Did you know that most medications for mental illness are actually used “off label” (ie, not for what they are approved for), and that serious mental illness is usually treated with a cocktail of medications not one?
Let’s start with the common stuff.
Major Depressive Disorder:
First line treatment is an SSRI (Prozac, Zoloft, Celexa, etc). Frequently in combination with a benzodiazepine (Xanax, Valium, Klonopin). The first combo I was given was Zoloft and Klonopin. If like me at the time, you didn’t know, SSRI’s can take 6 weeks or so to work. You may get worse around the 2 week mark before you get better. It’s more common in adolescents to react poorly to antidepressants. I was 22. I wasn’t informed of this. But now you are! Try the med for 6 weeks before you write it off. Expect to feel worse for a week or so at week 2, esp if you’re under 25.
Depending on comorbidities (psych talk for co-existing disorders), other treatments vary.
SSRIs are used alone or in combination with benzos for anxiety or anxiety + depression.
Your next round would be the SNRIs (ie Effexor) or NDRI (Wellbutrin)
Effexor is more activating, same with Wellbutrin. Wellbutrin is also used for smoking cessation and weight loss. Generally these aren’t used in patients with anxiety or high blood pressure.
If those don’t work you start getting into the fun stuff as add ons –
Lithium: the only medication primarily approved for bipolar. They used to put it in soda (lithiated soda) 100 years ago, which is probably why people were so much more chill. 7 up I think. You can actually buy it otc at wegman’s now in the supplement aisle. I swear to god I saw it. Yes it’s the same stuff as in batteries. The therapeutic dose is horrifyingly close to the toxic dose and it has a lot of side effects. I assume the batteries are a different formulation please don’t eat batteries 😆.
Anticonvulsants “Mood stabilizers” : aka epilepsy and migraine meds (depakote, lamictal, Trileptal, etc) – they work on nerve impulses. They’ll flatten you out and fatten you up. Depakote esp causes weight gain.
Atypical Antipsychotics – abilify, geodon, seroquel, saphris, etc. they’re second generation. 1st generation (haldol, thorazine) have worse sedation and movement issues so they’re used primarily as sedatives, not continued treatment. But the atypicals ARE still sedatives – just not quite as strong. And they have worse metabolic effects. Like, 3 digit pound weight gain. I gained 150lbs. I know several others in the 70-80lb range of gain. Diabetes, heart issues, etc are also side effects. They’re not magic. They don’t “cure” psychosis. They’re sedatives. They calm you down.
Stay tuned for part 2 if i feel like it.
Laughs and Lobotomies 