Invitation to Psychology

Chapter 12 Approaches to Treatment and Therapy 421

medications should not be stopped abruptly with-

out supervision by a physician because withdrawal

symptoms may occur—including depression and

anxiety, which can be mistaken for a relapse, and

even mania, which can then cause the sufferer

to be misdiagnosed as having bipolar disorder

(Kirsch, 2010; Whitaker, 2010).

Antidepressants and most other psychotropic

drugs now carry strong warnings about the risks

of inducing suicide and violence. Of course, some

severely depressed people were suicidal before they

began taking medication. But the clinician and the

patient need to be aware that a person on these

medications may get worse; if that happens, medica-

tion should immediately be reassessed (Healy, 2012).

3

Antianxiety drugs (tranquilizers), such as Valium,

Xanax, Ativan, and Klonopin, increase the

activity of the neurotransmitter gamma-aminobu-

tyric acid (GABA). Tranquilizers may temporarily

help individuals who are having an acute anxiety

attack, but they are not considered the treatment

of choice over time. Symptoms often return if the

medication is stopped, and a significant percent-

age of people who take tranquilizers overuse them

and develop problems with withdrawal and toler-

ance (that is, they need larger and larger doses to

get the same effect). Beta blockers, a class of drugs

primarily used to manage heart irregularities and

hypertension, are sometimes prescribed to relieve

acute anxiety—for example, caused by stage fright

or athletic competition—which they do by slow-

ing the heart rate and lowering blood pressure.

But beta blockers are not approved for anxiety

disorders.

antianxiety drugs

(tranquilizers) Drugs

commonly but often

inappropriately pre-

scribed for patients who

complain of moderate

forms of anxiety, worry, or

unhappiness.

Although the newer drugs now comprise 90

percent of the market for antipsychotics, a large

federally funded study found that they are not

significantly safer or more effective than the older,

less expensive medications for schizophrenia, the

only disorder for which they were originally ap-

proved (Lieberman et al., 2005; Swartz et al.,

2007). And although antipsychotics are sometimes

used to treat impulsive aggressiveness associated

with attention deficit disorder, dementia, and other

mental problems, they are actually ineffective for

these disorders. One study followed 86 people,

ages 18 to 65, who were given Risperdal, Haldol,

or a placebo to treat their aggressive outbursts

(Tyrer et al., 2008). The placebo group improved

the most. Antipsychotics are also ineffective in

reducing the symptoms of PTSD, although about

one-fifth of combat veterans suffering from PTSD

are being given these drugs (Krystal et al., 2011).

2

Antidepressant drugs are used primarily in the

treatment of depression, but also for anxi-

ety, phobias, and obsessive-compulsive disorder.

Monoamine oxidase inhibitors (MAOIs), such as

Nardil, elevate the levels of norepinephrine and

serotonin in the brain by blocking or inhibiting an

enzyme that deactivates these neurotransmitters.

Tricyclic antidepressants, such as Elavil and Tofranil,

boost norepinephrine and serotonin levels by pre-

venting the normal reabsorption, or “reuptake,”

of these substances by the cells that have re-

leased them. These older antidepressants are usu-

ally more effective for severe depression than the

more recent and more popular ones, called selective

serotonin reuptake inhibitors (SSRIs). SSRIs, such as

Prozac, Zoloft, Lexapro, Paxil, and Celexa, work

on the same principle as the tricyclics but specifi-

cally target serotonin; Cymbalta and Remeron tar-

get both serotonin and norepinephrine. Wellbutrin

is chemically unrelated to the other antidepres-

sants but is often prescribed for depression and

sometimes as an aid to quit smoking.

All antidepressants tend to produce some un-

pleasant physical reactions, including dry mouth,

headaches, constipation, nausea, restlessness, gas-

trointestinal problems, weight gain, and, in as

many as one-third of all patients, decreased sexual

desire and blocked or delayed orgasm (Hollon,

Thase, & Markowitz, 2002). The specific side ef-

fects may vary with the particular drug. MAOIs

interact with certain foods (such as cheese) and

they can elevate blood pressure in some individu-

als to dangerously high levels, so they have to be

carefully monitored.

Although antidepressants are said to be non-

addictive, all of them, especially the SSRIs, can

produce physical dependence (Healy, 2012). These

antidepressant drugs

Drugs used primarily in

the treatment of mood

disorders, especially de-

pression and anxiety.

“Before Prozac, she loathed company.”

© The New Yorker Collection 1993 Lee Lorenz from cartoonbank.com. All Rights Reserved.