Medication FAQ

The role of a pharmacist has changed over the years. While one may remember a time when compounding and dispensing was their livelihood, the profession of pharmacy now encompasses much more. “Medication therapy management (MTM)” is a term that involves identifying, resolving, and preventing drug-related problems.

In addition, physicians are beginning to understand the value of a pharmacist’s opinion. For example, one study found that, when dealing with care of the elderly, 90% of general-practitioners welcomed pharmacist input, while another stated that 47-50% of pharmacist recommendations were followed by physicians.

Your medication record may not be complete in any given pharmacy if you fill your prescriptions from more than one pharmacy. A complete medication record would assist your pharmacist of choice to intervene on your behalf if medication problems were detected.

Committing to one pharmacy allows a relationship to grow between you and your pharmacist. Convenience can come out of this rapport, such as knowing the store’s hours and encouraging one to ask questions about minor conditions or over-the-counter products. Just remember, pharmacies are typically open longer hours compared to a physician’s office, you get immediate attention and, since the pharmacy cannot be open without a pharmacist, it guarantees one will always be there.

Aside from convenience, a pharmacist’s clinical approach is one of the most important reasons to use one pharmacy. When a pharmacist is filling your prescription, he / she is not just counting pills but reviewing your medication history on a continuous basis.

This is where MTM comes into play. The pharmacist is looking at your medication profile and reviews drug allergies to avoid cross-sensitivity, evaluates potential drug interactions, checks compliance to ensure you are getting the full benefit of the medication, checks for medication duplication (when a patient has two or more medications that give the same effect) and potentially looks for cost savings for you, the patient.

In summary, pharmacists take their professional relationship with the public very seriously. They strive to offer excellent MTM. This is why you should have a pharmacy of choice.

Drinking alcohol while taking antidepressants is generally not recommended because both of these substances can make you drowsy, less alert, and uncoordinated. When taken together, those effects are increased. However, since many patients are not willing to give up alcohol completely, it is important to combine alcohol and antidepressants in the safest way possible.

Some physicians allow moderate drinking for their patients. This means 1 drink per day for women and 2 drinks per day for men. “One Drink” is equivalent to 12 ounces of beer, 5 ounces of wine, 1 ounce of 80-proof whiskey, or 1 ounce of 100-proof spirits. It is also a good idea to drink slowly and eat some food while drinking to decrease the effects of the alcohol. However, you should not combine alcohol with your antidepressant until you know how your antidepressant will affect you. Many antidepressants will make people feel drowsy, dizzy, and less alert. People who experience these effects from their antidepressant will likely not be able to tolerate the combined effects of alcohol and antidepressants, and will not be able to perform routine tasks such as driving or operating machinery.

Combining alcohol with antidepressants could potentially be fatal. Alcohol can cause depression itself and also keeps some antidepressants from working as well as they should. This could lead to an increase in suicidal thoughts and actions. Also, if you drink alcohol while taking a certain type of antidepressant called an MAOI, your blood pressure could rise dramatically and could even cause a stroke. Finally, sometimes the liver cannot process all of the toxins present when alcohol is combined with antidepressants and fatal toxicity can occur.

The bottom line is that there are many reasons not to combine alcohol with antidepressants. If you wish to drink alcohol while taking an antidepressant, do so moderately and safely.

Your doctor, psychiatrist or pharmacist is your best resource for information on your treatment and medication. NAMI provides general information on mental health medication as well as individual medications provided by the College of Psychiatric and Neurologic Pharmacists.

Having trouble remembering to take medication is a common concern. Forgetting to take medication can be related to how many times a day a medication is prescribed. The more often a medication is prescribed, the more likely it is that the medication will be forgotten. Some medications are available as an extended-release form, which allows the medication to be taken less frequently. A physician or pharmacist will know if a medication is available as a once a day medication. It is important to know that medications taken once a day can be more expensive than medications given multiple times a day.

For some people, forgetting to take medications is due to the medication not being part of a routine. One way to make taking medication a part of a routine is the use of a pillbox or “pill minder.” Pillboxes come in a variety of sizes and can have spaces for taking medications up to four times a day. Fill a pillbox once a week and place it in an area it will be easily seen.

