Understanding Medication

Common Medication for Depression

Depression is commonly treated with anti-depressant medications. Anti-depressants work to balance some of the natural chemicals in the brain. These chemicals are called neurotransmitters and affect our mood and emotional responses. Anti-depressants work on neurotransmitters such as serotonin, norepinephrine and dopamine.

The most popular types of anti-depressants are called selective serotonin re-uptake inhibitors (SSRIs). These include:

  • Fluoxetine (Prozac)
  • Citalopram (Celaxa)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro)

All above are often used to treat panic disorder, OCD, PTSD, and Social Phobia (see below).

Other types of anti-depressants are serotonin and norepinephrine re-uptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine (Effexoer) and duloxetine (Cymbalta). Another anti-depressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.

SSRIs and SNRIs are popular because they do not cause as many side effects as other classes of anti-depressants. Older anti-depressants include tricyclics, tetracyclics and monoamine oxidase inhibitors (MAOIs). For some people, these still may be the best medications.

Side Effects of Anti-depressants

There are many side effects associated with anti-depressant medications ranging from headaches, nausea, drowsiness, agitation and sexual problems.

Some anti-depressant studies, have suggested that they may have some ‘unintentional’ effects, especially in young people. In 2004, the Federal Drugs Agency (FDA) looked at published and unpublished data on trials of anti-depressants that involved nearly 4,400 children and adolescents. They found that 4% of those taking anti-depressants had thought about or tried suicide (although no suicides occurred), compared to 2% of those receiving a placebo (sugar pill).

In 2005, the FDA decided to adopt a ‘Black Box’ warning label, the most serious type of warning, on all anti-depressant medications. The warning says that there is an increased risk of suicidal thinking or attempts in children and adolescents taking anti-depressants. In 2007, the FDA proposed that the makers of all anti-depressant medications extend the warning to include young adults up through age 24.

Anti-depressants commonly take 4-6 weeks to begin to relieve symptoms and the FDA warning also says that patients of all ages taking anti-depressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look out for at this time are depression that gets worse, suicidal thinking or behaviour, or any unusual changes in behaviour such as trouble sleeping, agitation or withdrawal from normal social situations.

An anti-depressant does not usually work straightaway. It can take 2-4 weeks before the effect builds up fully. A common problem is that some people stop the medicine after a week or so as they feel it is not helping. You need to give it time. Also, if it is helping, follow the course that a doctor recommends. A normal course of an anti-depressant lasts for at least six months after symptoms have eased. Some people stop their medication too early and the depression may then quickly return.

Anti-depressants are also used to treat anxiety, panic-disorder, obsessive compulsive disorder (OCD) and generalised anxiety disorder (GAD).

Although physical dependence is not such an issue, withdrawal can still be a concern. If discontinued too quickly, anti-depressant withdrawal can trigger symptoms such as extreme depression and fatigue, irritability, anxiety, flu like symptoms and insomnia.

Common Medication for Anxiety

Anti-depressants, anti-anxiety medications and beta blockers are the most common drugs used to treat anxiety disorders.

Anxiety disorders include:

  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalised anxiety disorder (GAD)
  • Panic disorder
  • Social phobia

Medication is used to treat anxiety and can relieve some symptoms, but they also come with side effects and safety concerns. They can be very effective but should not be thought of as a cure, providing only temporary relief and not treating the underlying cause. Once the drug is stopped, the anxiety symptoms often return in full force.

It is important to be aware of the risks of anxiety medication, as they can cause a wide range of unpleasant and sometimes dangerous side effects. Many medications for anxiety are also habit forming and physically addictive, making it difficult to stop them once started.

Anti-anxiety drugs, also known as tranquilisers, work by slowing down the central nervous system by reducing brain activity. Their relaxing and calming effects have made them popular. Anti-anxiety drugs are the most widely prescribed type of medication for anxiety, but they are also prescribed as sleeping pills and muscle relaxants.

BENZODIAZEPINES are the most common class of anti-anxiety drugs. They include:

  • Alprazolam (Xanax) – panic disorder, GAD
  • Diazepam (Valium)
  • Clonazepam (Klonopin) – social phobia, GAD
  • Lorazepam (Ativan) – panic disorder

Benzodiazepines are fast acting – typically bringing relief within 30 minutes to an hour. Because they work quickly, they are very effective when taken during a panic attack or another overwhelming anxiety episode, but despite their potent anti-anxiety effects, they have their drawbacks.

Side Effects of Anti-Anxiety Medications

The higher the dose, the more pronounced the side effects become. However, some people feel sleepy, foggy and un-coordinated, even on low doses, which can cause problems with work, school and everyday activities such as driving. Some feel a medication hangover the next day.

Benzodiazepines are metabolised slowly, meaning the medication can build up in the body when used over long periods of time, resulting in over sedation. People who are over sedated may look like they are drunk.

Common side effects include drowsiness, lack of energy, clumsiness, slurred speech, depression, confusion, disorientation, dizziness, impaired memory and judgement, blurred or double vision, nausea, stomach upset.

These types of drugs are also associated with depression. Long term users are often depressed and higher doses are believed to increase the risk of both depressive symptoms and suicidal thoughts and feelings. Furthermore, benzodiazepines can cause emotional blunting or numbness. The medication relieves the anxiety, but also blocks feelings of pleasure or pain.

Paradoxical effects of anti-anxiety medicines

Despite their sedating properties, some people who take anti-anxiety medication experience paradoxical excitement. The most common reactions are increased anxiety, irritability and agitation. However, more severe effects are mania, hostility and rage, hallucinations, aggressive or impulsive behaviour.

Whilst rare, these adverse effects are dangerous and most common in children and the elderly.

