In these uncertain economic times, the number of people unable to afford their medications is getting higher and higher. 

Many fixed- and low-income people find it an increasingly difficult task to pay for the medications they need to stay healthy. In many cases, it’s a choice between medicine and other necessities, such as food and heat.

The post “Financial Help with Prescription Medications,” written on July 7, 2008, has received a thorough rewriting with important new information. Since it was originally written, I have found several very helpful online sites that give information and application help for low- or no-cost medication programs sponsored by the pharmaceutical companies. 

The post gives the details that you need to help you or a person you know to find programs that will help pay for medications. The topics discussed are:

• Eligibility for prescription help
• Online assistance with prescription medications from the pharmaceutical companies
• Assistance with prescription medications from the pharmaceutical companies by telephone
• Medicare Rx extra help
• The State Health Insurance Assistance Program (SHIP)
• Samples from your doctor
• Reducing the cost: Mail-order and online medications
• Reducing the cost: Comparisons of pharmacy costs

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• Financial Help with Prescription Medications
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Antidepressants are often the medication of choice for addressing Anxiety Disorders.

Antidepressants all work because they affect serotonin, an important neurotransmitter in the brain that acts as a chemical messenger. They were first developed for depression, and later were found to be effective for treating most types of Anxiety Disorders, too.

Those taking antidepressants for the first time and even those who have been taking them a while often have many questions about them. These questions may not be answered fully by their doctor or by the information on the prescription bottle.

This post answers the most common questions that people have. If you have further questions, please do not hesitate to ask them in the comments or in a personal message using the “Contact” tab. Please note that this post does not cover the antidepressant medications in detail — there is another post entitled “Medications for Anxiety, Panic and Phobias” that does that. 

What are the antidepressants usually prescribed for Anxiety Disorder?

Not all antidepressants work with Anxiety Disorders, but most do. Any antidepressant that has an effect on the serotonin system can be helpful for patients with anxiety. 

• The Selective Serotonin Reuptake Inhibitors (SSRI) are typically used as the first choice of medications to address Anxiety Disorders. Brands include Celexa, Lexapro, Paxil, Prozac, and Zoloft. Prozac, Zoloft, and Paxil have been approved by the FDA for a wide range of Anxiety Disorders. Other SSRI’s work only on selected Anxiety Disorders.
• The Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) are a newer class of antidepressants. Brands include Effexor and Cymbalta. They work by increasing the levels of both serotonin and norepinephrine in the brain. SNRI’s have been approved to treat a more limited number of Anxiety Disorders than SSRI’s.
• The Tricyclic antidepressants have been around much longer than the SSRI’s and SNRI’s and are used for a limited number of Anxiety Disorders. Brands include Adapin, Anafranil, Elavil, Norpramin, Sinequan, and Vivactil. They work by affecting the concentration and activity of the neurotransmitters serotonin and norepinephrine. This class of antidepressants is not used as much as more modern medications because of their side effects.
• Monoamine Oxidase Inhibitors (MAOI) are the oldest class of antidepressant medications. Brands include Nardil, Parnate, Marplan, Aurorix, and Emsam. MAOI’s are not used much any more because of interactions with some foods, beverages, and other medications. 

Wellbutrin is not used for Anxiety Disorder because it is the only antidepressant that does not affect the serotonin system. It can even cause Anxiety and agitation in some patients. It is sometimes used in combination with SSRI’s for Anxiety Disorder to diminish the side effects of SSRI’s.

How does my doctor choose which antidepressant to give me?

All the SSRI’s and SNRI’s, Tricyclic and MAOI’s work the same way. The choice among them is made mostly on the basis of side effects and a person’s ability to tolerate a specific medication.

Most of the antidepressants are started at a low dose and gradually increased until they reach a therapeutic level. Some antidepressants also need to be gradually decreased in dosage when discontinuing them, particularly the SNRI’s, Effexor and Cymbalta.

How long does it take an antidepressant to start working?

It takes from two to six weeks for an antidepressant to begin to work. You may feel worse before you feel better because side effects can occur almost immediately, whereas therapeutic benefits appear later.

What are some of the side effects of antidepressants?

Side effects differ from person to person, and from medication to medication. The graduated dosages when you start taking antidepressants gives your body a chance to get used to them. Most side effects dissipate within days or weeks. Some of the side effects common to most antidepressants are nausea, nervousness, insomnia, weight gain and sexual dysfunction.

An adjustment in dosage or a switch to another antidepressant will usually correct bothersome problems. It is important to discuss side effects with your doctor so that he or she will know when there is a need for a change in medication.

Are antidepressants habit-forming?

Anti-depressants are not physically habit-forming and are not drugs of abuse. However, people sometimes become psychologically dependent upon them to relieve their symptoms, particularly if they have not participated in therapy, which teaches coping and management skills.

My first antidepressant didn’t work. What should I do?

It is not unusual for the first antidepressant tried either not to work or to have intolerable side effects. Finding the appropriate medication and dosage may take time. There are many antidepressants to choose from, and one of them is right for you.

The most frequent reasons for an antidepressant failure are that the dose was too low or the duration of treatment too short.

I feel so much better. Can I stop taking the antidepressant?

Feeling better is not a good reason for discontinuing or reducing your medications. People often are tempted to stop medication too soon, risking relapse or recurrence. For some Anxiety Disorders, medication may have to become part of everyday life to avoid return of disabling symptoms.

