Tag Archives: anxiety disorder

Feeling Anxious? Depressed? Check Your Meds

If you find yourself feeling on edge for no apparent reason while taking a cold medicine or diuretic, you most likely wouldn’t connect the two. However, anxiety happens to be just one of many mood-altering symptoms that can be brought on by certain meds.

“Many medications, whether prescribed or found over the counter, can cause psychiatric symptoms,” says Shiyun Kim, PharmD, BCACP, BCPP, CDE, a clinical pharmacist and clinical assistant professor at the University of Illinois Hospital & Health Sciences System, and a spokesperson for the American Pharmacists Association.

She explains that a wide range of factors influence the way a drug affects each person, including things like metabolism, underlying illness, and interactions with other drugs. “Any variations that occur, such as with improper doses or individual reactions, can result in undesirable psychiatric symptoms,” though they are relatively uncommon.

If you feel that you may be suffering from these side effects, notify your providers immediately. “Keep in mind that some medications can be stopped abruptly, while others need to be tapered to prevent further adverse effects,” Dr. Kim emphasizes. “Your provider can make the best decision with you.”

Take note of the following medications that can have these kinds of effects, and read on to find out how to minimize the risks.

Oxycontin and Similar Pain Medications

“Most prescription pain medication, such as oxycodone (OxyContin) or hydrocodone, can cause drowsiness, which can make one feel ‘cloudy’ and lack motivation — and these symptoms closely mimic depression,” according to Bree Meinzer, PharmD, CTTS, a pharmacy practice resident at Ohio Northern University. Opioids can also lead to more severe symptoms like paranoia, hallucinations, psychosis and dementia, especially at high doses. Signs that you may have taken too much of an opioid include trouble breathing and unconsciousness. People with opioid dependence and those who suffer from HIV, liver or lung disease or suffer from depression may be more susceptible to these effects, according to the World Health Organization. If you are on a pain medication that makes you drowsy or “cloudy” and you do not like how it makes you feel, you should talk to your doctor about other ways to adequately manage your pain.

Lasix, Microzide and Other Diuretics

Medications that reduce fluid retention and swelling, including furosemide (Lasix) and hydrochlorothiazide (Microzide), increase urination. This can lead to dehydration, especially in the elderly, and can result in hallucinations and dizziness, says Dr. Meinzer. SGLT2 inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance), which are drugs used to treat diabetes, can also increase urination and cause dehydration. If you are taking these types of medication, be sure to drink plenty of water to stay sufficiently hydrated. The amount of water to drink should be discussed with your doctor and is dependent on your weight. “These medications should also be taken in the morning or early afternoon to avoid frequent urination at night,” which could disrupt sleep, she advises.

Ask your doctor to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.

Requip and Other Dopamine Agonists. Medications like ropinirole (Requip), often prescribed for restless leg syndrome and Parkinson’s disease, increase the brain chemical dopamine, which helps regulate mood and behavior. Too much dopamine can cause hallucinations, notes Dr. Meinzer, and more extreme potential side effects include confusion, mania, depression and impulse control disorders like compulsive gambling or eating. “There are other options for restless leg syndrome that don’t increase dopamine, though medications like ropinirole typically work best.” There are also different medications for Parkinson’s, though you and your doctor should carefully consider your particular treatment needs. If you experience these kinds of symptoms while taking this type of medication, it may be that your dose is too high.

Ritalin, Adderall and Other Stimulants

Drugs that are commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD) include those sold under the brand names Ritalin and Adderall. Although these stimulant medications “help children and adolescents focus and stay on task, side effects include increased heart rate and insomnia, which can often cause anxiety and restlessness,” says Dr. Meinzer. Stimulants “excite the central nervous system and can disrupt normal communication between cells in the brain,” adds Dr. Kim. “This class of drugs may also cause bizarre behavior, agitation, mania, paranoia and nightmares.” Dr. Meinzer suggests talking to your healthcare provider if you feel extremely restless and anxious while taking this type of medication. Again, it is possible that your dose is simply too high.

