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Introduction
Chances are good that because you are reading this book, either you or a family member has begun or is considering medical treatment for an emotional or psychiatric disorder. Our intention is to present a lot of practical, useful information in the hope of answering many of the questions you may have about psychiatric treatment. We believe strongly that everyone has a right to acquire important information about treatment and treatment options.
In the past, it was common practice for you to be examined by a doctor, given a prescription for a certain medication, told how to take it, and sent on your way. The arrangement was one of "powerful doctor" and "passive patient." As a result, many, if not most, patients felt inhibited about asking questions regarding their treatment.
Fortunately, times have changed, and in our view, it is not only legitimate for you to inquire about your treatment, it actually makes the most sense to informed consumers. Accurate information not only is your right but can enhance your treatment outcome and increase the likelihood of treatment success.
It is important for anyone receiving psychiatric medication treatment to know at the very least the following treatment-related information:
¥ What is the diagnosis?¥ What are the recommended treatments for this disorder?
¥ If psychiatric medications are recommended:
1. Are the recommended medications standard and well-established treatments?
2. Are the particular medications addictive?
3. What can you expect from the medical treatment? This should include the following: (a) What are the common side effects? (b) Are any of theside effects dangerous? (c) How long must you wait to notice the positive benefits of the medication? (d) Are there any potential drug-drug interaction problems? (That is, is it dangerous to take this medication along with other prescription or over-the-counter drugs?) (e) Can you drink alcohol while taking this medication?
4. Assuming that the medication is effective for you, how long will you have to take it?
5. Are there any dangers in taking this medication for an extended period of time?
¥ Is psychotherapy recommended in addition to medication?
Of course, additional questions may come up that will be important to address, and we encourage you to assert your right to inquire about any aspect of your treatment.
Possibly as many as 85 percent of all prescriptions for psychiatric medications are written by primary care and family practice doctors. And, as you well know, a typical office visit with a doctor is brief. It may be difficult, if not impossible, to ask all of your questions during such a short visit. Also, if you are like most of us, other questions may come to mind after your visit to the doctor or in the days that follow. It is our hope that this book will address many of those concerns.
The Spectrum: From Having a Bad Day to Having a Nervous BreakdownIn the chapters that follow we will be writing about several common emotional and psychiatric problems. Some of these disorders are serious but fairly rare (e.g., schizophrenia). Many, however, are common, especially depression and anxiety disorders. It is important to understand that among these disorders, a great deal of variability exists with regard to severity. Most of us experience occasions of mild depression or anxiety. These times may last only a day or two, or they may be present for longer periods, causing discomfort but not debilitation. Sometimes however, anxiety and depression can become extremely severe.
At this severe end of the spectrum, these disorders may become all consuming and have the potential to ruin a person's life. Not only is there great personal and emotional suffering, but there also can be a collapse into a sort of paralysis and a total inability to function. Dysfunction may take the form of fearfulness that is so intense the person cannot leave home or be left alone: or depression so engulfing that the person is literally bedridden. Depression can also cause such an extreme disorganization of thinking that the individual is convinced he or she is going crazy.
While a number of people can and do experience serious, chronic psychotic illness, the percentage of such disorders in the general population is only about 1 percent. A much higher percentage of people go through very serious bouts of anxiety and depression that result in significant dysfunction. At the extreme end of this spectrum, these emotional disorders are what some of us grew up calling a "nervous breakdown" or "mental breakdown." Furthermore, these disorders can and do happen to many people who have gone through much of their lives functioning quite well. In fact, such grave versions of these kinds of psychiatric reactions can, under certain circumstances, strike otherwise mentally healthy individuals (as is often the case with bipolar disorder or post-traumatic stress disorder).
The good news is that current treatments for psychiatric disorders have a well-established record of effectiveness. The bad news is that many people suffer and never seek treatment. It is critical to understand that emotional and psychiatric problems are very common, that most problems can be treated successfully, and that someone suffering from such a problem can take action by seeking treatment.
How to Use This Book
This book is divided into two parts. Part One consists of Chapters 1 through 12, which discuss psychiatric diagnoses and the specifics of medication treatment. Part Two is a compendium of psychiatric medications and provides detailed information on specific medications.
The first four chapters of this book address some general issues to help you learn more about the use of psychiatric medications. Our clients routinely ask about specific issues that relate to psychiatric diagnosis, the biology of emotional illnesses, and how medications work. Thus, we have attempted to speak to many of these concerns.
What follows are chapters devoted specifically to groups of psychiatric disorders such as depression, anxiety disorders, and others. In each of these chapters we provide a great deal of specific information about treatment, including the following:
¥ Signs and symptoms
¥ How the diagnosis is made
¥ The role of a medical evaluation in diagnosis
¥ Theories about the biology of the disorder (to help explain how medications appear to work)
¥ Specifics of medical treatment, for example: (1) standard medical treatments, (2) details regarding treatment (e.g., recommended doses, what to expect, common side effects), (3) precautions, (4) treatment options when first-line treatments are ineffective
¥ Frequently recommended nonmedical treatments (e.g., types of psychotherapy)
Self-help references (books and support groups) can be found at the back of the book.
As is the case in all areas of medicine, there are several generally accepted, standard treatments for any particular disorder or disease. Rarely is only one approach or one medication the treatment of choice. This is certainly the case in the treatment of psychiatric disorders. Thus, this book presents the major points regarding standard psychiatric treatment for each particular disorder.
Treatment decisions will be influenced by several unique factors (particular symptoms, one's age, medical status, and so forth) and may vary from person to person. We provide general information about all the available treatments because we strongly believe that people have the right to know as much as possible about their disorder and its treatment. However, be advised that particular treatment decisions will be unique for each individual.
Although we recommend that you read Chapter 1 for some background, it is also fine to skip ahead and turn to the particular chapter that is relevant to your current concerns.
Life Is Hard
We, the authors, do not know of anyone -- friends, family, our patients, and ourselves -- who has not been through difficult times, often very difficult times. Life brings joys and blessings, as well as hardships. All of us are entitled to find ways to reduce suffering for ourselves and for our loved ones. Sometimes, professional help can be a godsend, whether in the form of counseling or as treatment with psychiatric medications. Too many people suffer needlessly, either putting off seeking treatment or rejecting such options outright. We encourage our readers to take action to reduce emotional suffering. We also encourage you to become knowledgeable about currently available treatment choices. This is your right.
Copyright © 2000, 2003, 2009 by John D. Preston Psy.D.,Mary C. Talaga, R.Ph., Ph.D., and John H. O'Neal, M.D.