I want to take some herbs and diet supplements. Are they safe with antidepressants?

You should never mix medications of any kind — prescribed, over-the counter, herbs, or borrowed — without consulting your doctor. Some substances, like alcohol, reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer and hard liquor. Grapefruit juice also has a negative effect on some antidepressants. Always follow the instructions of your doctor and on the prescription label to the letter.

Some medications, which are usually safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Always tell dentists, pharmacists and other medical specialists that you are taking antidepressants.

How long will I have to take antidepressants?

The length of time you will need to take antidepressants varies from person to person, and depends on the severity of the Anxiety Disorder. It also depends strongly on whether the drug is taken alone or is combined with therapy. 

Are antidepressants enough to control my Anxiety Disorder?

Antidepressants work best in most people when prescribed alongside a course of psychotherapy. People taking both medication and engaging in psychotherapy generally take less time to feel better. They also maintain their gains longer than those taking antidepressant medications alone.

Where do I find information about the medications I am taking?

It is sometimes hard to tell if what you are feeling is a drug side effect or a symptom of a physical condition. It is a good practice to look up the drugs you are taking and make a list of the “normal” side effects and the serious side effects. That way you will know when to call the doctor about an uncomfortable feeling or illness. And you will also be better informed about your side effects when you visit your doctor.

These online resources are particularly good for researching prescription medications, over-the-counter drugs, and diet supplements, such as herbs:

• Medline Plus 
• Mayo Clinic 
• PDRHealth (Physician’s Desk Reference) 

When taking any medication for Anxiety Disorders, you should…

• Ask your doctor to tell you about the effects and side effects of the drug being prescribed.
• Tell your doctor about any alternative therapies or over-the-counter medications you are using.
• Ask your doctor when and how the medication will be stopped. Some drugs can’t safely be stopped abruptly. They have to be tapered off slowly under a doctor’s supervision.
• Be aware that some medications are effective in Anxiety Disorders only as long as they are taken regularly, and symptoms may occur again when the medications are discontinued.
• Work together with your doctor to determine the right dosage of the right medication to treat your anxiety disorder.

In Summary

Despite the long list of facts, taking antidepressants is not a complicated affair. However, it is very important that you:

• Follow your doctor’s orders explicitly.
• Follow the diet and other instructions on the prescription bottle faithfully.
• Be informed about the side effects of your medications.
• Be patient: It sometimes takes a while for you and your doctor to find the right medications for you.

What do you think?

• Do you have any questions that are not on the list?
• Have you found any other good online sources of drug information?
• What are your experiences taking antidepressants?

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©2008 Anxiety, Panic & Health. All rights reserved.
Resources used in this post:

Chong, Josepha. (2006, August 30). Key Points about Antidepressant Therapy. Retrieved June 27, 2008 from Psych Central Web site: http://psychcentral.com/lib/2006/key-points-about-antidepressant-therapy/

Hartman, Daniel G. (2007, June 12). Treating Anxiety with Antidepressants. Retrieved September 26, 2008 from The Sidewalk Psychiatrist Web site: http://thesidewalkpsychiatrist.wordpress.com/2007/06/12/treating-anxiety-with-antidepressants/

HealthyPlace. (2008). Medications for Treating Anxiety. Retrieved September 26, 2008 from HealthyPlace Anxiety Community Web site: http://www.healthyplace.com/Communities/anxiety/treatment/medications_2.asp

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Drugs are commonly used in conjunction with therapy to reduce the effects of Anxiety Disorders.

One of the purposes of psychiatric medications is to relieve a person’s symptoms enough to allow therapy to be effective. This has been a standard approach for years.

A radical new approach to drugs and therapy has been proposed by researchers and published in the June 15, 2008, issue of Biological Psychiatry. 

Instead of using drugs to relieve symptoms, they propose using certain drugs to enhance learning during therapy sessions, improving the effectiveness of behavioral therapy treatment for Anxiety Disorders.

Traditional drug/therapy treatment may not be effective

Traditional drugs with therapy may not be effective

Anxiety is a normal human response to stress. But in some, it can develop into a disabling Anxiety Disorder with excessive and irrational fears, such as Obsessive-Compulsive Disorder, Panic Disorder, or Post Traumatic Stress Disorder. Effective treatments are available and can involve behavioral therapy, medications, or a combination of both.

David Tolin, Ph.D., one of the authors of the study, says that,

It makes intuitive sense that combining these two treatments [psychiatric medications and therapy] would result in even better results.

However, Tolin notes that this has unfortunately not been the case. The majority of the evidence suggests that combined therapy is no more effective than behavioral therapy alone, and in some cases can even be less effective.

The reasoning behind the new drug paradigm

Therapy: new ways of thinking, acting and reacting

Psychotherapy for Anxiety Disorders depends upon the patient’s being taught by the therapist new ways of thinking, acting and reacting to the fears they experience. It often involves what is known as exposure therapy, in which a patient is gradually exposed to the feared situation or object and learns new ways of managing and controlling those fears. 

As stated, psychiatric drugs often are prescribed along with therapy to help the person to cope with their fears while therapy is taking place.

