Psychiatric Medications Online Conference Transcript

Medications. Our visitors are always asking about psychiatric medications. "What's this medication used for? What are it's side-effects? The dosage seems to high for me."

Our guest, Dr. Lorraine Roth, will be discussing all aspects of psychiatric medications and taking your personal questions.

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Dr. Roth is a Diplomate of the American Board of Psychiatry and Neurology specializing in the practice of Psychopharmacology -- medication for the treatment of psychiatric disorders.

• Some of the non-psychotic conditions for which medication is prescribed include depression, anxiety, panic attacks, phobias, eating disorders, and obsessive-compulsive disorders.
• Psychotrophic medication is usually necessary for the treatment of the major psychiatric disorders, such as schizophrenia, manic-depression (bipolar affective disorder), and major recurrent depression.

Dr. Roth practices in the Chicago area, and is licensed to practice medicine in both Illinois and North Carolina. A graduate of the University Of Texas Medical Branch at Galveston, Texas, Dr. Roth received her Medical Degree in 1979. She completed her residency in Psychiatry at the Duke University Medical Center in Durham, North Carolina, in 1983. Dr. Roth also completed a fourth-year post-graduate fellowship in Forensic Psychiatry through Duke University, at the Federal Correctional Institution in Butner, North Carolina.

Dr. Lorraine Roth specializes in the practice of Psychopharmacology. She discusses the best medications for psychiatric disorders and the side-effects of medications.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Psychiatric Medications". Our guest is psychiatrist, Lorraine Roth, M.D.

Dr. Lorraine Roth is a board-certified psychiatrist based in Chicago, Illinois. She specializes in psychopharmacology, medication for the treatment of psychiatric disorders.

David: Good Evening Dr. Roth and welcome to HealthyPlace.com. We appreciate you being here tonight.

Has science gotten to the point where most of the psychiatric disorders can be attributed, at least in part, to a brain chemical imbalance?

Dr. Roth: We think we know most of the biochemical pathways evolve in many psychiatric disorders, but we don't have everything at this point in time.

David: Do you picture a time, in the not too distant future, when there will be a psychiatric medication for most mental illnesses that will give the patient significant relief?

Dr. Roth: We already have medications which can give a considerable amount of relief for most psychiatric disorders. Personality disorders or character problems are more or less unable to offer help, medication wise.

David: Why is it that, for some people, finding the right medication is still a "hit and miss" type of thing?

Dr. Roth: Medicine is not perfected in terms of knowing precisely which meds will work for any one individual. It's not unlike the antibiotics that work for some and not others.

David: As I understand it, there are no blood or other types of tests that can pinpoint which brain chemical may be out of whack. So, is choosing the right medication still a matter of trial and error?

Dr. Roth: For the most part, yes. But there are certain tests that can be run for certain conditions, but it is far from being an exact science in this point in time.

David: Can you elaborate on that a bit? Explain more about these tests and what they are used for?

Dr. Roth: Most of the tests are used in research settings, for example, we can test cortisol levels to determine if someone is responding to an antidepressant but we can't test to see exactly which antidepressant is going to work the best.

David:Since many of these medications are fairly new, do patients have to worry about the long-term effects of taking them?

Dr. Roth:That depends on which meds you are concerned about. Some meds have to be watched more closely for long-term effects. Others, you do not have to worry about side-effects.

David:One last question from me before we start taking some audience questions. Today, all types of doctors, not just psychiatrists, can prescribe psychiatric medications. What's your thought about this and having people going to their family physician and getting antidepressants, anti-anxiety medications, etc.?

Dr. Roth:There is no problem for mild symptoms, such as temporary insomnia, transient stressors, etc., but for more serious illnesses, you would probably want someone more familiar with psychiatric medications and patients.

David:By the way, which medications do patients have to worry about the long-term effects?

Dr. Roth:Medications which are called anti-psychotic, which may cause long-term movement disorder or meds which may affect the thyroid glands.

David:We have a lot of questions from the audience, so let's get started Dr. Roth.

hawthorne:I have epilepsy controlled by medication and my doctor has put me on Serzone for Panic Disorder. I'm a little bit scared of taking it as I have heard it can cause seizures. Do I need to be concerned?

