Questions & Answers on Psychiatric Medications
Tadao Ogura, M.D.
How Are “Psychiatric” and “Regular” Medications Different?
As noted in the previous section, there is no such thing as “regular” medication per se. There are prescription medications and over-the-counter medications, but otherwise, all medicines fundamentally work on various body functions. And, as discussed in the previous section, psychiatric medications mainly work on the brain, a part of the body, and, therefore, they are not different from any other medications you might take for "physical" illnesses.
Having said that, there is one thing to remember about all medications, that is especially important to remember about psychiatric medications. That is: We are NOT created equal when it comes to medications.
What does this mean? It means that a medication that works great for one person may be disastrous for another. Or, the same medication may work for many people, but at very different dosages.
Sometimes, even doctors make the mistake of assuming that all people are created equal and give the same medication and dosage to most of their patients. For example, when the medication Prozac first came out into the market, it worked well for many patients. Then, some doctors started to prescribe it for almost all of their patients. As you may know, this turned out to be a disaster, because the news media picked up on the few cases where Prozac was “bad” for the patients and made it look like a dangerous drug.
What the news media failed to mention was the fact that no doctor deliberately prescribed the wrong medication on purpose. Prozac just happened to be a medication that worked very well for many people, and doctors tried it on most of their patients, hoping that it would work for all of them as well. Unfortunately, it is often impossible to know in advance how a particular medication works for a particular patient.
This difficulty in selecting and dosing for each patient is because, in psychiatry, we are dealing with “intrinsic factors,” and not any "extrinsic factors" of his or her condition. When we deal with infectious diseases, we are dealing with “extrinsic factors” which are the bacteria or viruses that invade the body from the outside. In such cases, one medication may work for all patients, as long as they are infected with the same strain of bacteria or virus and they do not have particular sensitivity reactions to the medication.
“Intrinsic factors,” however, are factors that contribute to a condition inherent to a patient’s own body. Intrinsic factors affect conditions such as heart disease, lung disease, diabetes, as well as psychiatric disease and the “one size fits all” approach we use for infectious diseases will never work. Individual differences become more important and critical, and medications must be selected more carefully, and adjusted individually.
There is another very significant difference between "psychiatric" and so-called "regular" medications, and that is the magnitude of individual differences in optimum dosages, reflecting the extremely wide individual variability and sensitivity in brain chemistry, physiology and structures as compared with other organs in the body.
To give you some perspective, I had one patient who did extremely well on Prozac at 100-mg per day and another of a similar age and condition who did equally well on Prozac, but at a mere 2-mg per day. This magnitude of variance in treatment dosage is never seen in any other branch of medicine, suggesting how difficult it can be for psychiatrists to prescribe the “right medications” in the “right dosages” for their patients.
In summary, all psychiatric medications are essentially the same as other “regular” medications, in that, they are all medicines that deal with the body’s functional problems of one kind or another. However, the individual differences in selecting and dosing is far wider and is generally much more difficult with psychiatric medications than so–called “regular” medications.