The new approach is to use drugs to enhance the learning during therapy sessions, not to relieve symptoms. Dr. Tolin explains the reasoning behind their study: 

Recently, several researchers have tried a radically different approach: instead of just throwing two effective monotherapies [i.e. drugs and therapy] at the problem, they have instead looked at medications that specifically target the biological mechanisms that make psychotherapy work in the first place.

John H. Krystal, M.D., Editor of Biological Psychiatry and another of the study’s authors, adds that,

There has now been a sufficient amount of research in this area to take a step back to look at the basic research conducted in animals and the initial clinical trials [with humans].

The details of the research

D-cycloserine enhances the learning process

The study involved the addition of D-cycloserine, an old drug long approved by the U.S. Food and Drug Administration for the treatment of tuberculosis, to exposure-based fear treatment. The research’s meta-analysis, a pooling of the published literature on this approach, provides evidence that D-cycloserine enhances the learning process in the brain. 

The researchers found that gains due to use of D-cycloserine were generally maintained at follow-up sessions. They also found that it was more effective when administered a limited number of times and when given immediately before or after the therapy session.

D-cycloserine was found to be particularly effective for learning during exposure therapy, a major component of therapies for many Anxiety Disorders.

There is one drawback, however. The authors also discovered that tolerance may develop to this effect. Dr. Krystal comments that, if so, 

It may be best used before therapy sessions to “warm up the brain” and make it more responsive to the treatment sessions rather than as a daily treatment.

In summary

There may be other drugs to enhance therapy

This study’s confirmation of the effectiveness of D-cycloserine is a positive step forward in improving treatments for individuals suffering with Anxiety Disorders. As research continues, there may be other existing medications found to enhance learning during therapy sessions.

Psychotherapy has been proven over and over to be an effective means of learning to manage Anxiety Disorders. Cognitive-Behavioral Therapy has been particularly useful in treating these disorders. This new drug approach only makes this therapy more effective, resulting in fewer sessions required and better learning for the patient.

Dr. Tolin makes an additional, important observation regarding this line of work: 

Another very exciting aspect of this work is that it’s one of the few really good examples of translational research in psychiatry: taking basic science from the laboratory … and translating that research into useful interventions.

What do you think?

Would you take a drug to enhance therapy?

The number of sessions required for some Anxiety Disorders is 8-12, while other, more serious disorders, require many more. This radical approach to the use of medications improves the effectiveness of therapy sessions greatly, both enhancing the learning during sessions and reducing the number required.

I have been seeing my current therapist for almost two years, and, although I like him greatly, I would welcome a way to speed up my learning during sessions and to reduce the time that I have to continue seeing him.

• If D-cycloserine or a similar-acting drug were available, would you use it to enhance your therapy sessions?
• Do you think that there are other drugs, approved for other purposes, that might be used to treat psychiatric conditions?
• Do you think that “learning drugs” should be used with psychotherapy at all?

As always, your comments are welcome!

If you have enjoyed this article, please consider subscribing to this blog, either via RSS or email at the top of your screen. It’s free! I would also appreciate your sharing it using your favorite social media, such as StumbleUpon or Digg. Just click the little green “ShareThis” button at the bottom of this post.

Resources used in this post:

Krystal, John H.; Norberg, Melissa M.; Tolin, David F. (2008, June 15). A Meta-Analysis of D-Cycloserine and the Facilitation of Fear Extinction and Exposure Therapy. Retrieved September 24, 2008 from Biological Psychiatry Web site: http://www.journals.elsevierhealth.com/periodicals/bps/article/S0006-3223(08)00106-6/abstract

Science Direct. (2008, July 22). D-cycloserine May Improve Behavioral Therapy Treatment for Anxiety. Retrieved September 24, 2008 from Science Direct Web site: http://www.sciencedaily.com/releases/2008/07/080716101303.htm

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Do you treat your mental health issue with medication only?

If you do, you are part of a growing trend among mental health care providers.

This shift to the sole use of medication to treat mental health problems is detailed in a study released this month in the Archives of General Psychology. The authors find that market forces, primarily insurance reimbursements, are forcing psychiatrists to limit their time with patients to 15-minute medication maintenance visits rather than also providing psychotherapy.

The percentage of patients who received both medication and psychotherapy from their psychiatrists fell to 28.9 percent in 2004-05, from 44.4 percent in 1996-97. 

The findings are expected to intensify a debate over the increased medicalization of psychiatric care. The debate is about the shifting emphasis on the biology of mental illness, as opposed to the processes of the mind addressed in psychotherapy. This debate is seen in the mental health stances of the two Presidential candidates. McCain’s plan emphasizes the use of medications over psychotherapy, while Obama’s seeks a balance between the two.

Integrated Psychiatry and Psychotherapy is not being received by those that need it

Psychotherapy is recommended as a front-line defense — with or without medication — in many types of mental illnesses, including Panic Disorder, Post Traumatic Stress Disorder, Social Phobia, Generalized Anxiety Disorder, and Specific Phobias. 

Diagnosis is squeezed into 15 minutes

Often, and especially in the diagnostic stage of treatment, more time is required to get at the roots of the patient’s problems before prescribing medication. Traditionally, psychiatrists were able to spend the time necessary to get a good diagnosis, but now they are being forced to shorten this diagnostic time to 15 minutes.

The wide range of mental health care professionals besides psychiatrists are not covered in the report, so it is not reported how this trend is affecting them. Yet from other studies, it is known that insurance companies and managed health care plans favor shorter and less-intensive mental health treatments. They also favor using lower-paid counselors over more highly-paid psychotherapists. It is widely known that most insurance companies’ reimbursements for medical and mental health services are not at parity, with mental health receiving far less coverage.

