Taken from the Grand Rapids Press which is located HERE.
If a person is not mentally healthy, what good is physical health?
Too often it’s a question most people do not take seriously, experts say.
This, despite the fact that many would not hesitate to take medication to treat physical ailments such as diabetes or high blood pressure.
Many times stigma and the mistaken belief those who suffer from mental illness can overcome it on their own prevent patients from seeking out and consistently taking medications their brain badly needs.
myths and bring focus to people who silently suffer, this post explores issues surrounding medications.
We turned to three West Michigan experts for answers: Dr. Kevin Furmaga, Dr. Jamie McLean, and Dr. Eric Achtyes.
Furmaga is a board certified psychiatric pharmacist and clinical researcher who serves as a clinical psychopharmacology specialist with Pine Rest Christian Mental Health Services and Saint Mary’s Health Care in Grand Rapids.
McLean is a psychiatrist with appointments at Network 180, Kent County’s community mental health agency and Touchstone Innovare.
Achtyes is researcher and staff psychiatrist at Pine Rest and Touchstone Innovare in Grand Rapids.
Here’s what they had to say:
Q: What causes mental illness?
A: One prominent hypothesis is that an imbalance of certain neurotransmitters in the brain can contribute to mental illness, Achtyes said.
Psychotropic medications can help by replacing neurotransmitters if their levels are too low, or by blocking their action if the level of neurotransmitter is too high, he said
Neurotransmitters are chemicals that go between brain cells and allow them to talk to one another, such as serotonin, norepinephrine and dopamine. These can affect mood, energy, addiction and pleasure.
Too little serotonin can lead to depression or mood disorders. An imbalance of dopamine, often too much, plays a role in schizophrenia and schizophrenia-related disorders. Disruption in norepinephrine can lead to anxiety and mood disorders.
”I think it’s extremely hard for people to understand how the brain and chemistry within can really affect people’s perspective,” McLean said. “People don’t understand that negative things going on around us can actually change our brain chemistry, and medications can help to stop that, and to reverse that to a certain degree.”
Q: What triggers it? What increases the risk?
A: In most cases, stress, Furmaga said. Often times, he said, early on in these illnesses there’s usually some major stressor that can be identified that triggered the first bout of depression or psychosis.
There’s also a genetic aspect.
”Some people inherit a vulnerability to develop a certain type of brain chemical imbalance leading to their symptoms,” he said. “So that vulnerability is always going to be there and that’s going to put folks at risk for recurrent bouts of these brain chemical imbalances.”
Genetic influence definitely plays a role, but it’s usually not the whole answer, Achtyes said.
”For example, if you study identical twins who have exactly the same genetic makeup and look at pairs where one twin goes on to develop schizophrenia, there is only a 40 to 70 percent chance the other twin will develop schizophrenia too. It doesn’t happen 100 percent of the time,” Achtyes said. “This means that something besides genetics is playing a key role in the development of the disorder.”
In those situations they both have the same genes, but one often hasn’t had a life stressor to kind of tip that person over, Achtyes said.
Achtyes points to a landmark study that came out in the journal Science in 2003 that was the first to show that for people with a particular gene profile who were exposed to more stressful events, they were more likely to develop clinical depression.
”That was thought to be the first real positive evidence of this hypothesis,” Achtyes said.
Q: What are psychotropic medications?
A: There are five main types, Achtyes said: antidepressants, anti-anxiety medicines, antipsychotics, stimulants and mood stabilizers.
The most commonly used type of antidepressants are called Selective Serotonin Reuptake Inhibitors (SSRIs), which increase serotonin levels. They are widely used to treat depression and anxiety disorders.
Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Sometimes antipsychotics and antidepressants are used in combination with mood stabilizers to treat bipolar disorder.
Q: Just exactly how do the work and why?
A: By targeting chemical messengers, or neurotransmitters, to help correct the brain chemical imbalance, Furmaga said.
That means a medication is going to be helpful for certain symptoms, or certain conditions, if doctors get the right match with the brain chemical imbalance, he said.
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How brain chemicals work: Neurotransmitters can affect mood, energy, addiction and pleasure.
Q: Can finding the right one be a challenge?
A: Yes, Furmaga said.
”There is no one for whom there is just one treatment approach with medications,” he said.
Many times, it’s a balance between effectiveness and side effects.
”Why would we want to go with another drug (after a patient has already tried another)?” Furmaga said. “Well, it may be because a drug isn’t effective. Or, maybe it’s effective, but it has side effects for the patient that they can’t tolerate. It’s often time we select medications to target key symptoms.”
Not everybody’s depression is the same, he said, just as not everybody’s schizophrenia or bi-polar disorder is the same.
”I’m not going to want to use an activating antidepressant in somebody who may already be irritable and edgy,” Furmaga said. “On the other hand, that same activating antidepressant may be something I want to use in somebody who’s shut down, with lack of drive and motivation.”
Achtyes said picking the first psychotropic medication for a patient is based on science, but is also an art, and a little bit of luck.
”We do it based on side-effect profiles,” Achtyes said. “If I have a patient with depression who is having difficulty sleeping, has poor appetite and is feeling down and despondent, I’ll pick one that helps them sleep, and if I can find one, one that will make them hungry.”
CHANGE YOUR MIND ABOUT MENTAL HEALTH
Mental health is closely linked to and is as important as physical health. Problems are real and deserve to be treated. It’s no one’s fault or a sign of weakness or something you can “snap out of.” It’s OK for males and females to seek help. There’s hope. People recover with treatment and enjoy happy, healthy lives.
It can strike anyone, anytime: Abraham Lincoln. Michelangelo. Beethoven. Audrey Hepburn. Terry Bradshaw. Brooke Shields. Jane Pauley. John Lennon. Catherine Zeta-Jones. Your best friend. You.
It comes in all forms: Mental illness causes disturbances in thinking, feeling and coping, and it comes in all forms. It includes serious conditions such as schizophrenia, bipolar disorder and severe depression as well as anxiety, obsessive compulsive and personality disorders.
What to look for:
• Social withdrawal: lost of interest in hobbies, pleasurable activities
• Depression: little or no pleasure in life, low energy, change in eating or sleeping patterns, feelings of worthlessness or extreme guilt, crying a lot for no reason
• Unusual behavior: severe anxiety, panic, or fear, big mood swings, too much energy, trouble concentrating or following through, easily irritated or angry, racing thoughts or agitation, rapid weight loss, drug or alcohol abuse, unusual sensitivity to light and clothing
• Thought disorders: hearing voices, seeing images that other people do not, believing others are plotting against you, wanting to harm yourself or someone else.
• Inappropriate expression of feelings: sudden hostility, indifference in highly important situations, inability to cry, express joy, or laughter
What to do to avert a crisis:
• Reach out to people you trust.
• Engage people if they trust you, or find someone they do trust.
• Get professional help through a family doctor, employee assistance hot line, local * mental health agency or mental health advocacy group.
• If someone is in danger of hurting himself/herself or others contact local police or a local public mental health agency.
Sources: American Psychological Association, National Alliance on Mental Illness Michigan, Network 180, Mental Health Foundation of West Michigan