For some people, an easily seen area is near the coffee pot or another area on the kitchen counter, especially for medications taken in the morning. Placing medication near the alarm clock works well, especially if medications are taken in the morning and at bedtime. Another tip is to set an alarm on a phone when it is time to take medication. What is most important is to find a method that works for you. Ideally, the method is associated with something you do every day. Just remember to store medications in a cool, dry place and away from children or pets. Additionally your health care provider may refer an outreach team or visiting nurses to help assist people in taking their medications. If you have any further questions about ways to help you remember to take your medications, talk to your physician or a pharmacist.

It is very important that you stay on your medications to prevent your symptoms from coming back. Even missing a couple days of medication can cause problems. Everyone forgets to plan ahead sometimes, so you should not feel badly about it. The best thing to do is to go to your regular pharmacy and explain the situation to the pharmacist. In most all cases, the pharmacist will be able to give you a small supply of medication until your doctor can call in new prescriptions for you. You can plan ahead in the future by making a list of prescriptions that you need before seeing your doctor. A calendar can be used to remind you when to order refills from your pharmacy.

It is not uncommon for people to stop taking their antidepressant medication when they feel their symptoms have become controlled. Others may choose to stop their antidepressant medication because of bothersome side effects despite their mood being better. A person may not realize that most side effects can be effectively managed. While it may seem reasonable to stop taking the medication, the problem is that at least 50% of the time the symptoms of depression and/or anxiety come back. If you are taking an antidepressant, it is very important that you work together with your doctor before making decisions about any changes in your treatment.

Another problem with stopping your antidepressant medication, especially if you stop it abruptly, is that you may develop withdrawal symptoms that can be very unpleasant. If you and your doctor feel a trial off your medicine is a good idea, it is necessary to slowly decrease the dosage of antidepressant medications so that these symptoms don’t occur.

It is important to keep in mind that your doctor and pharmacist work together to make sure your medications are working safely and effectively. You should talk with them about how you are doing and whenever there are side effects that might make you want to stop your antidepressant treatment.

Yes, this is true. The effects you may experience if you abruptly stop an antidepressant medication are known as discontinuation or withdrawal symptoms. Up to eighty percent of patients who abruptly stop taking antidepressants develop discontinuation symptoms. These symptoms generally appear within days of stopping an antidepressant and can last up to two weeks. If the antidepressant is restarted, the discontinuation symptoms are quickly eliminated.

Common antidepressant discontinuation symptoms can be divided into four groups.

• Gastrointestinal symptoms: nausea, vomiting, diarrhea and abdominal cramps
• Somatic symptoms: headaches, lethargy and sweating
• Sleep-related symptoms: insomnia, excessive dreaming and nightmares
• Affective symptoms: anxiety, agitation and low mood

In order to avoid withdrawal symptoms associated with stopping these drugs, the dosages are often reduced gradually by your health care provider. Therefore, you should never abruptly stop taking your antidepressant medication. You should always consult your doctor or pharmacist before discontinuing any medication. Finally, be sure to maintain a sufficient amount of antidepressant medications at all times by refilling your prescriptions regularly.

The symptoms you are experiencing could be due to your medication. These types of symptoms are consistent with a side effect referred to as akathisia. Those with akathisia experience an inability to sit still and a constant urge to move. Due to a feeling of inner restlessness, a patient may experience fidgeting, pacing, rocking while standing or sitting, crossing and uncrossing legs while sitting, and constant movement of the feet. Patients have also described these feelings as “wanting to jump out of my skin” and as a “crawling skin sensation.”

Antipsychotics are the most common cause of akathisia, but it may be caused by other medications as well. You can ask your pharmacist or doctor if any of your medications have been known to cause akathisia. Some of these medications include (but are not limited to):

• Antipsychotics: aripiprazole (Abilify®), fluphenazine (Prolixin®), haloperidol (Haldol®), olanzapine (Zyprexa®) and risperidone (Risperdal®)
• Selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa®), fluoxetine (Prozac®), fluvoxamine (Luvox®), paroxetine (Paxil®), sertraline (Zoloft®)
• Antiemetics: metoclopramide (Reglan®) and prochlorperazine (Compazine®)6

Akathisia may range from being mild to severe, and can occur at different phases of treatment. Some symptoms may be mistaken for anxiety or agitation. Akathisia may also appear to be a worsening of a disorder. Consumers may then be diagnosed incorrectly and wrongly treated by increasing their current dose, which could lead to a worsening of the akathisia.

