Questions & Answers on Psychiatric Medications

Tadao Ogura, M.D.


How Do I Know If I Really Need Psychiatric Medications?

The answer to this question is not simple because there are so many factors involved in judging whether you need psychiatric medication or not. But you should remember, if you need ANY psychiatric medication, you must have a psychiatric condition, and the condition must be bad enough for you to consider the use of it. And, ultimately, you (and your family, if you live with them) must be the only judge(s) to decide if your condition is "bad" enough.

First, you should ask yourself, and your family and friends, the following questions:

"Am I really doing as well as I used to be?" (on my job, at home, or in my relationship?)
"Can I feel or do better than this?" (have you not been happy or enjoying life as much as others seem to?)

If the answer is a unanimous "yes," you may go to the checklist at the end of this section and try to find out what condition, if any, you might be suffering from, and you may get a fairly good idea about your problems.

However, it still takes a well-trained, experienced psychiatrist to truly determine whether you need psychiatric medications or not. I would also recommend that you undergo the initial diagnostic evaluation together with at least one other individual who can shed light about your condition from a different perspective.

This is because too many people are in denial of their psychiatric conditions, possibly because of the cultural stigma attached to "psychiatric" conditions. Even if you are not, you are often "blind about yourself," and just as your eyes cannot see your own face without a mirror, you cannot really "see" yourself as others do about you. Therefore, you are not always the best judge of your own condition.

I have often heard from many of my patients that someone close to them, a spouse, relative, or friend, was clearly showing the symptoms of a psychiatric condition, but was in adamant denial of his or her problems. These people would refuse to listen to anybody about their conditions, despite repeated efforts to try to help them. This, by the way, is almost always the case with alcoholics who are in denial!

There are many classes of psychiatric conditions you may be concerned about: Mood Disorders (Depression and Bipolar Disorders), Anxiety Disorders (including Panic Disorders and Phobias), Obsessive-Compulsive Disorders, Addictive Disorders, Psychotic Disorders, and Organic Brain Syndromes.

The symptoms of the first four classes of these diseases are well known and can usually be self-diagnosed - the self-diagnostics have been included later in this section. The other two types of psychiatric conditions, Psychotic Disorders, including Schizophrenia, and Organic Brain Syndromes (such as Alzheimer's disease) are much more difficult to diagnose, and self-diagnosis is not recommended.

If you identify with one or more of the conditions in the following section, you have to evaluate how that condition(s) is affecting your life, family, and/or job. If the negative impact of the condition is significant, you might consider psychiatric treatment. Your doctor will evaluate the severity of your condition and decide the best course of action based on your needs.

Generally speaking, if a condition is severe, as in a case of suicidal depression, or a totally incapacitating panic attack, the use of medication(s), or other treatment modalities, such as ECT, can be often, literally, life saving.

However, if the condition is neither disabling nor life threatening, you may be able to choose non-medication approaches as described later in this booklet. Or, you may still choose to use medication, if it is an option, and if your physician approves it, to make your recovery faster or more effective.

One thing you should not do is to do the "popular" thing and opt for "Natural Remedies" from the health food store, without consulting your doctor first. As explained later, so-called "Natural Remedies" are also "drugs" and are often more harmful than the medications that are commonly prescribed for psychiatric conditions.

a) Symptoms of Depressive Disorders

Clinical Depression is actually not a "mental" illness, in the strictest sense. It is really more of a physical illness or even an organic disease, in that it is a condition that results in the brain functioning at less than its optimum or normal levels. In other words, the brain is functioning in a "depressed" state. This, in turn, affects all of your mental, emotional, and physical functions.

Mentally, a depression disturbs your concentration, compromises your creativity, impairs your memory functions, tends to promote "negative thinking," and even causes "suicidal thoughts."

Emotionally, depression makes you hypersensitive, extremely vulnerable, unhappy, and gloomy. The condition also tends to make you easily lose control over your anger and frustration, unable to enjoy your life, and makes you feel hopeless and helpless, and even suicidal.