Other types of medications for anxiety/panic

Many medications originally approved for depression have been found to relieve the symptoms of anxiety and are often preferred as the risk for dependency and abuse is smaller. As anti-depressants can take 4-6 weeks to take effect, there use is often limited to chronic anxiety problems that require ongoing treatment.

Common Medication for Heart Problems

BETA BLOCKERS are a type of medication used to treat high blood pressure and heart problems. However they are also prescribed off label for anxiety. Beta blockers work by blocking the effects of norepinephrine, a stress hormone involved in the fight or flight response. This helps control the physical symptoms of anxiety such as rapid heart rate, trembling voice, sweating, dizziness and shaking hands.

Because beta blockers don’t affect the emotional symptoms of anxiety such as worry, they are mostly used for phobias, particularly social phobia and performance anxiety. People often take them if anticipating a specific anxiety situation such as giving a speech.

Types of beta blocker:

  • Inderal (Propranolol)
  • Tenormin (Atenolol)

Side Effects of Beta Blockers

Light-headedness, sleepiness, nausea, unusually slow pulse.

BUSPAR (Buspirone) is a new anti-anxiety drug that acts as a mild tranquiliser. It relieves anxiety by increasing serotonin in the brain as like the SSRIs but also increases dopamine. Compared to traditional anti-anxiety medications it is slow acting, taking around 2 weeks to start working. However the advantages are that it is less sedating, does not impair memory, is not very addictive and the withdrawal effects are said to be minimal. This can make it a preferred choice for those with a history of substance abuse and older individuals. However, its effectiveness is limited, used mainly for GAD.

Anti-anxiety medication safety concerns and risk factors

Whilst the tranquilising drugs are relatively safe when taken occasionally and in small doses, they can lead to severe problems when combined with other substances or taken over long periods of time. Furthermore, some people have adverse reactions to any amount of anti-anxiety medication. They are not safe for everyone, even when used responsibly.

Taking anti-anxiety medication with alcohol, prescription painkillers or sleeping pills can be fatal. Dangerous drug interactions can also occur when taking anti-histamines, which are found in many over the counter cold and allergy medications. Anti-depressants can also heighten their toxicity. Pregnant women, those over 65 and people with a history of substance abuse are all at higher risk.

Common Medication for High Blood Pressure

In the medical world, a GP will look for a blood pressure reading to be around 120/80.

There are 5 main classes of medicines used to lower blood pressure:

  • Angiotensin-converting enzyme (ACE) inhibitors – captopril, perindopril, ramipril etc. side effects – irritating cough.
  • Angiotensin receptor blockers – candesartan, eprosartan, losartan etc. side effects -dizziness.
  • Calcium channel blockers – amlodipine, verapamil, isradipine etc. side effects - dizziness, facial flushing, swollen ankles, and constipation.
  • Diuretics (water tablets) – bendroflumethiazide, indapamide etc. side effects – gout, impotence.
  • Beta blockers – atenolol, bisoprolol etc. side effects – cold hands and feet, poor sleep, tiredness, impotence.

Common Medications for Insomnia

GPs are reluctant to prescribe sleeping tablets as they only relieve the symptoms and don’t treat the cause. In cases of long term insomnia, medication is unlikely to help. The smallest dose should be given for the shortest period of time, ideally, less than a week. They are addictive, even after a short-term course and should really only be given if the problem is severe, or causing great distress.

BENZODIAZEPINES are often used, which are tranquillisers designed to reduce anxiety, promote calmness, relaxation and sleep.

  • Temazepam
  • Loprazolam
  • Lormetazepam

Z MEDICATIONS are a newer type of drug but work in the same way, so if one type has been ineffective, the same will apply with any of the others.

  • Zopiclone
  • Zolpidem
  • Zaleplon

The common side effects are feelings of being hung over and drowsiness during the day, causing a caution with driving and operating machinery.

Common Medications for Type 2 Diabetes

Most common is METFORMIN to treat Type 2 (adult onset) diabetes. It is used to help diabetics respond normally to their own insulin, to keep blood sugar levels stable. Often used in combination with diet and exercise. Side effects include gut disturbance, nausea, diarrhoea, vomiting, abdominal pain, appetite loss, metallic taste in mouth.

INSULIN is used for Type 1 diabetes or when the body can no longer make its own insulin. This results in high sugar levels in the blood. Side effects include increased weight gain and appetite, sustained nausea and vomiting.

STATINS are also commonly prescribed in diabetes, to lower cholesterol, due to a greater risk of heart attack and stroke.

  • Atorvastatin (Lipitor)
  • Fluvastatin (Lescol)
  • Pravastatin (Lipostat)
  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)

Side effects include headaches, liver function issues, abdominal pain, constipation, flatulence, diarrhoea, vomiting, rashes, memory problems, increased risk of developing Type 2 diabetes.

Common Medications for Obesity

This type of drug works by altering metabolism, appetite or absorption of calories. Only Xenical (Orlistat) is currently approved by the FDA for long term use. Acomplia (Rimonabant) has been approved in Europe (at time of writing) but not yet received approval in Canada or the US due to safety concerns. In 2008, the European Medicines Agency recommended the suspension of the sale of Rimonabant as the risks were deemed greater than the benefits. A further drug, Meridia was withdrawn from the market in Canada and the US in 2010 due to cardiovascular concerns.

Side effects include frequent, oily bowel movements, oily leakage from the back passage, stomach pain and flatulence. These drugs are often seen as a last resort and many have been associated with medical complications as they contain substances that are related to amphetamines. It is considered that anti-obesity medications are not practical long-term solutions for people who are overweight. Yet a number of new drugs are in clinical trials as of October 2009.