This side effect may cause a patient to want to stop taking their medication. Despite your side effects, do not stop taking your medication until speaking with your doctor. Discontinuing your medication may worsen your current disease state and be very damaging. Akathisia can be very debilitating for a person, making it important to properly recognize and manage immediately after one begins to experience the effect.

Akathisia is manageable. Options include stopping the medication, lowering the dose of the current medication, switching to another medication or adding another medication that treats akathisia. Akathisia symptoms can be treated with a beta-blocker (such as propranolol (Inderal®)) or a benzodiazepine (like lorazepam (Ativan®)). No changes should be made to your medication regimen until speaking with your doctor. The doctor can then further evaluate your signs and symptoms and work with you to choose the best treatment option in your situation.

Changes in sexual function may be caused by many things. If you notice any changes in sexual function after starting these medication your doctor can determine whether your medicine may be responsible. Some medications, such as Paxil, Prozac, Zoloft, Celexa and Lexapro, can cause sexual side effects, including lowered sex drive, delay in the time it takes for you to have an orgasm, or make you unable to have an orgasm. Not everyone who takes these medications experiences sexual side effects. These types of side effects will usually occur within the first several months of treatment if they are going to happen, and will continue as long as you take the medication.

If you do notice you are experiencing these types of effects and it is bothersome to you, talk with your doctor or pharmacist before deciding to stop your medication on your own. While it may be uncomfortable to talk about such side effects with your doctor, he or she needs to know about your concerns. If you do experience a sexual side effect from your medicine, it is possible for your doctor to treat the side effect so that you can continue taking medicine that is helping you. There are also other medications available that do not cause these side effects.

Decisions about stopping or changing your medication must be a mutual decision between you and your doctor. Stopping your medication abruptly on your own could cause uncomfortable withdrawal symptoms, such as irritability, anxiety, and difficulty sleeping. It is important to have the guidance of your physician when stopping or changing your medication. Furthermore, stopping medications like Paxil too soon can cause your original symptoms to come back.

A very common concern about long acting, slow release or extended-release medications is that a ghost tablet or capsule may appear in the stool. A ghost tablet contains only the outer shell of a pill without active ingredients. When this happens a person may worry the medication did not dissolve and did not work. Finding a pill in the stool is entirely normal for long acting medications. In a recent study, over half of the people taking a long acting form of Metformin for diabetes reported seeing ghost tablets in the stool. Extended-release products work like a little pump as they pass through the GI tract, slowly releasing the medication contained inside the tablet shell over a certain time period. The outer shell is then expelled upon defecation.

Many long acting, slow release or extended-release tablets or capsules (usually, but not always designated CR, SR, XL, ER, LA, etc.) are formulated to perform quite normally in this manner. It is important that the tablet be swallowed whole and not crushed, divided or chewed. If the tablet is not swallowed whole, the medication will stop being long acting and will release its contents all at once. This may result in an increase in side effects or loss of effectiveness of the medication. It is important for all members of a person’s healthcare team to discuss and understand ghost tablets of long acting medications.

Tardive dyskinesia (TD) is a movement disorder that may occur in patients treated with certain medications. TD is characterized by repetitive, involuntary movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Movements of the extremities or trunk may also occur.

TD is most commonly associated with the use of antipsychotic medications, such as haloperidol, fluphenazine and thiothixene, but it may also occur after exposure to various other medications such as anti-emetics (metoclopramide, prochlorperazine), antiparkinsons agents (L-dopa) and stimulants (amphetamine). Antipsychotics are commonly used to treat patients with schizophrenia, schizoaffective disorder or bipolar disorders. TD can be severe and irreversible, and is associated with high dose and longer use of antipsychotics. Monitoring for TD should be done every six months.

