7. Other Agents for Anxiety and Sedation. Neurontin (Gabapentin), an antiseizure medication is often used in individuals in seizures, and seems to affect GABA, and may produce a calming effect on those with anxiety. In the past, bromide containing compounds (Miles Nervine) were sold over the counter and they also were touted to decrease anxiety. There are several agents that may be used to help one's sleep when associated with anxiety. Included in this category are Doral (Quazepam), ProSom (Estazolam), Restoril (Temazepam), etc. It may be that Quazepam is more specific in the benzodiazepine receptor side and associated with less amnesia and cognitive impairments. (The same may be true for Paxipam [Halazepam]). There are other agents (Barbiturates; Nonbarbituates sedatives such as Quaalude, Miltown, Equanil, Doriden, Placidyl; and Chloral Hydrate) that are rarely used today because of fear of addiction, but were used a lot in the past.

C. Sleep Medications. Much of the discussion of sleep medications could be summarized by saying, "see the discussion above on antianxiety medications." However, a few extra comments should be made.

1. Ambien (Zolpidem). Ambien is a newer sleeping agent that may work on more specific subdivisions of the GABA receptor complex than some of the older agents such as many of the Benzodiazepines. Thus, it is conceivable that tolerance may be less of an issue, but still a concern.

2. Sonata (Zaleplon) is the newest sleep medication. It also acts on a subdivision of gaba receptors it has a very short half-life(approximately one hour) and there for usually has no side effects regarding next day sedation or memory impairment.

3. Tylenol PM™. Tylenol PM™ and many similar agents combine a pain medication with an antihistamine (see the discussion above).

4. Minor Tranquilizers. There are various minor tranquilizers that are often specified more for sleeplessness (Dalmane [Flurazepam], Doral [Quazepam], ProSom [Estazolam], Restoril [Temazepam], etc.). It may be that Quazepam is more specific in the benzodiazepine receptor site and associated with less amnesia and cognitive impairments (the same may be true for Paxipam (Halazepam).

5. Antidepressants. Trazodone, Serzone, and Remeron are more new antidepressants that often help with insomnia.

6. Herbs. Melatonin and Valerian are herbs that have been used.

D. Medication for Obsessive - Compulsive Disorder. Since OCD may be a genetic, physiological, and biochemical abnormality, the mainstay of treatment is often Psychopharmacology. Anafranil (Clomipramine) was one of the leading drugs for this disorder in the recent past. The Selective Serotonin Reuptake Inhibitors (SSRIs) (Celexa, Prozac, Paxil, Luvox, and Zoloft) have also been used effectively. Luvox may be one of the best for not decreasing sex drive. These drugs block the reception of serotonin, and thus block their degradation in the mitochondria with a subsequent result of increase of serotonin in the synapse between nerve cells. This increase in serotonin may be why they work. Minor tranquilizers such as Klonopin (Clonazapan), Xanax (Alprazolam), and BuSpar (Buspirone) also seem to be a significant agents for augmentation, at times, to decrease obsessions. Occasionally, when an individual may be near a break with reality with their OCD, the new antipsychotic medications (Zyprexa, Risperdal, Seroquel) may be considered, as well as the old ones (Haldol, Moban, Navane, Stelazine etc.). Other augmenting agents that have been used include Clonidine, Tegretol, Trazodone, and Lithium. Tricotillomania, an Impulse Control Disorder, may be part of an OCD spectrum disorder and has been treated as a matter of practice with SSRI's.

E. Medications for Psychosis (A loss of touch with reality). See also the discussion of major tranquilizers (Neuroleptics) above.

These drugs came out in the early 1950s. After their introduction, individuals went home by the thousands from the mental hospitals. In fact, it was one of the greatest medical discoveries of all times. Sanity could be restored. Hallucinations ceased. Delusions went away. Bizarre behavior abated. Today, stability is possible. Functioning is within reach. Now, even socialization may be restored.

F. Medications for Attention Deficit / Hyperactivity. Medication is one of the most successful treatments for the child with ADHD. Children often more become organized, calmer, and less stubborn. Benefits:

1. More control over conduct, social behavior, aggressive behavior, and impulsiveness.

2. Improvement in attention span and in the quality and completion of school work, in general.

3. Healthier relationships with peers and family members. Three classes of medications exist:

a. Psychostimulant. This classification stimulates the nervous system in the areas of the brain that determine the attention, impulses, and self-regulation of behavior. Experts think that these medications are helpful for at least seventy to eighty percent of patients. These types of medications include: Ritalin, Dexedrine, Cylert, and Adderall (a newer drug with an increase in popularity).

b. Antidepressants.