Many patients are unable to afford both a psychiatrist and a therapist, and have to make do with medication alone.

Dr. Mark Olfson of Columbia University Medical Center, a study author, said patient attitudes might also be hastening the shift. Taking a pill may look a lot easier to patients than psychotherapy, which is more time-consuming and may involve the regular participation of family members.

Insurance company reimbursements are fueling the shift to medications alone

Only those who pay out of pocket receive psychotherapy

Financial incentives for psychiatrists are weighted against psychotherapy. Reimbursement for a 45- or 50-minute psychotherapy session is 40.9 percent lower than that for 3, 15-minute medication management visits. Only those who pay out of pocket, generally the wealthiest patient group, are more likely to receive psychotherapy. The authors write,

Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often.

Also pushing the trend along is the aggressive marketing of psychotropic medications to psychiatrists and patients. This push has helped make antidepressants one of the largest-selling classes of drugs.

“We don’t want to decide treatment based on reimbursement.”

Dr. Alan F. Schatzberg, chairman of the department of psychiatry at Stanford University School of Medicine and president-elect of the American Psychiatric Association, said the trend was not necessarily bad. It could be seen as a natural evolution, similar to what is seen in other fields of medicine. Though he added, 

What we don’t want to do is decide treatment based on reimbursement.

Psychiatrists are losing an important skill

The authors of the report write,

[D]espite the traditional prominence of psychotherapy in psychiatric practice and training, there are indications of a recent decline in the provision of psychotherapy by U.S. psychiatrists — a trend attributed to reimbursement policies favoring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects.

Going to war with fewer weapons

Dr. William H. Sledge, interim chairman of the department of psychiatry at Yale, said the report was worrisome. Although training in psychotherapy is a standard part of psychiatric training, he said, the know-how is in danger of becoming lost. He continues, 

A group of practitioners is losing an important skill. It is like going to war with fewer weapons at your disposal.

The authors conclude,

These trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalization of psychiatric practice. A key challenge facing the future generation of psychiatrists will likely involve maintaining their professional role as integrators of the biological and psychosocial perspectives while working within the constraints of the strong market forces of third-party payers and managed care to implement advances in the diagnosis and treatment of mental disorders.

What do you think?

The American public likes its pills, and regards them as silver bullets that cure all ills. And the drug companies play to this with advertisements blanketing the airwaves and print media. The insurance companies encourage the shift to medication only as a way to keep their costs low and make more money. 

I am uneasy over the long-term viability of mental health care should this trend continue. Rather than enable the patient to feel better, get better and stay better, the moneyed interests are encouraging the treatment of mere symptoms with drugs, creating a whole class of people who are dependent on their wares to function in their daily lives.

• If you take medications only, do you feel the need for a therapist?
• Are you taking drugs only because you can’t afford a therapist?
• Do you think my opinions are valid, or are they sound like conspiracy theories?

As always, your comments are welcome!

If you have enjoyed this article, please consider subscribing to this blog, either via RSS or email at the top of your screen. It’s free! I would also appreciate your sharing it using your favorite social media, such as StumbleUpon or Digg. Just click the little green “ShareThis” button at the bottom of this post.

Resources used in this post:

Gellene, Denise. (2008, August 5). Medication increasingly replaces psychotherapy, study finds. Retrieved August 5, 2008 from Los Angeles Times Web site: http://www.latimes.com/news/science/la-sci-shrink5-2008aug05,0,7966688.story

Mojtabai, Ramin; Olfson, Mark. (2008, August). National Trends in Psychotherapy by Office-Based Psychiatrists. Retrieved August 20, 2008 from Archives of General Psychiatry Web site: http://archpsyc.ama-assn.org/cgi/content/abstract/65/8/962

Science Daily. (2008, August 11). Psychiatrists Shift Away from Providing Psychotherapy. Retrieved August 17, 2008 from Science Daily Web site: http://www.sciencedaily.com/releases/2008/08/080804165316.htm

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If you are suffering from an Anxiety Disorder, you may be facing the issue of whether to take medications or not. It may even increase your anxious worrying!

Excessive worry is a symptom of Anxiety Disorders. It is common for the issue of taking medications to become a focus of worry.

And excessive worry is often associated with procrastination and difficulty with decision making. This makes the task of deciding about the use of medication all the more difficult.

Medication for the treatment of Anxiety is generally safe and effective. But it often takes time and patience to find the drug that works for you.

Medication vs. Therapy

The first treatment many people receive for Anxiety Disorder is therapy. Most psychologists believe that the most effective treatment for Anxiety is Cognitive-Behavioral Therapy (CBT). It has two components: cognitive and behavioral. The cognitive component helps people change thinking patterns that keep them from overcoming their fears. The behavioral component seeks to change a person’s reactions to Anxiety-provoking situations. CBT is effective in a majority of cases.

But some people find that excessively high levels of Anxiety make them unable to get the most out of therapy. They may avoid therapy sessions or feel unable to carry out the instructions of the therapist between sessions. 

Medication may help these people’s overall levels of Anxiety and allow full participation in therapy. Those without access to CBT or those who have not had a satisfactory response to it may benefit from medication, as well.