TD is believed to develop from long periods of antipsychotic treatment in order for it to occur in vulnerable patients. If movements similar to those of TD emerge, it may be tempting for patients to immediately discontinue certain treatments. This is typically not advised since an abrupt discontinuation of medications can also result in an increased intensity of psychiatric symptoms and put such patients at risk for re-hospitalization. It is therefore very important that you work closely with your health care provider. Ask questions about your medications and your concerns about potential side effects, including tardive dyskinesia. Your health care provider is qualified to answer these questions and make the best choice of medications, doses, and duration of use that would take into account your illness, the side effects of medications and how to prevent, monitor or treat these side effects.

It is true that antidepressants may increase the risk of suicidal thoughts and behavior in children and young adults up to age 24. However, studies did not show an increased risk beyond age 24. Also, studies show that older adults (ages 65 and older) taking antidepressants actually have a decreased risk of suicidal thoughts and behavior. The information sheet that came with the medication may be intimidating but if you know what signs to look for, depression can be safely treated.

Depression is a disease that affects over 14 million Americans a year. In 2006, about 33,000 people in the United States committed suicide. Typically 90% of those people have some type of mood disorder (i.e. – major depression, bipolar disorder). However, long term treatment of depression with antidepressants can decrease suicidal thoughts and behavior.

All patients, but especially children, should be monitored for any signs of worsening depression or suicidal thoughts or actions, especially during the first several weeks of treatment. Things to look for include irritability, sleeplessness or withdrawal from normal social situations or activities. Contact your healthcare provider if you experience any new or unusual changes in behavior, feelings or mood. Also, it is important that you do not stop taking the antidepressant without first consulting a healthcare provider, so make sure you keep any follow-up appointments.

There are a few things to consider when thinking about long-term treatment of mental illness. Similar to the treatment of high blood pressure and diabetes, a person can be on medications for many years, even a lifetime. The reason for this is that they are prescribed by doctors to help relieve symptoms or put disorders in remission but not be a cure in most cases.

Most important, medication treatment needs to be tailored to the person depending on the type of symptoms and response to treatment. Tailored medication treatments are decisions that are made between the person and doctor.

There is some evidence that the longer a person has suffered with a mental illness the longer the person may need to stay on the medications. A person is more likely to need medications for a longer period of time if:

1. you have been suffering with a mental illness continuously for 2 years or longer;
2. you have had repeated relapses of the illness;
3. you need combinations of medications to control your symptoms.

The good news is some exciting evidence that the sooner a person is treated for a mental illness the better the response will be. Also, the longer the person remains symptom free while taking the medication the better the chances that the doctor may later consider lowering the dose of the medication and possibly stopping the medication. Remember, there are always exceptions to the rule depending on the person and the type of illness. Even in the best-case scenario, a person will need to be re-evaluated on a regular basis for the need for ongoing medications. Please always consult with your doctor if you are thinking of stopping your medication or are concerned about how long to take your medication.

This is a great and important question when considering starting a family. Depression during pregnancy can occur in up to two out of every 10 women. A history of depressive episodes prior to becoming pregnant increases your risk of future depressive episodes. Treatment for depression includes psychotherapy and/or antidepressants, depending upon the severity of your symptoms. The most common antidepressants used for treatment are selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). The benefits and risks of antidepressant treatment during pregnancy must be carefully weighed against those associated with untreated depression. Risks of untreated depression in the mother include the continuation or recurrence of depressive symptoms, increased risk of poor prenatal care and miscarriage. The baby may experience an early delivery known as pre-term birth or a low birth weight. Antidepressant use during pregnancy have also been associated with low birth weight and pre-term birth.

If depression is considered severe or thoughts of suicide are present the use of antidepressants is strongly encouraged. If the depressive episode is considered mild to moderate the use of treatment other than medication can be considered. For some women, it may be appropriate to stop the antidepressant during pregnancy. Before stopping a medication for depression, it is important to discuss this with a health care provider. If the previous depressive episodes were considered mild to moderate or there have been no symptoms for six months, it may be appropriate to stop the antidepressant. In most cases the medication dose will need to be slowly decreased to reduce the risk of side effects, collectively known as serotonin withdrawal symptoms. These symptoms include headache, dizziness, nausea and diarrhea. Return of symptoms of depression needs to be discussed with a health care provider.