Dr. Roth:Probably not, if you are taking the recommended dose. It is very important with antidepressants like serzone to take exactly what is prescribed and not taking extra.

cd:Which medications affect the thyroid gland?

Dr. Roth: Lithium is probably the most common culprit, but it is nothing to be to concerned about if you are taking it because it can be checked on a regular basis for any significant problems that may arise.

Annie1973:I have severe depressive disorder with anxiety. I have had problems with side-effects on most medications. Due to my history with drug abuse and suicide attempts, my doctor won't prescribe a few medications that do work for more than a short while. Any suggestions? I only take Buspar at the moment and it does very little.

Dr. Roth:That would be very difficult for me to comment on. Given what you have told me, I would probably do the same thing your doctor is doing. I would prescribe the meds that work best but in small amounts.

David:For a more detailed look at the various medication side-effects, visit our psychiatric medications pharmacology.

lambieschmoo: There is a lot of talk about the negative effects of long-term SSRI use. Could you please comment on this?

Dr. Roth:To my knowledge, there are very few long-term problems with SSRIs. Generally, they are safer than most other classes of antidepressants.

David:Do patients taking medications like antidepressants, mood stabilizers, anti-anxiety medications, have to worry about becoming "addicted" to them?

Dr. Roth:For the most part, no. None of the antidepressants, mood stabilizers have addictive potential. Some of the anti-anxiety medications can be addicting, but only in very few people. Anti-anxiety medications are very safe.

David:On the same subject, here's an audience question:

Hysign3: Dr. Roth, could you please tell me the proper way to get off Ativan? I take .5mg twice a day and 1mg at bedtime and I am having bad side-effects from it.

Dr. Roth: If you are having bad side-effects of medications, you should stop taking it. However, if you can withdraw, that is highly recommended. You should talk to your doctor about a withdrawal schedule. It would be dangerous to stop it all at once.

DottieCom1:What are the consequences of lifetime use of high doses of Sinequan?

Dr. Roth: That is one of the older tricyclic antidepressants. There are no long-term side-effects problems with Sinequan when taken as directed.

Dana1:I've had severe Generalized Anxiety Disorder (GAD) and Phobias for 20 years now. I am in setback and have $4000.00 in books and tapes. Any suggestions on anything new to change my thinking besides Cognitive Behavioral Therapy (CBT)? And, can one "program" the mind to not fear the mornings and symptoms?

Dr. Roth:There are many meds which can be helpful for Generalized Anxiety Disorder (GAD) and phobias. I would imagine you have been on some of them. If not, you should talk to a doctor to prescribe medication for your condition.

David:Because some people are without insurance, or on a limited budget, given the choice of medications vs. therapy for depression, anxiety disorders, bipolar disorder, and OCD (Obsessive-Compulsive Disorder), which would you recommend?

Dr. Roth:Meds and therapy together work best. A county mental health clinic may offer treatment on a sliding scale, which you can afford without insurance. See if your county has one.

David:But if you can't get in on a program, which would you recommend-- the medications or the therapy?

Dr. Roth:Medications should work more quickly to relieve the most problematic symptoms. Some meds are relatively less expensive.

tears2: Why does it seem that SSRIs work great for about 6 months, then stop working?

Dr. Roth:They shouldn't quit working. It may be that the depression or other symptoms are relapsing or getting worse and a higher dosage may be required from time-to-time.

dano:Why do many psychiatric drugs cause weight gain?

Dr. Roth:We don't know the answer to that. We can only speculate and identify the drugs that are known to do that.

AllWithin: Does Zyprexa cause weight gain?

Dr. Roth:Yes, it does. It may be the most notorious drug for weight gain. It is also one of the best anti-psychotics on the market.

David:So, I guess what you are suggesting, Dr. Roth, is that there's a trade-off in many psychiatric drugs. Many have side-effects. Hopefully, the benefits outweigh the medication side-effects.

Dr. Roth:It's all a question of benefits and risks. That applies to surgery and all medications we have. There is nothing in all of medicine that has no side-effects or risks, and we always have to weigh them.

dhill: Why don't doctors encourage parents/patients to try other avenues first? e.g. counseling, realistic thinking, etc.?

Dr. Roth:That should depend on the symptoms of the illness. If the symptoms are not causing major dysfunction, then therapy can be very helpful and is all that is needed. But if the symptoms are serious, for example keeping you out of work, then the psychiatric medications are needed.