For some, though, medication may be required from the beginning of their diagnosis. This is particularly true in panic attacks, Panic Disorder, Post Traumatic Stress Disorder, and General Anxiety Disorder sufferers who have chronic insomnia. 

Remember that it is important to give medication a fair trial. Some drugs take several weeks to take effect. If one drug doesn’t work, the odds are that another one will, so don’t give up hope!

The Varieties of Medications

There are four major classes of medications that are used in the treatment of Anxiety Disorders:

• Benzodiazepines
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Benzodiazepines

The Benzodiazepine class of drugs was introduced in the 1960′s. Brands include Ativan, Klonopin, Halcion, Xanax and Valium and the generic Alprazolam. The exact mechanism of how these drugs work is unkown. Some research has shown that they enhance the function of gamma aminobutyric acid (GABA) in the brain.

The Benzodiazepines are very frequently used for the short-term management of Anxiety Disorders of all types. They are often prescribed on an as-needed basis rather than being taken daily. The Benzodiazepines are highly effective in promoting relaxation, reducing muscular tension, and other physical symptoms of Anxiety.

Long-term use may require increased doses to achieve the same effect. This may lead to problems related to drug tolerance and dependence. Abruptly stopping the drugs may result in significant withdrawal symptoms, including rebounding Anxiety and insomnia.

Tricyclic Antidepressants

Concerns about the long-term effects of the Benzodiazepines has led many doctors to favor the Tricyclic Antidepressants for treatment of Anxiety. This class of drugs was first introduced in the 1950′s. Brands include Adapin, Anafranil, Elavil, Norpramin, Sinequan, and Vivactil. 

The Tricyclic Antidepressants are prescribed for Panic Disorder, Post Traumatic Stress Disorder, and General Anxiety Disorder. Of all the Tricyclic Antidepressants, only Anafranil is used for Obsessive-Compulsive Disorder. They work by affecting the concentration and activity of the neurotransmitters serotonin and norepinephrine, chemicals in the brain thought to be linked to Anxiety Disorders.

Although effective in the treatment of Anxiety Disorders, the Tricyclic Antidepressants  can cause significant side effects. These include a drop in blood pressure on standing, constipation, urinary retention, dry mouth and blurry vision.

Selective Serotonin Reuptake Inhibitors (SSRI’s)

The Selective Serotonin Reuptake Inhibitor class of drugs was introduced in the 1980′s for the treatment of depression. Testing of this medication class led to its being used for treating Anxiety Disorders. Brands include Celexa, Lexapro, Paxil, Prozac, and Zoloft. SSRI’s work by affecting the concentration and activity of the neurotransmitter serotonin.

The SSRI’s quickly gained popularity for treating all types of Anxiety Disorders. Doctors and patients liked them because they generally produced fewer side effects, especially when compared with the Tricyclic Antidepressants. However, there are side effects with the SSRI’s. Among them are insomnia or sleepiness, sexual dysfunction, and weight gain.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s)

The Serotonin-Norepinephrine Reuptake Inhibitor class of drugs were first used for depression. They later were discovered to be effective for Anxiety Disorders, as well. Brands include Effexor and Cymbalta. They work by increasing the levels of serotonin and norepinephrine in the brain.

The SNRI’s are used to treat all types of Anxiety Disorders, although the use in Post Traumatic Stress Disorder has not been fully researched. 

The SNRI’s side effects include stomach upset, insomnia, headache, sexual dysfunction and a minor increase in blood pressure. Both Effexor and Cymbalta cause withdrawal symptoms in people quitting the drugs.

Atypical Antipsychotics

The newest class of drugs used to treat Anxiety Disorders are called “second-generation” drugs, or Atypical Antipsychotics. Brands include Abilify, Geodon, Risperdal, Seroquel, and Zyprexa. They work by effecting the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to Anxiety Disorders.

The Atypical Antipsychotic medications are usually prescribed at low doses for the treatment of Anxiety. They are used to augment the action of other drugs rather than being used by themselves. The Atypical Antipsychotics may be especially effective in treating ruminative worry and in aiding sleep. 

Anxiolytics

The only Anxiolytic drug used for Anxiety Disorders is BuSpar, which is usually prescribed only for General Anxiety Disorder. It works by enhancing the action of serotonin in the brain.

BuSpar takes more time than the Benzodiazepines to achieve an anti-Anxiety effect, typically three to four weeks. However, it has not been associated with the tolerance or dependency problems of the Benzodiazepines.

Making a Decision

If you and your doctor have decided on medication as a treatment option, you have many choices. Work with your doctor to find the medication that is right for you. With patience and persistence, you will find a treatment that will help alleviate your Anxiety symptoms.

Always remember that any psychiatric medication is intended to combat the symptoms of Anxiety — they are not a cure. Therapy is the first choice among treatments. It can help you learn how to manage your symptoms, not only in the short term, but for the rest of your life.

What Do You Think?

It seems like I have taken almost every one of the drugs mentioned in this post! It has taken quite a while for my psychiatrists to find a combination of drugs that are effective for both my Bipolar Disorder and my Anxiety Disorders. But now I feel better than I have in years.

• Have you taken any of the medications mentioned in this post?
• How long has it taken you to find an effective medication?
• Are you and your psychiatrist still searching for the medication that’s best for you?

