy and Effectiveness Efficacy is defined as the “ability of an intervention to produce the desired beneficial effect in expert hands and under ideal circumstances”. Effectiveness is defined as the “ability of an intervention to produce the desired beneficial effect in actual use”. The efficacy and effectiveness of atypical Anti-psychotic medications far out weigh the efficacy and effectiveness of conventional medications.


Clinical Effectiveness: Determining if Medication Works: Clinical Effectiveness: Determining if Medication Works 4 domains Domain 1: efficacy (performance in ideal settings) Domain 2: tolerability and safety Domain 3: function including daily activities and quality of life Domain 4: acceptability for both the patient and care provider as well as compliance


Clinical Effectiveness of Atypical Anti-psychotic Medications: Clinical Effectiveness of Atypical Anti-psychotic Medications The clinical effectiveness of all the atypical Anti-psychotic is far superior to its conventional counterparts. Clozapine is the only exception and needs to be determined on a case by case basis. (Lalonde, 2003)


Implications for Parents: Implications for Parents Understand the symptoms Plenty of information available on the various types of medication Understand the side effects and how life with or without medication will impact your family No known alternative for treatment Consult your physician


How Anti-depressant Medication Works: How Anti-depressant Medication Works The current belief as to the cause of depression is low levels of the neurotransmitters dopamine, serotonin, and norepinephrine. Medication boosts these levels.


Types of Anti-depressant Medication: Types of Anti-depressant Medication Monoamine oxidase inhibitors (MAOIs) Tricyclics (TCAs) Selective serotonin reuptake inhibitors (SSRIs) Serotonin and noradrenaline reuptake inhibitors (SNRIs) Each type works differently


Anti-depressants: MAOIs: Anti-depressants: MAOIs Common Monoamine Oxidase Inhibitors include: Nardil & Parnate After sending messages to the brain, the 3 neurotransmitters get burned by by a protein called monoamine oxide, so MAOIs block that “burn up” activity www.webMD.com first introduced in the 1950’s not considered a first line of treatment due to the dangerous interactions with some food and most other medications (your physician can give you a list)


Anti-depressants:TCAs: Anti-depressants:TCAs Common Tricyclics include: Amitriptyline (Elavil), Imipramine (Janimine), Doxepin, Marotiline (Ludiomil), and Desipramine (Norpramin) Beefs up levels of norepinephrine and serotonin which allows the flow of nerve impulses to return to normal www.webMD.com introduced in the 1950’s as well no negative interactions with other medications www.healthatoz.com have been found to be more effective than SSRIs (Parker, 2002)


Anti-depressants: SSRIs: Anti-depressants: SSRIs Common Selective Serotonin Reuptake Inhibitors include: Zoloft, Luvox, Fluoxetine (Prozac), Paxil, Paroxetine (Seroxat), and Celexa Targets serotonin Reuptake means reabsorbing and inhibitor means interfere, so SSRIs reabsorb the serotonin thereby boosting its levels in the brain Introduced in the 1980s Have been dubbed “ happy pills” Better tolerated than tricyclics Less cardiotoxic in over dosage No negative interactions with other medications www.healthatoz.com and www.webMD.com


Anti-depressants: SNRIs: Anti-depressants: SNRIs Common Serotonin and norepinephrine reuptake inhibitors include: Ventlafaxine (Effexor), Reboxetine (Edronax), Miratazapine (Zispin), Escitalopram (Cipralex), Flupentixol, Tryptophan Introduced in the late 1980’s No listed side effects or interaction dangers with other medications (Gillam, 2004)


Side Effects of Anti-depressants : Side Effects of Anti-depressants


Treatment Resistant Depression (TRD): Treatment Resistant Depression (TRD) Defined in 1974 as depression that fails to respond to a standard course of antidepressants Several options exist for combating TRD Augmentation: Lithium, Thyroid hormone, Anti-psychotics Changing Anti-depressants: changing within the same family, changing from SSRI to another family (SNRIs, MAOIs, TCAs) Combining Anti-depressants (Pridmore and Turnier-Shea, 2004)


Problems with Anti-depressants: Problems with Anti-depressants Once Anti-depressants have been demonstrated safe for humans, they are tested again and prove to be better than placebo in at least 2 different studies. Many medications have been terminated due to failed trials, but after years on the shelf have been reintroduced. (Blier, 2004)


More Problems with Anti-depressants: More Problems with Anti-depressants It is unlikely that a single agent will ever be effective in all depressed patients. (Blier, 2004) Oct. 2004- FDA concluded that Anti-depressant medication can increase the risk of suicidal thoughts- www.webMD.com


Alternatives to Anti-depressant Medication: Alternatives to Anti-depressant Medication Psychotherapy-talking about the causes and feelings of depression Electroconvulsive therapy (ECT)- electronic current used to produce seizures which is believed to release chemicals that aid in nerve communication Brain implants provide and electrical shock or impulse


Implications for Parents: Implications for Parents Know the symptoms Understand how the medication works and how it may or may not interact with other medications Understand the side effects Investigate the alternative forms of treatment Consult your physician


Traditional Treatment for ADHD: Traditional Treatment for ADHD Psychostimulant medication has been the first choice of treatment by the medical profession. Several studies have established stimulant medication as being effective in approximately 70% of patients with ADHD. (Szymanski, 2001)


How Stimulant Medication Works: How Stimulant Medication Works It enhances the activity of catecholamine neurotransmitters. The main areas of the brain that are affected are the reticular activating system, limbic system, and the prefrontal cortex. (Hickey & Fricker, 1999) Simply put: these stimulants are given to stimulate the brain activity in the parts of the brain controlling attention, arousal, and inhibitory processing; therefore, providing the jump start for the brain to exercise more control in these areas.