Corticosteroids

Medications like prednisone, cortisone and methylprednisolone are often prescribed “to help respiratory symptoms and decrease inflammation with chronic diseases,” Dr Meinzer explains. They are typically only “used for a short term to help alleviate symptoms, but if you are on these medications for a long time, they can cause some unwanted side effects.” Use of these drugs for more than a few months can increase the chances of experiencing mania, anxiety, depression, paranoia and psychosis, which have mostly been reported by patients using high doses or abusing the medication, says Dr Kim. Though experts are unclear about the exact reasons for such side effects with these drugs, research suggests that it may have to do with the way steroids work in the area of the brain that influences memory and emotion. It is also possible that “high levels of steroids result in brain damage and cause cognitive dysfunction.”

Zarontin and Other Anticonvulsants

Medications such as ethosuximide (Zarontin), which are used to control seizures in people with epilepsy, can cause symptoms resembling depression. These drugs have also been found to increase suicidal thoughts and behavior. “If you start to experience these symptoms on an anticonvulsant, you should talk to your doctor about other regimens,” Dr. Meinzer recommends. “There are other medications in the same class that are less likely to cause this side effect,” though your doctor may want you to stay on the medication because it may be the one that is most effective for you. “Anticonvulsants are usually tricky to dose and may need lab monitoring to make sure they are in the proper range.”

Dr. Kim offers the following general tips to help prevent or deal with these side effects:

  • When you are prescribed a drug, ask your provider about potential side effects that are commonly noted and reported.
  • Ask your provider to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.
  • Withdrawal of some drugs can cause symptoms such as anxiety, agitation or depression. Therefore, call your doctor before stopping medications on your own.
  • When purchasing an over-the-counter (OTC) medication, take the time to read the instructions on the package. If anything is unclear, ask the pharmacist for guidance.

High Percentage of Americans Taking Psychiatric Drugs

Nearly 17% of Americans — 1 in 6 adults — took a drug to treat a mental illness at least once in 2013, with antidepressants as the most common prescription filled.

About 12% of adults said they used antidepressants; 8.3% filled a prescription for an anxiolytic, sedatives or hyponotic; and 1.6% reported taking an antipsychotic.

White adults were the most likely to have taken a psychiatric medication. Nearly 21% of them did. Next were black adults at 8.7%, followed by Hispanic and Asian adults at, respectively, 8.7% and 4.8%

The analysis, published Dec. 12 in JAMA Internal Medicine, was based on data from the 2013 Medical Expenditure Panel Survey. The authors said that the use of these drugs could even be much higher as the prescription use data was self-reported.

Older age was also associated with higher psychiatric drug use. About 25% of adults 60 to 85 reported use compared with 9% of adults 18 to 39 years of age. Also, women were significantly more likely than men to take medication for a mental health issues.

“Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use,” the authors noted.

If you are experiencing side effects with antidepressants, check out MedShadow’s feature on how to cope with them.

Quick Hits: Non-Depression Conditions Boost Antidepressant Use, & More

Antidepressants are prescribed for conditions other than depression nearly 50% of the time, as many doctors give them to patients to treat conditions including anxiety, insomnia, fibromyalgia and chronic pain, according to Canadian researchers. 2 out of every 3 antidepressant prescriptions given for conditions other than depression were for off-label use. The results are not entirely surprising given that antidepressant use in the US has skyrocketed, surging nearly 400% between 1988-1994 and 2005-2008, according to the Centers for Disease Control and Prevention. In the study, the researchers found only 55% of antidepressant prescriptions were actually for depression. Other conditions antidepressants were prescribed for were anxiety disorders (18.5%), insomnia (10%); chronic pain (6%) and panic disorders (4%). Posted May 24, 2016. Via Healthday.

A major insurance company is aiming to cut opioid use among its members by 25% in 3 years in an effort to help combat the prescription painkiller epidemic. Cigna says it will limit the quantities of prescription opioids supplied when appropriate and is working to find additional ways to curb use by high-risk customers. The insurer is also endorsing quick adoption of new CDC guidelines on opioid use, prescribing the pain pills for the shortest possible time for acute pain and education patients about risks and options before initiating long-term opioid therapy. Cigna is also backing efforts that would require doctors to search a state’s Prescription Drug Management Program database when prescribing more than 21 days of opioid drugs. Posted May 19, 2016. Via Company News Release.