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Resources used in this post:

Kent, Justine. (2008). Treating Anxiety Disorders With Medications. Retrieved July 24, 2008 from the Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/newsletter/2008/TreatingAnxietyDisordersWithMedications.asp

Anxiety Disorders Association of America. (2008, April). Medications. Retrieved July 24, 2008 from the Anxiety Disorders Association of America Web site: http://www.adaa.org/gettinghelp/anxietydisorders/chart.htm

For further reading: 

Anxiety Medication Chart from the Anxiety Disorders Association of America  

Introduction: Common Medications for Anxiety Disorders article from HealthyPlace.com  

Psychiatric Medications for Mental Illness: Antianxiety Medications article (long) from HealthyPlace.com  

©2008 Anxiety, Panic & Health. All rights reserved.

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Medications are an essential part of treatment for mental disorders. But medications have uncomfortable side effects and can interact badly with other drugs.

Your doctor doesn’t always know of these right off the top of his head. It’s up to you to take charge of your medications to make sure that your medications aren’t making you sicker!

You need to know everything you can about your medications, including what their common and dangerous side effects are, and if you take more than one drug, whether they interact negatively.

If you see more than one doctor, and it’s probable that you do, each one can prescribe medications without taking into account what the others have prescribed if you do not make it your responsibility to ask questions.

And each drug has side effects that indicate that something is going wrong. If you take multiple medications, what is a dangerous side effect for one may be a normal side effect for another. You need to know this information!

In this post I’m going to show you how to:

• Find online information about your medications
• Note each medication’s side effects and drug interactions
• Build a data sheet to take with you to your doctor’s appointments
• Talk to your doctor about your medications

My Mother died from conflicting medications!

This was brought home to me after my Mother died of a cerebral hemorrhage caused by a fall while out walking. She took many medications for her heart condition, kidney condition, diabetes and other small ailments, prescribed by four different doctors.

She had been feeling “funny” for quite some time, but not bad enough to visit her doctors. Upon checking her medications after her death, I found that there were some major conflicts among them, including one that accelerated the action of the blood thinner that had a role in the cerebral hemorrhage taking her life!

Find online information about your medications

First, you need to check out the specifications of all the drugs you take, not just the psychiatric ones. There are many good references online. The ones I use are: 

• Medline Plus, a US government site  
• The Mayo Clinic’s drug and supplement information 
• PDR Health, from the people who make the Physicians’ Desk Reference  

Although each one of these sites intends to be complete, I find that often one will have a little bit of information that the others don’t have. So I use all three to crosscheck the others.

Note each medication’s side effects and drug interactions

Get a notepad and a pen and divide the page into columns for common side effects, dangerous side effects, drug interactions and notes. 

Each website displays information differently, so you will have to scroll until you find the information you need. Write down the side effects and drug interactions for each of your drugs. In the notes section, write down anything that you think is important. For example, one of my medications, Abilify, causes involuntary chewing motions that drive me crazy. That would be something I would put in the notes column.

As you fill in your sheet, you will start noticing that some of the common side effects of one drug are listed as dangerous side effects of another. Mark these as something to ask your doctor about when you next see them. If any of your drugs are listed as interacting negatively, I recommend that you contact your doctor(s) immediately.

Build a data sheet to take with you to your doctor’s appointments

You will want to distill your notes into a one-page document that you can take with you to your doctor’s appointments. I use a spreadsheet in Excel, but you can just line a sheet of paper and write the information in.

Below is what my data sheet looks like (click on it enlarge it). I also have a smaller version that I carry in my wallet. I will gladly share this spreadsheet or a printable version of it with you on request. Just email me using the Contact tab at the top of the page.

How to talk to your doctor about your medications

When I first started bringing my data sheet to appointments, I was afraid that my doctors would be insulted or defensive that I was checking up on them. Instead, I have found that doctors appreciate my vigilance, and especially my data sheet. All my doctors make it a part of my chart.

If you have any concerns about side effects or drug interactions, be sure to write that on your data sheet to help you remember your questions. Do not be afraid to ask about these. I have found that being prepared like this makes the doctor slow down and listen to you.

When the doctor is prescribing new medication, ask specifically if the new drug’s side effects will exacerbate any side effects on your data sheet, making them intolerable. Ask specifically if the new drug will not interact negatively with any of the ones you are currently taking. This is especially important for your General Practitioner, who usually will not have the specifics of your psychiatric drugs at her fingertips.

What do you think?

• Would keeping track of all your drugs make you more comfortable or more anxious?
• Do you keep track of your drugs’ side effects and interactions? 
• What has been your experience talking to your doctor about your drugs?

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Last update: January 1, 2009

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• Financial Help with Prescription Medications

The cost of prescription medications is sky high and going higher. Many fixed- and low-income people find it an increasingly difficult task to pay for the medications they need to stay healthy. In many cases, it’s a choice between medicine and other necessities, such as food and heat.