This is an important decision and you need to gather as much information you can and consult with a doctor who is comfortable with this risk benefit assessment to help you make the best choice for yourself. Understanding your supports, stressors, past response to psychotherapy and medications in the past will help you make these decisions. It is also important to think about the post-partum period where the risk of recurrence of depression is higher.

It is true that some medications used to treat depression and other psychiatric disorders have the potential to cause weight gain as a side effect. However, this is not experienced by everyone who uses them and it’s not possible to predict who will gain weight with a new medication. Besides medication, one reason for gaining weight may be the changes that occur when recovering from an illness such as depression. Some people may have eaten very little while they were depressed, and now that they are recovering they are eating more. Others may have been very inactive during their depression and are now becoming more active and therefore losing weight. People notice when weight changes occur and thus can inform their doctor and work together to develop a plan to manage the weight change.

While most antidepressants typically do not cause any weight gain themselves, there are some that can. The selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa®), sertraline (Zoloft®), and fluoxetine (Prozac®) are usually not associated with weight gain (1); they are often a good choice when this is a concern. Unfortunately people react to drugs differently and this is not always the case. Some people (10%) may have weight gain after taking an SSRI for an extended period of time, perhaps months to years later (2). Some older antidepressants known as tricyclic antidepressants (TCAs) are more likely to cause weight gain. Examples of drugs in this class are amitriptyline (Elavil®) and nortriptyline (Pamelor®). With drugs in this class weight gain will often occur soon after starting the medication, and may be dose related.

Achieving a therapeutic dose is preferred for effective treatment of depression, and it is important to report weight gain to your doctor while the medication dosage is being increased. People who gain weight are at a higher risk for developing diabetes and your doctor can monitor you for this possibility.

In answer to your question the possibility of weight gain would not necessarily be a reason to stop your therapy. Discontinuing your medication can lead to other problems and worsening or return of depressive symptoms. Self-medication and certain diets can also be dangerous (over the counter “diet pills” and herbal supplements can cause drug interactions, and grapefruit is know to increase blood levels of many drugs). That is why possible diets should be discussed with your doctor or pharmacist beforehand.

Both your physical and mental health is important. Before giving up on a medication that could or has caused you to gain weight, talk with your doctor about how this can be managed through eating a healthy diet and getting adequate exercise (which provides other mood and health benefits as well!). If this is unsuccessful, your doctor can help you to find a proper therapy that works best for you and minimizes weight gain.

Great question! First, if you have any questions regarding non-prescription medications (also known as over the counter medications) or herbal medications, your pharmacist can help answer those questions for you. Pharmacists are experts on both prescription and non-prescription medications. Never be afraid to ask your pharmacist a question; we love to help.

Your doctor is right about lithium having many drug interactions. It is always important that you let ALL your doctors, including dentists and pharmacists, know you are taking lithium in order to avoid potential drug interactions.

As for over-the counter medications that can interact with lithium, the most common drug interactions with lithium are with the Nonsteroidal Anti-Inflammatory Agents (NSAIDs) that are often used to treat aches and pains. When combined with lithium, NSAIDs can increase lithium levels in the blood resulting in an increased risk for serious adverse effects like confusion, tremor, slurred speech, and vomiting. Examples of non-prescription NSAIDs include:

• Ibuprofen (Advil® or Motrin®)
• Naproxen (Naprosyn®, Aleve®)

There are also many prescription NSAIDs such as the following:

• Celecoxib (Celebrex®)
• Diclofenac (Voltaren® or Cataflam®)
• Etodolac (Lodine®)
• Indomethacin (Indocin®)
• Ketoprofen (Orudis®)
• Ketorolac (Toradol®)
• Meloxicam (Mobic®)
• Nabumetone (Relafen®)
• Oxaprozin (Daypro®)
• Piroxicam (Feldene®)
• Tolmetin (Tolectin®)

In general, it is best to avoid the NSAIDS listed above when taking lithium. Certainly, they should not be used frequently or on a regular basis without consultation with your doctor(s).

If you do need a pain reliever while taking lithium, acetaminophen (Tylenol®) is a safe alternative. Sulindac (Clinoril®), a prescription pain reliever, can also be used as an alternative.

Also, too much caffeine can decrease the effectiveness of lithium and possibly increase your symptoms.