David:We all see or hear ads for medication trials. "Free Checkups and Medications". When people with no insurance hear that, they take that as an opportunity to get help. What do you think about the clinical trials for medications, and are patients at-risk participating in them?

Dr. Roth: I hope they would check out parties that are conducting the research. If it is a well-known medical hospital or school, it is a great opportunity to get the latest care for free. Keep in mind, that without research programs, we would have no meds at all!!

wishing_A:Do you know of any medications that could be tried on a child of 12 that has been diagnosed with ADHD (Attention Deficit Hyperactivity Disorder), Intermittent Explosive Disorder, and Disruptive Behavior Disorder?

Dr. Roth:I generally treat adults, but I'm aware of many meds which we have which would be appropriate for a trial in such a child. Many of them are the same medications used for adults but in smaller dosages.

iglootoo1:My 16 year old son takes 30 mg a day of Adderall for ADHD (Attention Deficit Hyperactivity Disorder) Inattentive. He feels better able to focus, but still claims he "cannot" remember to write things down to keep track of assignments, etc. Is this "learned helplessness" or a short-term memory problem that won't be helped with medication? He sounds so sincere when he says he can't, I don't know what to believe and want to understand.

Dr. Roth:I doubt that it is a short-term memory problem. I also would not attribute it to learned helplessness. Some people are naturally "absentminded" and this may be the problem. Be Positive! He sounds like he's doing well.

David:Now here's an adult ADD (adult Attention Deficit Disorder) question, Dr. Roth:

Richardsbb:What medications would you recommend for an adult diagnosed with ADD (Attention Deficit Disorder), Inattentive type?

Dr. Roth:If ADD is the correct diagnosis, then one should prescribe the same meds that would be prescribe for a child with that diagnosis.

David:And those would be?

Dr. Roth: The stimulants, like Ritalin, and the antidepressants. For "inattentiveness" one would want to be certain they are not dealing with a petit-mal type of seizure disorder.

tracy565:Have you heard of the new drug, Pagoclone, and does it seem to have positive results with panic disorder?

Dr. Roth:I have not heard of that drug. I'm not sure that you have spelled it right.

cd: I was on Effexor (Venlafaxine) for about six weeks, then went off after hearing about withdrawal. I have been having weird brain jumbling. Why is this? I called my doctor and he said Effexor is one of the safest anti-depressants. Is it really, and what is this brain scrambling stuff?

Dr. Roth: You might have been talking Paroxetine. One should never go off meds quickly and that may be a withdrawal response. I have not heard of such a symptom but no meds should be stopped abruptly.

David: What are the consequences of sudden withdrawal from some of these medications?

Dr. Roth: It can be different depending on the medication. Anti-anxiety medications are the most dangerous to stop abruptly. Discontinuation of anti-depressants may cause a relapse of depression. Likewise, stopping lithium may cause a manic relapse.

David: Why are anti-anxiety medications the most dangerous and what can happen?

Dr. Roth: Stopping a moderately high dose too fast for some time can cause a seizure.

Serena32: Is there a danger in taking more than one antidepressant at a time or being on too many psychotropics at the same time.

Dr. Roth: Certain anti-depressants should never be combined. These are primarily MAO inhibitors. One also has to avoid certain foods while on these MAO inhibitors.

David: And that's something you can get from your doctor or pharmacist.

lilly2:Is it necessary to take medications to recover from eating disorders such as anorexia and bulimia?

Dr. Roth:Medications can be helpful with those disorders. But they can be helped a great deal with psychotherapy also.

insight:Can you please comment on the relation between root causes of illness and psychiatric medications. There is concern that although medications can aid healing, and/or control symptoms, it can also interfere with healing - again depending on the root cause and the psychiatric illness involved. Your response to this would be appreciated.

Dr. Roth:You can't always wait to learn the root cause of an illness before prescribing medications. If a person is suffering from severe symptoms, such as sleeplessness or more severe symptoms of depression, then meds can relieve these symptoms so a person can concentrate and make therapy work for them. They can't use therapy if they can't think clearly.

David:What do you think about alternative medications or herbs for some of these disorders, i.e. St. Johns Wort, etc.

