• medications help with a limited number of well defined dimensions of expenience and behavior
• medications work for the most part indirectly, effecting the balance of neurotransmitters
• medication side effects are usually brief occuring for the most part at the outset of treatment, persistent side effects    usually require a change in medication
• weight gain, a potential side effect of some medicines can often be overcome by healthy living

Medications play a substantial role in relieving psychiatric symptoms and often do so with little or no side effect.

Humans have a remarkable degree of diversity, but the kinds of symptoms that medicines help with fall into relatively narrow dimensions.  There are five categories that most psychopharmacologists pay attention to: good and restful sleep, freedom from depression or anxiety, mental strength and resilience, and accurate thinking with good concentration.  Beyond these lie the complexities of personality, but these few dimensions are so important that problems in any one of them can lead to significant dysfunction.

Sleep and energy are often disturbed in psychiatric patients.  The most common symptom in this area is insomnia, but surprisingly, oversleeping in just as debilitating.  You will notice that your doctor pays a lot of attention to the impact of medicines on your sleep and energy. 

Depression and anxiety are conspicuous symptoms, but can have insidious aspects.  A central feature of depression is a quality we call anhedonia, a word of Greek origin meaning a diminished capacity for pleasure.  Depressed people will often report a bland response to things that ought to be exciting.  The depressed person's senses are blunted, and hence the mind is not nourished by the healthy stimulation of ordinary living.  Mentally energy is correspondingly depleted.  Patients are frequently less aware of anhedonia than they are other components of their depression such as low mood or sleep disturbance, but a patient cannot be considered really well until the senses come back to life. 

Anxiety also has its subtle facets.  One feature of anxiety is its relationship to inhibition.  Anxiety is a kind of pain, and patients will naturally try and avoid this pain by retreating more and more from the world.  The subtle point here is that your doctor will not only want make sure you are free from anxiety, but will also want to determine that you are sufficiently free to live your life in a way that promotes fulfillment and success.  That is, he will want to make sure that you are not trading off a lack of anxiety by living a restricted life.

Mental strength is a very important dimension of human behavior.  To be strong is to be able to encounter stress with sufficient poise and balance to be able to deal effectively with the ordinary demands of life.  Mental strength is what allows us to bare the stress of life long enough to be able to bend and shape life into directions we want it to go.  A person who is mentally strong tends not to 'fly off the handle.'  Phamacotherapy can help a lot with this dimension, particularly with symptoms such as poor anger management or irritability. 

Distortions of thinking and perception are a halmark of schizophrenia, but are also seen in common conditions such as depression if it is severe.   Modern medications can treat these symptoms quite effectively. 

ADD is probably the most common of the disorders effecting cognition, but it does not distort or alter thinking, rather, affected people will have problems with attention, distraction, and impulsivity.

How Medicines Work

The brain is an incredibly complex network of circuits that are mediated by natural chemicals we call neurotransmitters.  Neurotransmitters are chemical mediators that bridge the transmission of electrical impulses around the brain.  Psychiatric medications work for the most part by modifying the action of the neurotransmitters.  This leads to a re-tuning of activity in those brain circuits that are responsible for the important dimensions of mental experience described above. 

Patients often want to know how long they should stay on their medicines.  This is actually a very important issue because the beneficial effect that medicines promote is not a stable change until those changes have been sustained by the medicines for considerable periods of time- in most cases at least a year or two.  We do not know exactly why this is so, but a metaphor will help visualize the kind of things that might be going on. 

The enormously complicated circuits in the brain are like a thicket in the woods whose pathways remain open and facile because they are used a lot.  When a medicine produces beneficial change, new pathways begin to be traversed.  It takes a considerable period of time before the new pathways are fully established and the old ones become overgrown.   Such changes occur outside the patient's awareness.  It is very important for patients to talk to their doctors about length of treatment issues to assure a good final outcome.