1) This classification of medication is often used if the individual is depressed and also has ADHD.

2) There are several types of antidepressants used in treatment of depression and ADHD; Wellbutrin (Bupropion); Effexor (Venlafaxine); Tricyclic antidepressants (Imipramine, Desipramine, and Nortriptyline). The SSRIs (Selective Serotonin Reuptake Inhibitors) such as Celexa, Prozac, Paxil, and Zoloft have been used, especially when anger is a major issue. Remeron (Mirtazapine) is being tried.

c. Other medications

1) Clonidine (and Tenex) is often used to treat tic disorders in children and blood pressure in adults, but can also help in calming aggressive behavior present in ADHD.

2) Mellaril, Risperdal, and Zyprexa may help some children with ADHD who are near breaking with reality.

3) Lithium works on brain chemistry and may be useful in calming aggression in children.

G. Medications Used in Anger and Aggression. In some cases, medication can make a major difference with anger control problems. For example, in depression with anger, a group of medications known as the Selective Serotonin Reuptake Inhibitors (SSRIs Celexa, Prozac, Paxil, and Zoloft) may make a dramatic difference. There has even been talk of working toward approval of these drugs in more severe Premenstrual Syndrome (PMS) with its associated depression and anger. Also, many other drugs have been suggested as possibly helping in various conditions with anger and aggression: beta blockers such as Inderal and Visken; mood stabilizers such as Lithium, Depakote, Tegretol, and perhaps Neurontin; minor tranquilizer such as Ativan and BuSpar; dopamine agents such as Risperdal, Seroquel, and Zyprexa; and Attention Deficit/Hyperactivity Disorder agents such as Adderall.

H. Medications used in Dementia and Memory Loss. Several medications have been used with varying results in dementia. Those tried include Acetylcholinesterase inhibitors (Aricept/Donepezil and Cognex [Tacrine], Ginkgo [an herb]), Vitamin E, Estrogen, and Nonsteroidal Anti-inflammatory Drugs. Of course, Neuroleptics, antidepressants, and antianxiety medications have been used, as well, for associated symptoms. A new diagnostic test for Alzheimer's may soon be available (a protein AD7c-NTP in the cerebrospinal fluid). The newest medication for Alzheimer's is Exelon (Rivastiqmine tartrate) The newest preliminary studies seem encouraging.

I. Medication for Bipolar Disorder. See discussion of antidepressant medication.

J. Medications for Eating Disorders. In the eighteenth and nineteenth centuries, eating disorders were less because there was less food and less emphasis to be thin. Today, anorexia nervosa and bulimia are major issues among the young, with death from these disorders being far too common. According to the World Health Organization, obesity "should now be regarded as one of the greatest neglected public health problems of our time." In fact, approximately three hundred thousand premature deaths per year can be attributed to obesity and related lifestyle behaviors such as reduced physical activities. Thirty-three percent of Americans are overweight.

New and exciting medications are being tried for eating issues, as they are in other illnesses. That this medical adjunct should be added to Cognitive Behavioral Therapy is very appropriate, considering that the latest research is showing abnormal levels in subdivisions of the neurotransmitters serotonin (5HT1 and 5HT3C). The causes of eating issues are often complex with genetic, physiological, psychological, and social issues all being important. Thus, the cures are not simple. An exercise program, an accountability system, psychotherapy, a healthy diet program, spiritual support, and medication may all be important. In anorexia nervosa, food is, of course, the best medicine; but other measures such as SSRIs and Periactin are being tried. In bulimia, SSRIs and Trazodone are being tried. In obesity, several medications have been tried. Amphetamine-like drugs have long been tried from very mild over-the-counter preparations to highly controlled drugs (Dexatrim, Acutrim, Tenuate, Adipex). Serotonergic agents have been tried. Redux (Dexfenfluramine) and Pondimin (Fenfluramine) were removed from the market on September 15, 1997. Phentermine is still on the market. It increases norepinephrine release. A relatively new weight loss drug, Meridia (Sibutramine) is now on the market. Pharmacologically, Meridia is an MAO inhibitor and the usual dose is 10mg daily. Another drug, Xenical, an absorption inhibitor, is now out. Thermogenic agents (ephedrine, caffeine) have long been tried. Diet-Phen is one of the ever so popular herbal preparations (St. John's Wort, Ephedra, L-Phenylalanine, Acetyl-L-Carnitine, Chromium, Niacin, and B6).

