Can I offer you a Kleenex®? Or perhaps a Q-tips®? Have you ever “Googled” for the nearest coffee shop because you needed a Starbucks®? Sometimes a product’s brand can become so pervasive that the branded name can actually replace the more generic term (i.e., tissue, cotton swab, internet search, coffee). Unfortunately, we have the opposite problem in psychiatry. That is, no matter how wonderfully branded the latest and greatest medication may be, once our clients find out what generic class the medication belongs to we might hear, “I’m not taking that!”
The Horrible Branding of Psychiatric Medication
Although several classes of psychiatric medications may have more than one name, the names most often recognized among professionals and known to the public include:
- Mood Stabilizers
- Antipsychotics (atypical & typical)
- Anxiolytics or Anti-anxiety medications
- Stimulants (ADHD & others)
- Pain Medications
At first glance this list seems to make a lot of sense. People suffer from different types of mental health conditions, and should therefore receive treatment from the class of medication most specific to their condition. But, it’s just not that simple.
Medications, even those within the same class, have many different features and can be used for several purposes other than what the name of their class may suggest. So when your prescriber carefully selects a medication for you that is outside the class that you would expect, remember that the source of your surprise likely stems from the names of the very poorly branded medication classes.
Versatile Meds & Inaccurate Brands
Despite what the names may imply, the drugs from the various classes of psychiatric medications can often be prescribed for different reasons.
No surprise that within the class of antidepressants are drugs we regularly associate with the treatment of depression (e.g., Zoloft, Paxil, Lexapro). Antidepressants are the gold-standard & first-line choice for the medical treatment of clinical depression. But the treatment of depression is just the beginning of the sundry conditions this class of medications can be used for:
- anxiety – many antidepressants are the first-line choice for anxiety conditions and are fantastic options for treating nervousness, panic and other anxiety-related symptoms.
- insomnia – some antidepressants are quite sedating and their prescription can be a wonderful solution to those who are having difficulty sleeping.
- pain – a few members of this class are prescribed by my colleagues in neurology for the treatment of migraines or nerve pain associated with diabetes or trauma.
- other examples – bupropion is an antidepressant that is often given to those who are trying to quit smoking and is sometimes used for ADHD, Brintellix® has been suggested to be helpful with the cognitive symptoms of some mental health conditions, mirtazapine can cause some weight gain and be helpful for people who are having unwanted weight loss.
If you are suffering from depression, wouldn’t you want something to stabilize your mood? True, but this class of medications is referring to those drugs that help individuals suffering from the kind of depression that might have an associated “energy fluctuation” akin to what you might see in the disorders from the “bipolar spectrum.” In a way, mood stabilizers are the “antidepressants” for those who might have a bipolar-related disorder.
But in addition to helping with a “bipolar-type” depression, these medications are also helpful in the treatment of those who are suffering from the other side of bipolar symptoms which are called mania or hypomania (e.g., getting less sleep than usual and not missing it, increased impulsivity & irritability, increased productivity & feelings of euphoria). But their usefulness to psychiatry doesn’t end there:
- anxiety – many of the mood stabilizers have calming effects that can be useful for the treatment of anxiety. Some of them are actually approved over in Europe specifically for the treatment of anxiety.
- pain – just like a few of the antidepressants listed above, several members of this class of medications can be helpful with the treatment of pain and neuralgia.
- seizures – actually, the vast majority of these medications are also classified as anticonvulsants for the treatment of seizure disorders.
- alcohol abuse – if you are among the group of people that have a GRIK1 genetic variant (a specific kind of genetic profile), then your prescriber might offer a drug called topiramate which has been shown to be very helpful in the reduction of alcohol consumption.
- other examples – lithium (even at low doses) is a helpful adjunctive therapy to other classes of medications, and has also been linked to better levels of general mental health and lower suicide rates for communities that have a higher level of the element in their drinking water. Both lithium and valproate are associated with an increase in the brain’s ability to release an important substance called BDNF (brain-derived neurotrophic factor), which is the body’s natural Miracle-Gro® for neurons and can be deficient in some people with depression and other mental health conditions.
I have a lot of problems with the branding of this class of medications. I have carefully selected an antipsychotic for many of my clients, and I continue to run into people who immediately refuse to take my recommendation even though the drug may be the one most helpful to them. This class of medications was originally designed to help those suffering from symptoms of psychosis (e.g., hallucinations, delusions, disordered thinking), but as our knowledge of the brain has expanded, so has the list of potential uses for this important group of drugs.
