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Medication

SSRI compounds

SSRI is an abbreviation of the term Selective Serotonin Re-uptake Inhibitors. These substances work by affecting the brain’s serotonin system. Serotonin is a neurotransmitter that is released from a nerve cell, after which it influences the neighboring cell. If one is being treated with an SSRI compound, the brain’s serotonin system is stimulated.

These compounds are effective with respect to anxiety disorders, depression and OCD. They typically begin to take effect after 2-4 weeks – with OCD it sometimes takes half a year. Dosage for OCD is higher than for anxiety disorders and depression. SSRI compounds are not physically habit-forming, but without relevant cognitive behavior therapy it may be expected that anxiety and OCD symptoms will return if the patient stops taking the medication.

Side effects are usually mild. It should be noted, however, that anxiety symptoms may at first worsen when treatment begins. Likewise at the beginning of treatment there can be nausea, headache and mild, influenza-like symptoms which will later ease off. It should also be noted that quite a few people who take SSRI medication are troubled by sexual side effects, primarily in the form of reduced desire. There are no known long-term side effects from taking SSRI medications.

Dual-action compounds

These modern substances affect not only serotonin, but also the neurotransmitter noradrenalin; hence the popular term “dual-action”. This sometimes makes the medication more effective, but it normally also results in more side effects. The compounds are especially used to treat depression, or if there is a depressive element in cases of anxiety or OCD. The substances in question are Effexor (37.5-300 mg), Remeron (15-30 mg) and Cymbalta (30-60 mg).

Tricyclic antidepressants

These older compounds are used to treat severe depression, as they are more effective than the above substances, but they also have more side effects, especially in older people.

Benzodiazepines

For emergency treatment of anxiety, benzodiazepines may be used, for example Oxazepam or Stesolid. These compounds are rapid-acting and highly effective, but after a short while they result in physical dependence. The medication is therefore typically only used for short-term therapy, and one must remember to phase out slowly in order to avoid withdrawal symptoms.

Valdoxan

This is a completely new antidepressant that works by stimulating the brain’s melatonin system, which plays a critical role in sleep. The mode of action is thus completely different from traditional antidepressants, although Valdoxan does also have an effect on the serotonin system. The medication was registered for use in Denmark in June 2009, so practical experience with it is still modest, but so far the clinical experience is good.

Mood stabilizers

For bipolar (manic-depressive) disorder, the primary treatment is mood stabilizing compounds – Lithium, anti-psychotics or antiepileptic drugs. Lithium is the first choice for the so-called bipolar type 1 disorder, where there have been clearly manic phases in addition to depression. For bipolar type 2, where there have only been mildly manic phases – hypomanic phases – it is often a good idea to treat with the antiepileptic medication Lamictal, which is effective and has very few side effects. Among the anti-psychotics which are effective against bipolar disorder are Zyprexa, Abilify, Seroquel and Risperdal.

Ritalin

This drug is used for treatment of ADHD. The compound increases the ability to concentrate, which is critical for this disorder, in which the ability to focus one’s attention is reduced. The drug only works for 3-4 hours, but on the other hand, a single use is enough to determine whether it works at all.

Lyrica

This compound is a relatively new anxiety-reducing medication which also has an effect on epilepsy. It is often highly effective and has few side effects. It may initially cause lethargy, but this passes off quickly, and one can choose to slowly increase the dosage.

Medication for alcoholism

Naltrexone and Selincro for alcoholism are described under ”Alcohol abuse”.

This chapter was written by consultant doctor, DMSc. Jakob Ulrichsen, medical specialist in psychiatry, on 14 December 2013.