Side Effects

There are two kinds of side effects and it is very useful to distinguish between them.  The majority of side effects are transient and are a function of not being used to a new medicine.  Transient side effects tend to go away in a week or two.  It is important to know what to expect when starting a new medicine because these temporary artificial sensations are much easier to bare if they are not causing worry.  It's also helpful to keep in perspective that while side effects sensations tend to be strongest at the beginning of treatment, the therapeutic action is also weakest at this point too.  Unless warned, patients tend to be discouraged in the first week or two when all they are experiencing are bothersome artificial feelings without having had time for the beneficial effect of the medicine to become evident.  Some degree of transient side effects are inevitable during the first few weeks of therapy, and usually are of little concern.  But, there are a couple of persistent side effects that are so common that they deserve separate mention.

Weight Gain

Weight gain is one of the most feared side effects for many patients but is also the one side effect that patients can do something about.  It is true that a number of medicines have been associated with weight gain, most notably the so called 'atypical neuroleptics' and the 'mood stabilizers'.  Regardless, patients can be reassured by a number of things.  First consider the issue of weight and calories.  A 'Calorie' is a term describing a unit of energy.  Applied to food, calories quantify how much energy is in the food you eat   The body uses food as a fuel to supply its energy needs.  Weight gain occurs when the amount of calories consumed is greater than the amount burned.  Medications don't cause weight gain.  What they can do is tip the scale of energy expenditure in directions that make it easier to over-consume calories, either by promoting sedation and reducincg energy expenditure, or more commonly, by stimulating appetite.

A person must consume 3000 calories beyond what he needs in order to gain a single pound.  So fortunately, weight gain is a slow accruing problem and if monitored for can be addressed early on before it progresses (incidedentally, rapid weight gain is often due to water accumulation.  Our bodies are 60% water and even small shifts in water retention can lead to big changes of weight- a gallon of water for example weighs about 8 lbs.)  The problem of obesity is a preventable epidemic in the US and a little knowledge can go a long way in thwarting the problem.  To some degree, patient's who are worried about the problem because they are on medications and take the time to do something about it are better off than the 'average joe' who takes no medicines but is ignorant of the basics of nutrition.  It's, for example, that over 60 percent of the citizens in North Carolina are overweight.

If you are on medicine and are concerned about weight gain here are some things you can do to combat the problem.  First, avoid simple carbohydrates.  Sugar, alcohol, and starchy foods are common sources.  These foods are extremely calorie dense, in fact too much so for human health.  These kinds of food hardly exist in nature are are the product of food processing.  Sugar should be the end product of digestion, not the source.  To get a better idea of what to eat, think of yourself as a hunter-gatherer, and the kinds of foods that would be available to you in a natural habitat.  When a person eats these healthy and complex foods the output of his digestion is a simple sugar and fat- in essence the basic ingredients of a donut.  This metaphorical donut is the end point of digestion and constitutes the raw energy source that the body burns.  If on the other hand, 'Krispy-Cream' has gotten a hold of god given natural foods before you do, and predigested them into a literal donut, you cause yourself harm by eating it.  The body is not designed to handle this much concentrated energy in a food source. It's like putting rocket fuel in a car, it will do the engine harm.

While we are mentioning hunter-gathers, it brings to mind the other side of the energy equation, which is exercise.  The hunter exercises when catching his prey.  For this reason, the human body is programmed to exercise, and there is no way a person can feel healthy and energetic without a moderate amount of exercise.  In terms of weight control, exercise doesn't burn calories as much as turn the body into an efficient calorie processing machine.  The threshold for medical benefit from exercise isn't a great deal either.  No more than the equilavent of walking 3-4 times weekly for a half-hour.  And by the way, a nice exercise freebee in day to day living is taking the stairs rather than the elevator.

 Persistent side effects are undesirable and usually require that a patient switch to another medicine.  Unfortunately, psychiatric diagnosis is not specific enough to tell us exactly which medicine will be the most effective and side effect free for any given patient.  Diagnosis gives a good idea of what kind of medicine is likely to helpful but ultimately the choice  of a particular medicine is made based on the patient's feedback to the perscriber.