When buying any non-prescription medication it is very important to look at the active ingredients on the package. Many non-prescription medications, such as those used to treat the cold and flu, contain multiple active ingredients and may interact with your medication. For example, Advil Cold and Flu® contains ibuprofen which can increase your lithium level. Also, read the labeling information on all non-prescription medications; this may help avoid drug interactions. When reading the active ingredients list on non-prescription medications or when in doubt about any drug interaction, ask your pharmacist!

First, ensure the pharmacy has your most up to date insurance plan information. Ask the pharmacist if the medication is part of your prescription drug coverage. If you do not have prescription drug coverage, talk with your physician, nurse practitioner, social worker, or health care professional immediately to see if you are eligible for prescription drug coverage or if another medication could be used that is less costly and affordable.

There are “Prescription Drug Assistance Programs” for many of the pharmaceutical companies that provide medications under certain circumstances to patients. You should work with your healthcare professional to fill out necessary forms to be enrolled in these programs. There are also circumstances where small quantities of medications can be given to you from your physician’s office called “samples.” These are intended for short-term use until you can receive your medication from your pharmacy or make other arrangements to obtain your medication. It is important to let your healthcare professional know as soon as possible if you have trouble obtaining your prescribed medication.

Find out more about getting help paying for your medication.

When exploring treatment options in children diagnosed with bipolar disorder, it is important to remember each child is different, and may respond to different medications. Some children may need more than one medication to control their symptoms of bipolar disorder. There are many different types of medications used to treat acute manic episodes, acute depressive episodes, as well as maintenance medications for bipolar disorder. Both “mood stabilizers” and “atypical antipsychotics” are medications used in children and adults although some of them are not approved by the FDA for children. The atypical antipsychotics Abilify® (aripiprazole), Risperdal® (risperidone) and Seroquel® (quetiapine) are FDA approved for bipolar disorder in children 10 to 17 years of age while Olanzapine (Zyprexa) is approved in children with bipolar disorder 13 to 17 years. Lithium, which is considered a mood stabilizer is also approved in children with bipolar 12 to 17 years of age. Other mood stabilizers are agents such as Tegretol® (carbamazepine), Depakote® (divalproex), and Lamictal® (lamotrigine); however, these are not FDA approved for the treatment of youths with bipolar disorder.

Currently, there are not any treatment guidelines for children diagnosed with bipolar depression. Based on studies in adults, lithium is recommended as one treatment option for children with bipolar depression. Other mood stabilizers, such as Depakote (divalproex) and Lamictal (lamotrigine) have also shown benefits but are not FDA approved. In some cases, an antidepressant may be added after a child has been taking a mood stabilizer. Please check out the medication facts to learn more about each of these medications. It is important to discuss treatment options with your child’s doctor, and to understand the risks and benefits of each medication. Some children may also benefit from cognitive behavioral therapy (CBT) or other types of psychotherapy in addition to medications.

Antipsychotic medications can help reduce positive and negative symptoms associated with schizophrenia. Hearing voices (having auditory hallucinations) is what is called a positive symptom of schizophrenia. Other positive symptoms that may occur include disorganized thoughts, visual hallucinations (seeing things that aren’t there), delusions (strongly held false beliefs) and acute anxiety (pacing, restlessness, agitation). Negative symptoms of schizophrenia include lack of self-care, decreased thoughts or speech, inability to feel pleasure, social withdrawal and the inability to express emotion.

Antipsychotics reduce auditory hallucinations primarily by blocking the brain chemical dopamine from working in specific parts of your brain. After one to two weeks with the correct medication, voices begin to decrease and may continue to improve throughout the length of treatment. It may take four to six weeks to receive the full benefit of the medication. Many patients describe the voices as having stopped or being “muted” after several weeks; however, it is possible to continue to hear voices after an adequate trial with your medication. If you still hear voices while on the medication, it doesn’t necessarily mean that the medication isn’t working anymore. If you feel you are not getting adequate relief from your symptoms, tell your doctor or pharmacist as there may be a need for a dosage or medication change. It is important to take your medication as prescribed and return to your doctor for regular follow-up appointments. Other strategies, such as cognitive behavioral therapy, can be helpful to manage persistent voices. If you feel like the voices are unbearable or urging you to harm yourself or others, seek medical attention immediately.