Lyrica (pregabalin), which is prescribed for epilepsy and fibromyalgia, may increase the risk for birth defects in women, according to a new study. Researchers conducted a study that study involved 164 women who took Lyrica during their pregnancy’s first trimester, as well as 656 pregnant women who didn’t take the drug. Most of the women on Lyrica started it before pregnancy but stopped taking the drug an average of 6 weeks into pregnancy. Women that took Lyrica were 6 times more likely to give birth to a baby with a central nervous defect compared to women not on the drug, the researchers reported in Neurology. Page Pennell, MD, an associate professor of neurology at Harvard Medical School, wrote in an accompanying editorial suggesting that women who are pregnant or a planning to be should avoid Lyrica. Posted May 18, 2016.Via Healthday.

Doctors should avoid prescribing the oral antifungal medicine ketoconazole to treat skin and nail infections due to a risk of liver damage, problems with the adrenal gland, and potential interactions with other drugs. A safety review conducted by the FDA found that oral ketoconazole is still being prescribed by many physicians for these 2 conditions, even though labeling was changed 3 years ago to advise of these risk and indications for the conditions were removed. Following this change, an individual taking oral ketoconazole for a nail fungal infection died. The FDA recommends that ketoconazole tablets should only be used to treat serious fungal infections when no other options are available. However, the agency adds that topical forms (e.g. creams) of ketoconazole have not been associated with the risks noted. Posted May 19, 2016. Via FDA.

France is tightening rules surrounding how drug trials in humans are conducted following the death of a volunteer involved in a trial for the Portuguese pharmaceutical company Bial. The Phase I trial, which is designed to test the safety of a drug only, enrolled 90 healthy people, yet 6 people became seriously ill while taking the experimental medication requiring hospitalization. A report from French authorities faulted both Bial and Biotrial, the laboratory conducting the trial, for taking days to notify the National Agency for Drug Safety after the first volunteer fell seriously ill. All trials of the drug, which is intended to treat mood and anxiety problems, as well as movement coordination disorders linked to neurological conditions, have since been suspended. Posted May 23, 2016. Via Associated Press.

Can a Magic Mushrooms Compound Treat Depression?

One of the psychedelic compounds found in so-called “magic mushrooms” may help ease depression in people who have failed on other treatments.

A new study, published in Lancet Psychiatry, found that people with depression who were given psilocybin, which occurs naturally in certain kinds of mushrooms, twice 7 days apart, saw their depressive symptoms subside as early as a week and as long as 3 months after the first dose was administered. In addition, improvements in anxiety and anhedonia, the inability to experience usually pleasurable activities, were seen.

Although psychedelic effects were seen after taking psilocybin, they typically wore off after 6 hours. All patients also had some temporary anxiety as the drug began to take effect, but that quickly subsided. Others complained of confusion, headaches and nausea, and that also tended to dissipate in a matter of hours.

While it’s not exactly clear how psilocybin may help to alleviate depressive symptoms, the compound is known to stimulate serotonin receptors in the brain. Serotonin, a neurotransmitter, is thought to contribute to feelings of well-being and happiness.

The authors noted that prior studies have provided preliminary evidence that psilocybin may also be effective for end-of-life anxiety, obsessive-compulsive disorder, and smoking and alcohol dependence.

However, before you go and eat some “magic mushrooms” to ease depression, it’s important to note that the study included just 12 people, and there was no control group as a basis for comparison. In addition, the trial participants offered to take part in the study, so the improvements felt may have been psychosomatic in nature as they would more likely to want the treatment to work.

Also, they all knew they would be getting the drug (open label), as opposed to double-blind trials, where patients are unaware if they are getting a drug or a placebo.

“This study provides preliminary support for the safety and efficacy of psilocybin for treatment-resistant depression and motivates further trials, with more rigorous designs, to better examine the therapeutic potential of this approach,” the researchers conclude.

Other drugs with known psychedelic effects, such as ketamine, are also under investigation as potential depression treatments.

