We are pleased to share a Q&A with Gale Garmong, PharmD.
Quiet Storm: What is the general attitude toward prescriptions for mental illness in the health field today?
Gale: I would say they generally are treated like prescriptions for any other health condition, and seeing them is not uncommon: 6 of the top 25 drugs dispensed in the US are for mental health conditions.
QS: What are some of the most commonly prescribed and/or successful medications for mental illnesses?
G: Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are the first-line therapies for depression and anxiety disorders. Atypical (or second generation) antipsychotics may be used in several conditions, including schizophrenia, bipolar disorder, and depression. Mood stabilizers (anti-seizure drugs or lithium) are typically the drugs of choice in bipolar disorder. Your doctor will likely discuss several factors with you when choosing a medication, though, including your age, pregnancy status/plans, other health conditions and medications, personal or family history with medications, your lifestyle and preferences, and insurance coverage/cost. Your pharmacist can also offer insight and help you understand how to best take your medications and what to expect in terms of benefits and risks.
QS: How important is a regular medication schedule for treating mental illness?
“Adherence” to the medication regimen that you and your doctor decide on is extremely important. In the words of Dr. C. Everett Koop (former surgeon general) “Drugs don’t work in patients who don’t take them.” Also, suddenly stopping many of these medications can lead to serious withdrawal symptoms. Fitting in taking medications as a part of your normal routine before or after other regular tasks may help you to remember. Your pharmacy may offer an app with medication reminders or special packaging to help organize your medications by when they should be taken, or they may be able to offer suggestions if cost is a barrier. They may also offer services like delivery or medication synchronization (where your medications are automatically filled on the same schedule each month) to make obtaining your meds easier.
When starting a new medication, keep in mind that while you should see some improvement after a week or so, sometimes the full effects of these medications will not be seen for 4-6 weeks, and often these medications require starting at a lower dose and working up (titration). Try not to get discouraged even if you are not feeling better then; you may respond differently to different medications, and finding the right one sometimes takes trial and error. (Perhaps less so in the future with the dawn of precision medicine and pharmacogenomics.) The important thing is honestly discussing your progress and sharing concerns with your doctor.
Occasionally people will have minor side effects like upset stomach or headache when starting these medications, but these may go away after a few weeks. If these or other side effects persist or make you unwilling to take the medication long-term, be sure to discuss them with your doctor. (Again, don’t stop taking the medication without checking with your doctor; they may want you to taper down to prevent withdrawal.) Seek immediate attention for thoughts of harming yourself or others.
QS: What are some factors or substances that can alter successful medication?
G: Alcohol, marijuana, other illicit drugs, and smoking can potentially interact with mental health medications or cause worsening of certain mental health conditions, in addition to other health risks they may pose. Over-the-counter medications and herbal products like St. John’s Wort and CBD can also interact with certain medications. Be sure to discuss use of any of these with your pharmacist and doctor.
QS: When, if ever, is a method of self-medication acceptable?
G: I think it depends on the reason for self-medicating. If your symptoms don’t rise to the level of substantially interfering with your life, and if you have no other health concerns or medications, I can understand how trying to self-medicate (such as with herbal products) might be a tempting option. (Keep in mind, though, that herbal products are not subject to the same FDA manufacturing standards as drugs, and manufacturers do not have to demonstrate that they are safe and effective before marketing.) However, discussing your mental health and treatment plans with healthcare professionals is always safest to give you perspective on how your condition may be changing. Particularly, I would advise against self-medicating just as a means to avoid discussing your health with others, especially if your symptoms are interfering with your life and definitely if you have had thoughts of harming yourself or others.
QS: What holistic approaches can we take with our medication to treat mental illness?
G: Cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), stress avoidance/management, meditation, and other non-pharmacologic strategies may help people reduce or cope with the symptoms of their illness and can complement medications that address the biochemical causes of the illness.
QS: What is your response to the thought, “Nature is the natural anti-depressant”?
G: As someone who enjoys being outdoors at parks or historical sites, I think there is some truth to this statement. If being outdoors helps you to de-stress, reminds you of the beauty in life, connects you to your higher purpose, or otherwise makes you smile, by all means take it in! At the same time, though, I do worry that this statement (and similar statements about faith, family, etc., as important as they are…) may trivialize the fact that depression and other mental illnesses are caused by changes in the brain which may keep people from finding those very things fulfilling, and that medications are often needed to help address those underlying causes.
Gale Garmong, PharmD, is a clinical/staff pharmacist with Klingensmith’s Drug Stores, an independent chain based in Armstrong County, PA, where his role includes both traditional dispensing and also providing enhanced patient care services like medication therapy management (MTM). He is a graduate of the LECOM School of Pharmacy in Erie and completed a PGY1 Community Practice Residency with the University of Pittsburgh & Rite Aid. Dr. Garmong is also an Adjunct Instructor of Pharmacy & Therapeutics at the University of Pittsburgh School of Pharmacy.