Dr. Roth:St. Johns Wort is one of the most widely prescribed meds in Europe. If someone wants to try it, they should try it, but you need to make sure that over-the-counter medications are not interfering with your prescription medication.

anonymous1:A friend of mine started on an antidepressant for the first time ever at three pills a day as prescribed by her doctor, only to go into seizures. Is this sort of thing common? Would this still have happened if the pills had been introduced more slowly to her system?

Dr. Roth:That depends on the dose of each pill, but it is very uncommon. I have never had a patient go into a seizure from medications. I wonder if she has an underlying seizure disorder?

David:Interesting you say that Dr., that you've never had a patient go into a seizure from medications because I'm getting a lot of questions about that and comments on experiencing that.

Michael A:My question pertains to my 13 yr old OCD (Obsessive-Compulsive Disorder) sufferer. He's on Paxil, Risperdal and Clonazepam. Is anything known about the long-term effects of using these drugs, particularly Riperdal?

Dr. Roth:Risperdal is the newest medication of those listed, and it has less known side-effects than other meds in it's class. If he is on a low dose, he should have nothing to worry about at this point.

David:For a more detailed look at the various medications, their effects and side-effects, view our psychiatric medications chart.

Whispers_with_in:Is there any medication that works well with someone who has been diagnosed Dissociative Identity Disorder - (DID)?

Dr. Roth: I would use a low dose antipsychotic medication and possibly some antidepressants.

David:For those who asked, this is Dr. Roth's website: http://www.deardrroth.com.

Dr. Roth, when a person starts taking psychiatric medications, should you plan on taking them for the rest of your life?

Dr. Roth: Again that depends on what the disorder is. If someone has a major disorder which has relapsed at least one or more times, it may be necessary to stay on it for the long-term. If it doesn't recur or recurs mildly, then it may not be necessary.

Mother of 4: Is Ritalin one of those drugs that you have to watch more closely?

Dr. Roth:Ritalin is fairly safe when taken as directed, but it can be abused.

Lori Varecka:I have an Eating Disorder and sometimes purge. None of the meds that I have taken has done me much good. Do you have a suggestion? Right now, I am on Effexor, but I had to decrease the dose because of visual disturbances.

Dr. Roth:If you can get psychotherapy with a therapist you feel comfortable with, who is knowledgeable about Eating Disorders and can see you at least once a week, I would recommend it.

Sharon1: Why is it that some of the antidepressants cause anxiety, but are given to people with anxiety disorders?

Dr. Roth:If anyone experiences the side-effect of anxiety from anti-depressants, they probably should be on a different antidepressant.

David:Also, I might mention here, for whatever reason, many people don't contact their doctor fast enough, if at all, to tell the doctor about the side-effects they are experiencing. This is very important to do. You don't have to be afraid to let your doctor know what's going on. In fact, it's very important that your doctor does know, so you can get the best care possible.

Funny Face1:My son is bipolar. He also has an alcohol problems. Isn't it true that the alcohol negates, or at least lessens, the benefits of the medication?

Dr. Roth: It can be dangerous to combine alcohol with medication, especially if he is drinking heavily, but he probably should stay on the meds in any case.

David: What are the effects of combining alcohol and let's say antidepressants or anti-anxiety medications?

Dr. Roth: It will probably increase both the sedating and the intoxicating effects. That can be very dangerous.

Brenda1:What about side-effects of medications, especially sexual dysfunction. Is there a way to deal with these?

David:And can you address that for both women and men?

Dr. Roth:Yes, that usually requires the meds dosage be adjusted, but it may also require trying a different medication if the side-effects are too problematic.

Sandrea:I have been on Prozac for 10 years and have tried to go off but I can't. I have noticed some strange behavior modes.

Dr. Roth:If the behavior changes have occurred only recently, it is unlikely it is due to Prozac. If you have been on Prozac for 10 years, and if your mood is disturbed recently, then you may need to try another antidepressant.

Henney Penney:I've heard that a medication that is effective for someone for one period of time, may not be effective when they try it again in the future. Have you found this to be true? And have you found that a medication can just become less effective over time even if there has been no change in the dosage taken?

Dr. Roth:Yes, I have seen this happen from time-to-time. I usually try to slightly increase the dose but sometimes you have to try another medication.

miri:What role should a patient play in creating medication strategies? How can a patient become well-informed with so many psychiatric medications available?