Nasty Side Effects of Psychiatric Medications

By Elaina J. Martin
If you ever want to gain 20 or 30 pounds, might I suggest getting on some mood-stabilizers with a side of anti-depressants? Antipsychotics will work, too. Maybe an anticonvulsant? Just swallow them down with the pizza and the chips and the cereal and the mashed potatoes and all the other carbs you eat in an effort to satisfy your insatiable hunger.

After being diagnosed in October of 2008 with bipolar disorder, I was put on Zyprexa, an atypical antipsychotic. The little pills went to work changing the chemistry of my brain, tranquilizing me, blocking receptors in the dopamine pathways. At night, hours after going to sleep, I would migrate to the kitchen and prepare a snack. Cereal. Ice cream. Spoon to mouth. Spoon to mouth. And although I barely remembered my nightly treks to the fridge, the evidence was always there in the morning. Empty bowls. Snack cake wrappers. Whoops, I forgot to put the milk back.

In just over a month I gained 20 pounds. It was quite incredible.

For the first year and a half after my diagnosis, it was a constant flux of prescription drugs. Zyprexa wasn’t quite right. Neither was the Lithium or the Geodone or the Trazadone or the Clorazepam or the Neurontin or the Luvox or the Xanax or the Zoloft or the Trileptal or the Seroquel. But with each try came a new, even if only short-lived, side effect such as fatigue, nausea, constipation, hand trembling, foggy brain clarity, double vision, headaches, and sweating. If there was a drug to treat bipolar disorder and anxiety, at some point, I believe I took it, and it seems like I experienced every know side effect of them as well.

A year and a half after my first hospitalization, a different psychiatrist introduced me to Saphris, another atypical antipsychotic. This drug, when coupled with Lamictal, an anticonvulsant used in bipolar patients as a mood stabilizer, provided me with stability for the first time since my diagnosis. The problem with Saphris was that it made me hungry. All the time. I gained five pounds in the first week. I talked to my psychiatrist and he put me on Topamax, an anti-seizure medication, the same one my boyfriend’s daughter takes for her epilepsy. He prescribed it to curb my appetite and it did.

‘The great thing about psychology today is that there are myriad medications out there; sometimes a simple switch from one SSRI to another can make a huge difference in the side effects you experience.’

I’ve been on antidepressants for the better part of a decade and as much as I appreciate their help with my OCD and their ability to keep me out of the hell that is depression, I miss having a sex drive.

So when is enough, enough? Personally, I say if you can handle it – though it may be inconvenient, annoying, and miserable – stick it out for a month. That should be enough time for your body to adjust to the medication. If problems persist, talk to your psychiatrist. The great thing about psychology today is that there are myriad medications out there; sometimes a simple switch from one SSRI to another can make a huge difference in the side effects you experience.

Medications aren’t the be all and end all of treatment. I am a huge proponent of talk therapy. I believe the two go hand-in-hand. In therapy you can learn how to navigate situations and relationships in a healthy way, while also learning how to cope with your illness. Therapy has taught me techniques to handle my OCD and anxiety — even my depression and mania. Things like imagery, breathing exercises, positive talk, using index cards to remind me of how to handle situations during crisis episodes have all helped me. I’ve also tried acupuncture, meditation, and yoga. All these things have helped me and didn’t come in a pill. I believe that in the treatment of bipolar disorder, especially severe cases like my own, medication is necessary, but there is a lot you can do to control things, too. Use medication to supplement your health and always remember to be your own best advocate.

Elaina J. Martin lives and thrives with bipolar disorder, obsessive compulsive disorder, and anxiety disorder. She is better now, better than before. Today she has hope.

She writes the blog, “Being Beautifully Bipolar,” at PsychCentral.com, as well as a personal blog at ElainaJ.com.

In a former life she was a fashionista who styled celebrities and models, worked on New York Fashion Week shows, and had a fashion radio spot and television gig. She has been published in half a dozen magazines including Jane, Women’s Wear Daily, Budget Living, Brilliant, Tribeza, RARE, WILMA, and both the StyleShaker and Zimbio websites. She has been an editor for 2 magazines and for a website.

Photo credit: Julie Fischer McCarter of Shoot Photo Inc.