If you find yourself or someone you know in this situation, there is help available to provide medications at no cost or low cost. This article discusses the following topics:

• Eligibility for prescription help
• Online assistance with prescription medications from the pharmaceutical companies
• Assistance with prescription medications from the pharmaceutical companies by telephone
• Medicare Rx extra help
• The State Health Insurance Assistance Program (SHIP)
• Samples from your doctor
• Reducing the cost: Mail-order and online medications
• Reducing the cost: Comparisons of pharmacy costs

Eligibility for prescription help

Means-testing for getting help

There is strict means-testing for getting help with prescription medications, whether it’s a government program or a pharmaceutical company program. The requirements vary by state and by company. But in general, you may expect requirements such as:

• You have no insurance coverage for the medication
• You are not eligible for Medicare, or Medicare will not cover the drug
• Your household income is below a certain threshold, usually quite low or even the poverty level
• Purchasing the drugs at retail would be a hardship for you due to your income and/or expenses

The National Council on Aging has a website called BenefitsCheckUp that will help you find federal, state, local and private programs that will help you with your prescription drugs and other needs. You can also apply for Medicare Rx Extra Help at this site. The information you will need to check on benefits for prescription drugs is:

• ZIP code
• Date of birth
• Type of residence (house, apartment, or mobile home)
• Approximate out-of-pocket dollar amount paid for prescription drugs and medical expenses
• Types of public benefits and prescription drug savings programs currently received
• Current income and assets from all sources for self and spouse and others in the household
• Veteran and TRICARE status for self and spouse
• Names of prescription medications you are taking (I recommend that you have available the prescription bottles or information about your medications from your health professional)

Online assistance with prescription medications from the pharmaceutical companies

Online help from the pharmaceutical companies

Low-income people may be able to get help with their medication costs, or even get their medications for free, from pharmaceutical companies. There are a number of resources for doing so, both online and by telephone.

The website NeedyMeds.org provides help in finding patient assistance programs for your particular drug, as well as a host of other services helpful to low-income users. Among the services that it provides for finding drug assistance are:

• Information about drug programs by the drug’s brand name or generic name
• Patient Assistance program list
• Company list with contact information (much more comprehensive than the list below)
• Patient Assistant application forms for many companies
• Medication Coupons for free brand name drugs
• Application assistance by state
• Discount drug cards
• Lists of government, Medicare, and SHIP sites
• Guidelines for means-testing

Another online resource is the Partnership for Prescription Assistance website. It is an organization that brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups. Their goal is to help qualifying patients who lack prescription coverage to get the medicines they need through the public or private programs. The website is geared not only to the patient, but to caregivers and doctors who prescribe medications. It is not as easy to use as NeedyMeds.org, but is very thorough as it walks you through finding the drug, abbreviated means-testing, and listing of several ways to obtain the medication.

Assistance with prescription medications from the pharmaceutical companies by telephone

Help by telephone from pharmaceutical companies

In the US, the Pharmaceutical Manufacturers Association (PMA) publishes a directory of medication assistance programs. Doctors can get a copy of the PMA’s official guide by calling (800) PMA-INFO. You or your doctor can also call the company that makes your medication directly to learn more about their low-income assistance programs. Following is a list of phone numbers:

• 3M Pharmaceuticals (800) 328-0255
• Allergan Prescription (800) 347-4500
• Alza Pharmaceuticals (415) 962-4243
• Amgen (800) 272-9376
• Astra USA (800) 488-3247
• Berlex (800) 423-7539
• Boehringer Ingleheim (203) 798-4131
• Bristol Myers Squibb (800) 736-0003
• Burroughs-Wellcome (800) 722-9294
• Ciba-Geigy Patient Support Program (800) 257-3273 or (908) 277-5849
• Eli-Lilly (317) 276-2950
• Genetech (800) 879-4747
• Glaxo (800) 452-7677
• Hoechst-Roussel (800) 776-5463
• Hoffman-Larouche (800) 526-6367
• Ici-Stuart (302) 886-2231
• Immunex Corp. (800) 321-4669
• Janssen (800) 253-3682
• Johnson & Johnson (800) 447-3437
• Knoll (800) 526-0710
• Lederle (800) 526-7870
• Lilly Cares Program (800) 545-6962
• Marion Merrel Dow (800) 362-7466
• McNeil Pharmaceuticals (800) 682-6532
• Merck Human Health (800) 672-6372
• Miles (800) 998-9180
• Ortho Pharmaceuticals (800) 682-6532
• Parke-Davis (202) 540-2000
• Pfizer Indigent Patient Program (800) 646-4455
• Pharmacia (800) 795-9759
• Proctor & Gamble (800) 448-4878
• Rhone-Poulenc Rorer (610) 454-8298
• Roche Labs (800) 285-4484
• Roxane Labs (800) 274-8651
• Sandoz (800) 937-6673
• Sanofi Winthrop (800) 446-6267
• Schering Labs (800) 521-7157
• Searle (800) 542-2526
• Serono (617) 982-9000
• SmithKline Access to Care Program (800) 546-0420 (patient requests) or (215) 751-5722 (physician requests)
• Solvay Patient Assistance Program (800) 788-9277
• Survanta Lifeline (800) 922-3255
• Syntex Labs (800) 822-8255
• UpJohn Co.(800) 242-7014
• Wyeth-Ayerst (703) 706-5933
• Zeneca Pharmaceuticals (800) 424-372

Medicare Rx extra help

Extra help from Medicare for drugs

If you have Medicare and have a limited income and resources, you may be able to get extra help paying for your Medicare prescription drug costs. Your income must be less than $15,600 if single and $21,000 if married and you must have resources less than $11,990 if single and $23,970 if married. Resource limits include a $1,500 burial allowance for singles and a $3,000 burial allowance for couples. If you qualify, you will have low or no deductible, low or no premiums, no coverage gap (also called the “donut hole”), and will pay much less for your prescriptions.