One answer is to let the person with mental illness know that he can always count on your love and friendship, but their best chances of improvement will occur when they accept that medication is crucial to their recovery. Sometimes one can help persons struggling with mental illness (especially bipolar disorder or schizophrenia) decide for themselves which is worse – the short periods of time without the medication and side effects, followed by the inevitable resurgence of the illness (often times with worse symptoms than before)…..or, the steadier, prolonged times of symptom-free living (or at least more manageable symptoms) while taking the medications, and coping with the side effects? In a recent study, Hamann and colleagues have shown that higher rates of non-compliance with schizophrenia treatment were associated with re-hospitalizations between 6 and 18 months following a previous hospitalization.

Simply being hospitalized can help some of those suffering with mental illness be more compliant with their medications. To them, being hospitalized means “hitting rock bottom”, and they will be more motivated to change whatever they can to ensure a better recovery. Others may not be prepared, and will be more difficult to reach. For these people, consistent support and patience are important to maintain.

Another valuable action you can take is to tell your friend about NAMI. There may be a NAMI group in the community in which he lives. You could take him to a NAMI meeting. Show him how to get on the NAMI website and navigate to the different sections available (“Inform Yourself,” “Find Support,” and “Take Action”). Being an informed consumer will help him understand not only more about his illness but also about the important role medications can have in controlling his symptoms.

It’s very important that your friend knows you will be there to help him when his symptoms are troublesome. Your support in helping him stay on his medications will benefit him greatly.

Medications for mental illness are generally safe and effective when used as prescribed. As with any medication, however, side effects may occur. Research shows that medications like antipsychotics, lithium and antidepressants can actually protect brain cells from damage caused by brain illnesses like schizophrenia and bipolar disorder. This improves overall functioning.

While this is true, consumers should know that every medication has some risk of long-term adverse effects. For example, clozapine (Clozaril®) poses a risk of lowering immune system function, valproate (Depakene®, Depakote®) has a risk of causing liver injury and lithium has a risk of decreasing kidney function. It is a good idea for consumers to be aware of the possible long term adverse effects of each medication prescribed for them. Please check out the medication facts to learn about possible side effects of your medication. Regular visits to your doctor and blood tests are often necessary to screen for and prevent these adverse effects.

The purpose of this question is to piggyback onto the previously answered question of “Why do psychiatric medications cost so much?”

To begin with, as stated previously, a “Brand” drug is a product with a patent that allows a manufacturer to sell it exclusively for a certain period of time before other manufacturers can produce the same drug and create competition. Why is this allowed? The complex process of getting that medication onto the market explains this. The main focus of this process is to ensure the safety and efficacy of medications before they are used by the public.

In the US, the Food and Drug Administration (FDA) is responsible for reviewing compounds (drugs) prior to them being taken by the general public. On average, a drug manufacturer will screen 10,000 compounds only to test 10 of these compounds as possible medications. Of these 10 tested compounds, only two will make it to the public market as a medication.

Drug Discovery:

To begin with, it takes on average 2-5 years to develop a compound. All this time is necessary to find a single molecule that may be used as a medication.

Drug Development:

It takes another 5-9 years to determine what the drug does and if it is safe for human usage. The drug manufacturer starts this process by determining how much drug is too large of a dose, so no one will be harmed in the upcoming trials. Afterward, the compound is put through Phase I tests. This is when the compound is tested in 20-100 healthy humans to establish tolerability and basic safety profiles. The company is looking for how the drug moves in, around, and out of the body (absorption, distribution, metabolism and elimination).

From here, the drug moves to Phase II studies which is when the drug is used on several hundred patients who are sick with the disease that the compound is intended to treat. This phase helps to establish what kind of dose should be given to patients, if the drug works and gives short-term safety information.

If the compound is a success, it will go to Phase III trials. For this phase, hundreds to thousands of sick patients are tested. This establishes longer-term safety information, while still looking at dosage and efficacy information.

At this point, the compound’s information will be submitted to the FDA. After (if) the FDA approves the compound, it will be produced and introduced to the public for use.

This entire process costs the drug company $800 million to $1.7 billion dollars (1). Therefore, the company can hold the patent in order to recover the money spent during the drug development process.