Physically, depression makes you have lower or no energy, and makes you feel sluggish or easily fatigued. It may make you sleep too much or too little, eat too much or too little, and lose sexual interest or function. Most importantly, depression lowers your immune resistance and makes you catch cold or get sick easier. Recently, depression was also found to be associated with higher rate of heart attacks.

b) Symptoms of Anxiety Disorders

The official classification of "Anxiety Disorders" covers many subcategories and includes Obsessive-Compulsive Disorder and Post-traumatic Stress Disorder. However, in this booklet, we will deal with the most common three types of anxiety disorders and deal with Obsessive-Compulsive Disorder under another heading.

The first type is classified as "Panic Disorders" with or without Agoraphobia. However, we will discuss Agoraphobia in the next section. If you experience a panic attack, you will feel totally overwhelmed (or panicked) with rapid heartbeat, difficulty or changes in breathing, shaking in the hands or legs, dizziness or light-headedness, and may also have tingling or numbness in some parts of your body. Each attack lasts 5 to 15 minutes but after an attack, you will feel totally exhausted. Many people actually think they are having a heart attack and rush to an Emergency Room.

The second type of Anxiety Disorder is "Phobias" including Agoraphobia (discomfort in or fear of wide, open spaces, or even being outside of your home), Claustrophobia (discomfort or fear of narrow or confined spaces), and Acrophobia (discomfort in or fear of high places). Other kinds of phobias include "Homophobia (fear of intimate human relationships)," and "Social Phobia (fear of social situations or gatherings)." The symptoms of Phobias may be the same as for Panic Attacks if a person is forced into a phobic situation and can be just as devastating as any Panic Attack.

The third type is "Generalized Anxiety Disorder" in that the sufferer worries excessively about things or situations that should not be worried about, but cannot help it. This is, however, a little more severe than a bad case of the worry-worts. Since everyone "worries too much" at one time or another, this may be the most difficult condition to self-diagnose, but the difference between a clinical case that requires treatment and a common worrier is how much the worrying is interfering with other aspects of your life. If your excessive worrying is significantly impacting your health and happiness, as well as that of those around you, it may be time to see if treatment might help. Most likely, the treatment will be fairly simple.

c) Symptoms of Obsessive-Compulsive Disorders

"Obsessive-Compulsive Disorders" have two dimensions.

Obsession affects your thinking, causing you to get "hung up" on a specific thing, event, or person. You cannot "let go" of it from your mind, even if you try, because the thought of it involuntarily invades your mind and controls it. When it is severe, the sufferer often feels devastated with hopeless and helpless feelings and may attempt suicide.

Compulsion affects your actions or behavior. As with Obsession, Compulsion causes your actions to be driven by a force you cannot resist. For example, you may keep washing your hands repeatedly or you may check the stove over and over again to make sure that it's turned off. You may be driven to keep things in a set order or certain pattern. And, if you are not allowed to follow your compulsion, you will feel very, very uncomfortable. Many sufferers of this condition feel trapped by their compulsion and lose their ability to function normally at home and/or at work.

If you find your thoughts and/or actions taking on very repetitive patterns, and you find yourself uncomfortable when you try to break the pattern, or find yourself unable to break the pattern, you may be suffering from an Obsessive-Compulsive Disorder.

d) Symptoms of Mood Swings (Bipolar Disorders)

When people talk about "mood swings," most people think about "Manic-Depression." In fact, there are many kinds of clinically diagnosable "mood swings." Most "mood swings" are caused by "Bipolar Disorders," which are classified into two categories: "Bipolar I Disorders" and "Bipolar II Disorders."

People with Bipolar I Disorder must have at least one episode of manic or hypomanic state in that they become (as seen by people around them) abnormally euphoric, overly optimistic, grandiose, super-energetic, full of too many "great ideas," arrogant and self-righteous. In this condition, the person does not listen to anyone else because they feel they are right no matter what. The manic or hypomanic state may last for a few days to a few months or longer.

Bipolar II Disorder is defined as "Recurrent Major Depressive Episodes with Hypomanic Episode." In other words, individuals who have this condition tend to go into repeated episodes of depression and occasionally go into a hypomanic state (a little better than normal mood). Mostly, depressive episodes are predominant and hypomanic states do not last long (generally only for a few hours to a day).


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