How Stimulant Medication Works continued: How Stimulant Medication Works continued Stimulant medication is taken orally, in pill form. Once the onset of action has occurred, effects of the medication are rapid, with visible changes seen in behavior 20-60 minutes after ingestion. Peak action occurs around 90-180 minutes after ingestion. (Hickey & Fricker, 1999)


The 2 Types of Stimulant Medication: The 2 Types of Stimulant Medication Short Acting A rapid onset of action with effects lasting up to 4 hours Usually need more than 1 dose a day, typically given once in the morning and once in the afternoon Long Acting A slower onset of action Effects last much longer Only 1 dose is given a day


Stimulant Medications : Stimulant Medications Methylphenidate (Ritalin) Dextroamephetamine (Dexedrine) Cylert Tenex Focalin Concerta Bupropin (Wellbutrin) Adderall


Stimulant Medication Continued: Stimulant Medication Continued Ritalin and Dexedrine are both available in short and long acting forms. Concerta is a form of Methylphenidate (Ritalin) and has a 12 hr duration period, available in 18mg, 36 mg, and 54 mg doses. Wellbutrin is a Tricyclics Anti-depressant that helps combat poor sleep and appetite. Adderall is an Amphetamine and Dextroamephetamine (Dexedrine) combination, available as long acting only. (Szymanski, 2001)


Side Effects of Stimulant and Non-stimulant Medication: Side Effects of Stimulant and Non-stimulant Medication


Side Effects of Stimulant and Non-stimulant Medication Continued: Side Effects of Stimulant and Non-stimulant Medication Continued


Dangers of Stimulant Medication: Dangers of Stimulant Medication Research has found some negative side effects that produce psychotic symptoms. These symptoms include hallucinations, excessive speech, disjointed thinking, agitation, aggression, overfocus, anxiety, withdrawal, mania, and dysphoria. Research also stated that when taken off the medication the symptoms subsided. (Cherland & Fitzpatrick, 1999)


Dangers Continued: Dangers Continued Stimulant medication has similar pharmacological properties to cocaine. (Block, 2000) The use of stimulant medication is banned in Olympic sports competition. (Hickey & Fricker, 1999)


An Alternative Medication : An Alternative Medication Non-stimulant medication: different pharmacological properties than stimulant medication Only 1 non-stimulant is FDA approved: Atomoxetine HCI (Strattera) Strattera is a norepinephrine reuptake inhibitor (meaning it reabsorbs the norepinphrine in the brain). It is for children as young as 6 years old and can be given 1-2 times a day. It is available in 10mg, 18mg, 25mg, 40mg, and 60mg doses. www.strattera.com


Implications for Parents: Implications for Parents At this time, medication combined with cognitive behavioral therapy is the most effective form of treatment. There are potentially very serious side effects. It is important to understand the symptoms, and how life with or without medication will impact your family. Consult your physician.


Questions and Discussion: Questions and Discussion


References: References Anti-psychotic medication. (n.d) anti-psychotic medication. Retrieved November 3, 2004, from http://www.about.com Blier, Pierre. (2004). How many good antidepressant medications have we missed? Journal of Psychiatry and Neuroscience, 29 (4), 248-249. Block, M. (2000). ADD: Attention Deficit or nutrition deficit. Better Nutrition, 62, 42-46. Cherland, E. and Fitzpatrick, R. ( 1999). Psychotic side effects of psychostimulants: a five year study. Canadian Journal of Psychiatry, 44, 811-813. Fricker, P, and Hickey, G. (1999). Attention Deficit Hyperactivity Disorder CNS Stimulants and sport. Sports Medicine, 27, 11-21.


References Continued: References Continued Anti-depressant/Anti-psychotic medication. (n.d). Anti-depressant.psychotic medication.Retrieved November 3, 2004, from http://www.healthatoz.com Anti-depressant/Anti-psychotic medication. (n.d). Anti-depressant.psychotic medication.Retrieved November 3, 2004, from http://www.healthyplace.com Gillam, T. (2004). Managing Depression: an overview. Mental Health Practice, 7(9), 33-37. Lalonde, Pierre. (2003). Evaluating antipsychotic medications: predictors of clinical effectiveness .The Canadian Journal of Psychiatry, 48(1), 3-12. Parker, G. (2002). Differential effectiveness of newer and older antidepressants appears mediated by an age effect on the phenotypic expression of depression. Acta Psychiatrica, 106, 168-170


References Continued: References Continued Pridomre, Saxby & Turnier-Shea, Yvonne. (2004) Medication options in the treatment of treatment resistant depression. Australian and New Zealand Journal of Psychiatry, 38, 219-225. Samuel, Mathew et al. (2003). Switching patients to atypical oral antipsychotics: a retrospective audit of depot clinic at tenders. Journal of Mental Health, 12(5), 513-519. Szymanski, M. (2001). Attention Deficit/Hyperactivity Disorder: management. American Family Physician, 64, 135-149. Anti-depressants/Anti-psychotic medications. (n.d). Anti-depressants/Anti- psychotic medications.Retrieved from November 3, 2004, from http://www.webMD.com