drmargaret

There is news about psychiatric medications once again. Children who are prescribed stimulant medications for attention deficit disorder are at a slight possibility of risk of heart problems. Women who take medications for depression, specifically selective serotonin reuptake inhibitors (SSRIs) like Prozac can also get heart problems and their babies, exposed prenatally can have withdrawal symptoms. So what are people to do for attention problems or depression?

First, look at the information rationally as it applies to you and your situation. No one should be taking medication if it isn’t needed. So be sure that medication is required prior to starting on any psychiatric medication. Let me go a step further. How do you know if medication is needed for attention problems or depression? First, non-medication treatments were tried. For attention problems, treatments involve parenting, behavior work in the classroom and behavior work at home. Sometimes a psychologist can be involved in providing behavior specialty work. sometime a specific professional called a behavior specialist is involved. School and clinical psychologists can be used to treat comorbid problems with emotional problems and academic difficulties that often accompany attention problems. Cognitive and interpersonal therapies can be used to treat those in addition to standard counseling. For depression, cognitive therapy seems to have the most research to show it is as effective as medication for mild and some moderate depression. There are some interpersonal therapies and some other types of therapies that also report effectiveness but don’t yet have the same research support behind them. Supportive psychotherapy, where someone just asks how your day is going and tells you when to come back after listening to you, is not very effective at all for any form of depression or anxiety. Therapy requires some form of activity on the part of the therapist to be effective.

Very severe forms of attention disorders or severe depression require medication. All medications cause side effects. Very few medications are specifically researched as safe or effective for children. Risks increase the younger the child is and the higher the dose of the medication. It’s important to understand how medications work to understand what goes wrong with the side effects. Stimulant medications increase the heart rate to increase the functioning of a specific part of the brain-the frontal lobe. The medications are excreted from the body from the kidneys and processed through the liver. Several things can go wrong. The heart can speed up too much or beat wrong causing an arrythmia or heart attack. The liver can stop processing the chemical or the kidneys can shut down. All these things can be fatal. Of all the millions of children taking stimulants, 24 had heart problems and died. Lots more had liver problems and some drugs got taken off the market a few years ago. The kidney problems are far less frequent. Seizures are less frequent, and are almost never fatal. The same effects can happen with caffeinated soda for the same reason. Caffeine speeds up the heart. People die from ephedra. People in college die from caffeine overdose with cardiac arrythmia during finals and mid-terms. Sure, they had pre-existing heart problems they never knew about and they added a drug they thought was safe. No-dose and Jolt Cola and other stimulants are considered so safe they are sold over the counter. For most people Ritalin and Strattera are safe and effective. For a very small minority there are unknown preexisting problems that the medication points out. But for anyone, if they suddenly get short of breath, complain of chest pain, start sweating profusely, get pain radiating down their arms or through to their back, even if it’s a child, they need medical attention. Heart attacks happen in childhood as well as in adults.

A similar thing is true for SSRIs. These antidepressants block the reuptake of serotonin all over the body. They have a significant impact of the GI tract, the spinal cord and the brain. The impact on the brain takes several weeks. The impact on the spinal cord and GI tract is within a few days. The people who notice an almost immediate impact to SSRI’s are responding to this GI and spinal cord impact. Pain due to muscle disorders and GI problems may be medical causes of depression that may have been overlooked in the initial diagnostic workup. Significant repose to an SSRI within 2 to 3 days of onset suggests a medical, not a psychological, cause of depression. There is a very small percentage of people who have some very strange symptoms with SSRIs. Seizures, abnormal bleeding, and heart problems as well as problems with metabolism of the chemicals cause difficulties with these medications. People who have a history of these types of problems should review their histories carefully with their prescribing MDs prior to choosing these medications and monitor their ongoing treatment carefully.

Especially with the SSRIs, it’s important that the medication be taken every day without fail. Intermittant use of medications like these ensures that the medications will not work correctly to reach the brain and will limit the impact only to the GI tract and spinal cord. episodic use increases the risk of side effects that reduce with time such as nausea that primarily have their impact on the GI tract.

It’s important when reviewing medications and medical histories with a treating MD to review all over-the-counter herbs, vitamins, supplements and prescription drugs as well as medications you may be borrowing from others (not a good practice). You may also want to review them with the pharmacist when you fill your pescriptions. If possible, fill all your prescriptions at the same pharmacy. With computerized tracking systems, potential drug interactions can monitored and hopefully avoided at the pharmacy. In addition, it’s always important to eat a normal diet and drink an adequate amount of fluid (6 to 8, eight ounce glasses of fluids a day).

Eat food, drink water. MDs don’t seem to tell people that. I still see people on weird diets not drinking enough water and getting dehydrated. They get sick in weird ways. Medications don’t work and their body doesn’t work right. It’s important on stimulants and antidepressants to eat and drink fluids. It keeps the body systems working right. It helps the medications work right too.