During the Open Enrollment period, which runs from November 15 to December 31, it is best to sign up with a drug plan before you know whether you qualify for Extra Help. If your application for Extra Help is denied and you didn’t enroll in a drug plan during the open enrollment period, you won’t be able to enroll until November 2007 and your coverage won’t start until January 2008. You’ll likely pay a higher penalty if you were eligible to enroll earlier, but chose not to do so. And you’ll pay this penalty for as long as you have Part D. Even without the Extra Help, you’ll likely save on the cost of your drugs by enrolling in a Medicare drug plan.

Visit BenefitsCheckUp to apply for Medicare Rx extra help. Also available is the AARP Extra Help Application Center at 800-985-6848.

The State Health Insurance Assistance Program (SHIP)

SHIP provides Medicare information and help

The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions. 

SHIP is an independent program funded by federal agencies and is not affiliated with the insurance industry.This program is a partnership of the Department of Economic Security Division of Aging and Adult Services and the Area Agencies on Aging.

When you contact your state or regional SHIP office, you will be linked with a local SHIP counselor, who can meet with you and help you with:

• Medicare Eligibility, Benefits and claim filing
• Medicaid (AHCCCS) Eligibility, Benefits and claim filing
• Medicare Part D (Medicare Prescription Drug Coverage)
• Long Term Care Insurance information
• Medicare Secondary Payor
• Other types of health insurance benefits
• Medigap insurance
• Medicare Advantage Plan options and enrollment
• Medicare Cost Sharing Programs and other Dual Eligible enrollment
• Medicare/Medicaid Fraud, Waste and Abuse
• Information regarding Medicare Costs and Deductibles 

The SHIPtalk website helps you find your state or regional SHIP office. There you will find contact addresses, telephone number and email addresses. You can also find local SHIP counselors on the site.

Samples from your doctor

Ask your doctor for samples

Your doctor may be able to give you drug samples to tide you over until you can afford to purchase the medications. All you have to do is ask! Of course, this is only a stopgap measure, but it can help for a while.

Reducing the cost: Mail-order and online medications

Mail-order or online drugs can reduce costs

You can often reduce the cost of your monthly medication bills by using a mail-order or internet pharmacy. They can mail your prescription to you at substantial savings over many local drug stores. Medications may be available from other countries as well. These can be very inexpensive compared to in-country costs.

Your doctor likely will have to fill out some paperwork before you can use these mail-order services. As with any other transaction by mail or over the internet, you will need to check the company’s reputation and quality of service before sending money or using your credit card. You will need to check customs regulations if dealing with out-of-country pharmacies, as well, especially if the drug is not sold in your country.

Communicating with these companies is usually done via fax, email or telephone. Some have online ordering. These companies normally will send you a three-month supply of the medications you need.

Ask your friends, your doctor or your insurance company for recommendations of mail-order pharmacies. Some insurance companies, such as some Blue Cross-Blue Shield companies, require medications to be purchased through a specific mail-order company.

Reducing the cost: Comparisons of pharmacy costs

Shop around for the best price

Consumer Reports magazine did an extensive report in June, 2008 called “America’s Best Drugstores” that rated chain and local, and some mail-order and online pharmacies for service and price. Your local library ought to have this recent issue of the magazine. The online version of the report, unfortunately, is by subscription only. 

Part of the article dealt with prices for a group of common prescription medications. The cost ranged from under $1000 to over $1300. Costco came in the lowest at $962, with AARP.com at $1005, and WalMart third at $1073. The most expensive was Rite Aid at $1302 for the same medications. Independent drugstores averaged $1192. Note that local drugstores will sometimes match the price of cheaper pharmacies to keep your business.

In Conclusion

For those unable to purchase the medications they need, there is help both online and by phone. However, there is a means test for every drug and every company or agency, so be prepared for some paperwork.

Prescription medications are not cheap, whatever bargains are to be found. It pays to shop around. However, I cannot emphasize enough that you need to verify the reputation and reliability of mail-order and online pharmacies before you send any money to them. Ask your friends or your doctor for recommendations. Check with your library for publications that list trusted sources. 

Above all, realize that there are alternatives to paying the full retail price for many medications. It just takes a little research and diligence!

What do you think?

There is help available, but it comes at a cost: filling out forms. There’s no way around it, but if it’s your only way of getting the medications you need, you have little choice. It seems a shame that our nation’s most vulnerable should have to wade through piles of red tape to stay healthy. It looks like there could be a central clearing house where a person could apply once, and if approved, get their medications from the various manufacturers and agencies.

• What do you think of the clearing house idea?
• Do you have any experience getting low- or no-cost drug assistance?
• Have you ever used online pharmacies? What is your experience?

As always, your comments are welcome!

If you have enjoyed this post, please consider subscribing to this blog, either via RSS or email at the top of your screen. It’s free! You can also follow me on Twitter from the same place. I would also appreciate your sharing this post using your favorite social media, such as StumbleUpon or Digg. Just click the little green “ShareThis” button at the bottom of this post.

Resources used in this post:

McGregor, Sherrie. (2007, January 21). Financial Help with Medications. Retrieved June 27, 2008 from PsychCentral: http://psychcentral.com/lib/2007/financial-help-with-medications/

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Revised December 10, 2008

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