Dr. Roth:It is important the patient be completely honest about medication side-effects and any other medication or substances they are taking. You can ask your doctor and pharmacist to explain each medication, their benefits and side-effects. No one can be expected to learn about all the medications available.

stef: I've suffered from major clinical depression since 1988, the birth of my last child, at which time I also had a tubal ligation. After many years of medication, I am going to try ECT (electroconvulsive therapy, electroshock therapy) and my first appointment is next week. What are your feelings on this type of treatment?

Dr. Roth:ECT is extremely safe and effective. If you have failed to get any benefits from a full trial of different meds, then ECT is a good option for you.

lprehn:My teenage daughter is on Prozac for Obsessive-Compulsive Disorder (OCD) and experiences bizarre dreams and also naps often during the day and has difficulty being awakened. Is this common? Any suggestions?

Dr. Roth:If these bizarre dreams are in the daytime and sedation has occurred as a side-effect of the Prozac, then she has to be on a different medication. Those medication side-effects are unacceptable.

Chlo:Aside from Prozac, does any other medication seem effective for treating bulimia?

Dr. Roth:Yes. Probably any antidepressant could be helpful. It is worth trying different ones if the first one doesn't work. Make sure you give it a full trial though.

flitecrew:I have a girlfriend who is bipolar and recently has become alarmed about some articles about the dangers of psychiatric drugs. She would like to know if there is a possibility of ever getting off all of them?

Dr. Roth:If she's true bipolar with significant symptoms, she may require medication long-term. However, that can be challenged, but she should do so with her doctor's supervision.

David: There has been talk about some of the antidepressants like Paxil, Zoloft, causing suicidal ideations and other types of "out of the ordinary" behavior. For instance, the court case that just concluded where the man held up the bank (no history of prior criminal behavior) and was acquitted after the jury was told he was taking Prozac and this type of behavior is a side-effect. What's your opinion about that?

Dr. Roth:I question these kinds of anecdotal stories. Prozac has been prescribed to hundreds of millions of patients worldwide with rare instances of such dramatic side-effects. I question that medications are responsible for such side-effects.

chuk69:Is there any herbal medicine that helps for anxiety, panic disorder?

Dr. Roth:I don't study the herbal medications but there are books on herbal medicines which can found in the library, if someone's interested.

KcallmeK: I have bipolar disorder, ADD inattentive type with temporal lobe issues, and I might be premenopausal. Distractibility is getting out of hand. For instance, I left my car running for almost 2 hours, not knowing I had left it on. Any suggestions?

Dr. Roth:I would hope that you have had some trials of medications. You have mentioned several different disorders, each of which can be treated with different medication. You should be in the care of a psychiatrist who can prescribe and combine meds properly to provide relief for you.

LauraE: How do you suggest starting a "medication holiday" if you are on a stimulant, and is it okay to not take them on weekends?

Dr. Roth: It depends on the medications and dosage. Medication holidays are not highly recommended anymore. Doctors used to recommend medication holidays but they are not considered to be helpful and can cause relapses.

derf: In regards to pregnancy and fetal health: what's worse? Being depressed (unmedicated) in pregnancy or being medicated (with new antidepressants) during pregnancy?

Dr. Roth: Depression is better left untreated in pregnancy unless the symptoms are so severe that the woman is in danger of suicide. If at all possible, it is much better to avoid medication during pregnancy. In severe cases, you should choose "electroshock therapy" as an option.

des: Do you know anything about DHEA?

Dr. Roth: I have read about it but I do not know if it has any medical place at this point in time.

Helen: Is long-term psychotropic medication considered necessary after just one manic episode?

Dr. Roth: No. One can't determine that medication is needed on a long-term basis unless the patient has relapsed after a proper withdrawal of the medication.

David: I know it's getting late. I want to thank Dr. Roth for being our guest tonight. I know we had tons of questions and hopefully, we can get to them at a future conference. Dr. Roth's website is at http://www.deardrroth.com.

Dr. Roth: Thank you very much for inviting me. I have enjoyed the conference very much and look forward to working with you in the future.

David: So everyone knows, we keep transcripts of all our conferences. You can find the list of topics here.

For a more detailed look at the various psychiatric medications, their effects and side-effects, you can check our psychiatric medications pharmacology.

I want to thank everyone in the audience for coming and participating. Good night everyone.