IIAT Philosophy on Medications and Psychiatric Disorders Medication can play a pivotal role in helping address mental health concerns. Studies have shown that when appropriately prescribed and monitored, and when combined with therapy, medication can help significantly improve the outcome of many psychiatric and psychological conditions. IIAT now has a board certified psychiatrist in the practice. We can offer advice about and prescribe medications for various mental health conditions ranging from anxiety to anger problems, as well as problem drinking. We are a team of professionals at IIAT that collaborates in order to best meet your needs. This includes talking with you and your therapist to ensure that everyone is on the same page when it comes to what medications you are being prescribed and why. Given recent media publicity about prescription drug abuse along with increasing concerns about unsafe prescribing practices, our philosophy at IIAT will always be to ensure that you are prescribed the appropriate medications and that your response is carefully monitored on a regular basis. Medications for Anxiety and Depression Anxiety and Depressive Disorders can respond well to several medications. Of these, the most commonly prescribed are the SSRI (Selective Serotonin Reuptake Inhibitors) medication class. Examples of this include Prozac, Paxil®, Zoloft® and Lexapro®. Other classes include the SNRI’s, such as Effexor® and Cymbalta®. Finally, there are the serotonin antagonists such as Remeron® or Nefazadone®. Collectively, these classes of medications have provided symptomatic relief to millions for conditions such as panic disorder, generalized anxiety disorder, and social anxiety disorder. The eventual choice of medication will always be the result of a careful discussion between you and us in order to ensure the most favorable response. Everyone’s genetic make-up is different. A medication that works well for one person may not work for another. When medications are prescribed appropriately, many people report significant improvements in symptoms such as worrying, depressed mood, restlessness, fatigue, as well as motivation and zest for life. With the help of our prescribing psychiatrist, you can mutually decide how long you will need to remain on your medication. Next are the benzodiazepines. Many people will probably be more familiar with medications such as Xanax® (Alprazolam), Klonopin® (Clonazepam), and Ativan® (Lorazepam) that belong to this class of medications. These medications are only recommended for very short-term relief of extreme anxiety, never as a long-term treatment option. They require a specially written prescription because they are known to be addictive and have been known to be overused and sometimes abused. Research indicates that many people have been inappropriately continued on these medications for years, and that they are now likely both physically as well as psychologically dependent on them. Unfortunately, they do nothing to improve the long-term outcome of chronic anxiety. IIAT’s philosophy is to avoid prescribing of benzodiazepines altogether. We believe in using the appropriate, non-addictive medications that have proven themselves effective for long-term treatment. If you happen to be on a benzodiazepine, we can work with you to slowly taper you off such a medication and find other options that are more appropriate for you in the long run. Anger Problems Anger problems are increasingly receiving attention. Current diagnostic classifications have proven inadequate to describe this increasingly common behavioral problem. While there is no specific medication designed for anger, getting to the root cause can help guide the choice of medications. For example, if a depressive or anxiety disorder is severe enough it can make some people very irritable, and even explosive. SSRI’s can help dampen down such irritable and reactive moods. For those who are not depressed, anger usually arises when some sort of trigger “presses the buttons.” In that case, a combination of therapy and mood stabilizing agents can prove to be quite effective. Examples of mood stabilizing agents would include Depakote®, Trileptal®, and Lithium. For others, low doses of agents such as Seroquel®, Risperdal® and Abilify® can also help make the mood less reactive and more even- tempered over time. In general, no “magic bullet” exists for anger disorders. However, if the goals of treatment are realistic, such as to reduce the frequency and intensity of anger outbursts, then significant improvement can be expected when medication is added to regular therapy. Problem Drinking While the term alcoholic remains vague and even stigmatizing, many people will attest to difficulty in controlling the amounts they drink. They may also drink more days per week than they want, even if they do not drink daily. Such patterns are now classified under the terms alcohol use disorder. Medications along with therapy can again play a crucial role in decreasing cravings as well as helping to reduce the amount of alcohol consumed in one sitting. Of these, Naltrexone (Vivitrol®) is known to blunt the pleasurable sensations that lead to wanting to drink more once a person has begun drinking alcohol. It has been proven effective in helping people to moderate their alcohol use in one sitting. For those who have had a known dependent pattern of drinking, and who now intend to maintain complete sobriety, Acamprosate (Campral®) has been proven to delay the number of days to relapse into dependent drinking, as well as to limit the severity of the relapse, if it occurs. Again, the most effective results have occured in those who also participate in some form of therapy. Medications when properly chosen, dosed, and monitored play a crucial role in helping people make a recovery from their psychiatric or psychological problems. As has been repeatedly shown, the best results are always likely when medication is combined with effective therapy. A last word: for many, medications are seen as a panacea or “magic bullet.” Most psychiatrists will tell you that these are unrealistic, though understandably human, expectations. At IIAT we will take the time to explain what to expect from medications and what not to expect, so that realistic treatment goals can be achieved. In addition, we use medication combinations with the safest but most effective doses in mind so that you get the maximum possible benefit.