- depression – several of these medications are excellent add-ons for the treatment of depression. In fact, a few have been specifically approved for their role in treating the disorder.
- mood stabilization – the subclass of antipsychotics called “atypical” are essentially equivalent in their ability to treat mood & energy fluctuations that may stem from a bipolar-spectrum disorder. Often a provider may prefer this class of medications over one of the “mood stabilizers” described above especially if the client’s mood fluctuation has some psychotic features associated with it or if the client would benefit from a more fast-acting medication.
- insomnia – similar to antidepressants, several members of this class are very sedating and can be helpful to those having difficulty sleeping.
- anxiety – I have had particular luck prescribing a few of these medications to those suffering from chronic anxiety. This is particularly the case for those who may have a genetic profile suggesting an irregularity in how their brain metabolizes dopamine. Since blocking/regulating dopamine is one of an antipsychotic’s major attributes, this might be the perfect medication class for a sufferer of anxiety disorders.
- ADHD – similar to the example above, some people with ADHD have shown up in my office with a long history of not liking to take their ADHD medications. For them, the source of their inability to focus or concentrate may be too much dopamine instead of too little. I have had several clients who experience a “new normal” of ADHD treatment with the introduction of a medication from this class.
Anxiolytics, Stimulants & Pain Medications
A complete list of all the different ways psychiatric medications can be used would make a long article even longer. So here are a few more examples of interesting methods of addressing mental health symptoms using medications from alternative classes:
- depression – there is growing evidence that some mental health disorders, particularly depression, may be related to the body’s own “inflammatory” response. So a few prescribers are turning to pain medications such as Celebrex® for the treatment of depression when other methods have failed. Also, for a client who is having difficulty beating a depression that makes them feel tired and lethargic, stimulants from the ADHD group of medications can be very useful.
- anxiety – I swear that I have gotten very good results in treating anxiety with stimulants. For a very select group of clients that have been found to have a genetic variant resulting in the over-metabolization of dopamine, adding an ADHD medication has been tremendously helpful to their processing of stress and their level of anxiety.
NOTE: FDA Approval
It should be noted that in many of the above examples of how psychiatric medications can be used for alternative therapies, that their alternative use is NOT FDA Approved and would be considered “off-label” prescribing.
From the U.S. Agency for Healthcare Research and Quality:
Off-label prescribing is when a physician or nurse practitioner gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.
(I added the words in italics above). So although my intention in this article is to expose the poor branding of psychiatric medications, you and your provider should always have a discussion if a medication that is being prescribed is for an “off-label” use.
Use Colors Instead
So what should we do about this branding problem? So far we have learned that antidepressants are anti-anxiety medications, that some antipsychotics can help with anxiety, and that some prescription pain medications can finally give you some relief to a lingering depression. So essentially none of the names of the general classes of psychiatric medications are entirely correct, and in all cases can be misleading and confusing to the public who needs to be active participants in the selection of the healthcare that is prescribed to them.
I say that we should just start using colors. Although the classes of psychiatric medications are meaningful groups, they have horribly misleading names. So I propose the following:
- YELLOW – antidepressants
- ORANGE – mood stabilizers
- WHITE – antipsychotics (atypical & typical)
- GREEN – anxiolytics or anti-anxiety medications
- RED – stimulants (ADHD & others)
- BLUE – pain medications
We also could use shapes, letters, or the names of NASA® Space Shuttle missions (honestly, why aren’t we giving these things inspirational titles like Discovery, Atlantis or Endeavour?). I really don’t care. What I do care about is that the existing names of medication classes are not helping me talk to my clients and act as a pretty consistent barrier to their full understanding of the recommended course of treatment.
So I, for one, am going to start using a sweet color-coded chart to talk to my patients about the medications I have selected. Maybe then when I think the best treatment option is a course of an antipsychotic, that I won’t have to spend valuable session time having to tell them about the “horrible brands of psychiatric medication.”
I think it would be simpler to say, “Depression can be treated with a yellow, orange, white, red or blue medication; and the reason I have selected a yellow one to start with is because…” Wouldn’t that seem to clear things up a bit?