K. Medication for Addictions. Various medications are being used in addiction issues. They include Wellbutrin (Bupropion) and Nicotine patches/gum for smoking addictions. In alcohol addictions, Antabuse (Disulfiram) has been used in the past which produces a very sick reaction if alcohol is consumed. Now, in alcohol addiction, Revia (Naltrexone) may even remove the desire to drink. SSRIs have also been used in some alcoholics. In alcohol withdrawal, Serax (Oxazepam) and Ativan (Lorazepam) have been used if there are problems with the liver. Of course, Valium (Diazepam) and Librium (Chlordiazepoxide) have been useful in alcohol withdrawal. In heroin withdrawal, Catapres (Clonidine) has been used.

L. Medications for Pain.

1. General medications for pain. Many medications have been used for various types of pain. In fact, aspirin is the number one selling drug of all time. Tylenol/ Acetaminophen is, of course, a leading competitor. Then there are the non-steroidal anti-inflammatory (NSAID) drugs for moderate pain which probably work through inhibitions of the biosynthesis of prostaglandins: Motrin (Ibuprofen), Naprosyn (Naproxen), Relafen, Nalfon, Lodine, Orudis, Toradol (Ketoralac), and most recently. The newest NSAID medication is Arthrotec (diclofenac Sodium/misoprostol), which includes a gastrointestinal mucosal protection that provides strong pain relief designed for arthritis patients. Then, there are the narcotic analgesics for severe pain: Morphine, Dilaudid, Demerol, Codeine, Percodan, Darvon, Talwin, Vicodin, Lorcet, Fioricet, Tylenol #3, and narcotic-like drugs such as Ultram. The narcotics probably work through effects on the neurotransmitter dopamine. The newest pain medication is Arthrotec (diclofenac Sodium/misoprostol), which includes a GI mucosal protection.

2. Medications for Migraines. Many medications have been used to either abate or prevent tension/migraine headaches. They include Midrin (Isomethoptene), Wygesic (Ergotamine), Imitrex (Sumatriptan) a weak affinity for 5-HT5A, 5-HT1A, and 5-HT7 receptors, Zomig (Zolmitriptan), Amerge Naratriptan Hydrochloride, and Maxalt (Rizatriptan Benzoate) Selective Serotonin (5-HT1B, 1D) agonists. Other medications that have been used include anticonvulsants, beta blockers, calcium channel blockers, minor tranquilizers, antidepressants, major tranquilizers, antihistamines, and muscle relaxants such as Soma, Flexeril, Parafon Forte, Robaxin and Lioresal. Skelaxin (metaxalone) have also been used. Finally, there are now new nasal sprays (Sumatriptan) and dihydroergotamine mesylate, USP (Migranal) available for migraine that may prove promising.

M. Other Medications Various medicines being used for numerous problems (DDAVP for bed wetting, SSRIs for premature ejaculation), Detrol for incontinence, Prilosec for gastric reflux, Orap for Tourette's Disorder, Evista for postmenopausal symptoms, Provigil / Modafinil for narcolepsy, Actonel for Osteoporosis.

As a matter of practice several medications (Orap, Haldol, Klonopin, Clonidine) have been used in Tourette's Disorder.

As a matter of practice several medications (SSRI's, Klonopin) have been used in Tricotillomania.

As a matter of practice several medications (mostly the new neuroleptics) are being used in Autism and Asperger's Disorder.

As a matter of practice several medications (Klonopin, Sinemet, Neurontin) have been used in Restless Leg Syndrome.

New Medications. (Touretts disorder, Tricotillomania, Asperger Disorder, Restless Leg Syndrome. New, remarkable medications are on the horizon. In the next ten years, we will see the advent of antidepressants, major and minor tranquilizers, pain medications, and medications that will virtually seem like miracles. It seems that almost every month a new and more specific medication is produced.

VI. Should Psychiatric medications ever be used?

Yes, Mental issues (Bipolar Disorder, Obsessive Worry, Major Depression Disorder, Panic Disorder, ADHD, Insomnia) can be just as medical as heart disease and high blood pressure. There can be a major medical, physiological, neurological, biochemical genetic factor. Why should this not be treated? Psychiatric medications are used to return body chemical (brain chemicals in this case) to normal just as one would in heart disease, hypertension and cancer.

CONCLUSION

There are medications today that may help in almost any emotionally connected issue: obsessive worry, panic anxiety, generalized anxiety, restless legs, too much weight, too little weight, inattention, decreased memory, drug addiction, manic highs, depressive lows, premature ejaculation, impotence, decreased sex drive, too much sex drive, PMS, anger, insomnia, pain, psychosis, and many more. The tools are powerful. They must be used in an appropriate, sensitive manner, by a skilled medical doctor.

" . . . the mind and the body are one and should not be treated separately . . ." ~Plato

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