Storing large quantities of medications at home can be potentially dangerous. Excessive amount of medications can lead to confusion about which medications to take, increase the risk of over-dose, and can be potentially dangerous to children and pets. It is very important to go through the medication cabinet, and dispose all leftover, expired and unwanted medications.

Proper disposal of unwanted medications should protect your privacy, discourage consumption, and not be a source of environmental contamination. Flushing medications down the sink or toilet is no longer recommended. Local municipals, trash services or hazardous waste facilities may be contacted, but some may not accept medication products.

The best plan is to dispose the medications in the trash. But first, protect your privacy by removing the label, or by crossing out your name and the name of the drug with a permanent maker, or by removing the medication from the original container. Secondly, discourage consumption of the medications by modifying the content with undesirable refuse such as wet coffee grounds, wet cat litter, or by adding a small amount of water to partially dissolve the medications. For liquid medications add table salt, flour, or non-toxic ill smelling spices such as mustard or turmeric and conceal the medication container with a duct or opaque tape. Place the container in a sealed non-transparent bag, empty can, or jar and dispose the contents in the trash.

If the medication is in blister (unit dose) packs, distort the name; wrap the blister packages with multiple layers of duct or opaque tapes, place in a non-transparent bag and dispose in the trash. If your leftover medications are ampules, vials, or intravenous (IV) bags, wrap the container with tape to prevent breakage, place in an opaque plastic container, and wrap the container with additional duct tape to prevent leakage and to further obscure the content. Dispose the container in the trash.

Recently the Drug Enforcement Administration (DEA) has been sponsoring a National Prescription Drug Take Back Day throughout the United States. This program allows the public to bring unused drugs to a central location for proper disposal. Find out more information at DEA National Take Back Initiative.

There are resources and programs available that are designed to help cover the cost of medication. includes information on health insurance options, prescription assistance programs and pharmaceutical company programs that discount medication. Learn more on our Getting Help Paying for Medication page.

Your county or community mental health care center may offer medication and mental health care services on a sliding scale basis. Your NAMI Affiliate may be able to help you locate this center.

If you’re out of medication and need help right away, free and charitable clinics may be able to help.

First it is important to understand the difference between receiving a “Brand” or “Trade name” product versus a “generic” form of a medication.

A “Brand” name medication has a patent that allows the manufacturer exclusive rights to sell the medication for a certain number of years. “Brand” name drugs cost more because the pharmaceutical company discovering the drug is attempting to recover the hundreds of millions of dollars it took to do the research to make sure the drug is safe and effective. Other costs involved with brand-name medications include manufacturing, distributing, and advertising.

When the patent time for a brand-name medication runs out other manufacturers are allowed to make and sell “Generic” versions of the same drug. The active ingredient(s) of “Generic” medications are identical to the “Brand” ingredient(s) though the tablet or capsule may look slightly different in color, shape, etc., and generally is less costly.

Check with your practitioner or pharmacist to discuss potential alternatives before starting or stopping medications.

This is a commonly asked question. Addiction involves taking more and more of a drug and craving it, despite having negative consequences from taking it. For some people who are addicted, much time is spent making sure that there is always an available supply of the drug. Common addictions are for drugs like cocaine and methamphetamine. Addicted individuals may crave these drugs but sometimes taking them makes them feel paranoid and even hallucinate.

Most medications for severe brain disorders like schizophrenia or bipolar illness do not pose a risk of addiction. These medications alleviate symptoms and improve your health but there is no craving and the outcome of use is positive. For example, sleep is improved and concentration is better when people having schizophrenia take an antipsychotic like risperidone (Risperdal®), quetiapine (Seroquel®), aripiprazole (Abilify®), olanzapine (Zyprexa®), ziprasidone (Geodon®), iloperidone (Fanapt®), asenapine (Saphris®), lurasidone (Latuda®), paliperidone (Invega®), clozapine (Clozaril®), or haloperidol (Haldol®).

Some prescription medications to relieve anxiety and improve sleep, for example, lorazepam (Ativan®), alprazolam (Xanax®), clonazepam (Klonopin®) and diazepam (Valium®) can pose a risk of addiction in persons prone to addictions. Ask your doctor or pharmacist about the risk of addiction with your specific medications.