What are some resources for understanding mental health medication?

October 19, 2015 12:57 PM

I have some Interesting Brain Chemistry (tm)--some cocktail of ADHD, anxiety, depression, and sensory processing issues, and lately, I have been considering further medication. (Current stats on that: 5mg Adderall Rx, Ativan as needed.) However, I always hated the guess-and-check method in math, and I am finding that I do not like it any better when it comes to my mental health. To that end, I am wondering if anyone can recommend good, detailed resources on how mental health medication works. I know the basics of SSRIs, etc., but why does one work and another not? I know the answer is partly, "Molecules have different shapes! Some shapes fit better!" ...I would like more nuance. Please recommend resources? (And any expert thoughts are also welcome.)

I've taken a year of Organic Chemistry, and I know biology and psychology basics. A lot of the medical resources that I can easily find are a bit on the dumbed down side, but a lot of the Google Scholar articles are highly technical. Is there some happy medium? I am also going to run things by my psychiatrist, but I'd like to prepare with specific and researched questions.

posted by Alex Haist to Health & Fitness (9 answers total)

Best answer: I know the basics of SSRIs, etc., but why does one work and another not?

I know very well how frustrating this is*, but the answer to this is mostly "It just does, and nobody really knows why". There are some educated guesses out there, as we learn more about the physiology of mental illness, but very little is understood about the causes of most mental illnesses, let alone how the treatments work. Most mental health medications were discovered basically by accident (i.e. surprise side effects of drugs tested for other illnesses), or by trying things that are similar to known treatments. Most of them work only on a subset of people and fail miserably for others, and nobody knows why, which is why treating most mental illnesses is such a complicated trial and error process.

*I've spent a fair bit of time researching this in my spare time, as a biomed grad student who likes to know all I can about medications I'm taking, particularly any that affect my precious brain. Even with good access to pubmed articles and the scientific background to understand them, it's pretty hard to find anything conclusive. Lots of speculation, but it's easy to see that we really don't understand much about the mechanism of action for most psychiatric medication, we just keep using it because it seems to work better than any other alternative. My psychiatrist has told me the same thing - it sucks, but we have to do trial and error and see what works, because there's just no way to accurately predict how psychiatric drugs will work for you. You pretty much just throw things at the wall and see what sticks. (If you want this to change someday, advocate for more funding of mental health research!)
posted by randomnity at 1:16 PM on October 19, 2015 [6 favorites]

Best answer: Stahl's Essential Psychopharmacology is what to ask your library for. There's a core text and a series of extras like case studies, antidepressants etc. It's definitely accessible, with illustrations.
posted by lokta at 1:26 PM on October 19, 2015

Best answer: I would look for a pharmacology reference aimed at psychiatric/medical practitioners and prescribers (frex), rather than trying to dive deep into the biochemistry. There's a vast array of chemical mechanisms at work with psychiatric drugs, depending on the exact class, and as randomnity alludes, most of them are not very well understood. Even for ones that are more well-explicated, explanations that go much deeper than chemical binding are (a) not going to be very illuminating if you're mainly interested in clinical effects and (b) not going to be very meaningful if you haven't had any biochemistry.
posted by Krom Tatman at 1:39 PM on October 19, 2015

Mental health professional here, seconding randomnity's answer, and +1 ing Stahl's (it has pictures!)
posted by arrmatie at 1:47 PM on October 19, 2015 [1 favorite]

Best answer: We're at the banging two rocks together stage of psychiatry.

So, first of all, get a vague understanding of the various brain chemistry receptors that your medications are working on. Mostly Serotonin (SSRI's), Norepinephrine, Dopamine (half-assed overview).

Maybe you have a deficit in one. You try an SSRI, and it doesn't work, because it actually Norepinephrine that you need more of. So you keep trying different meds because maybe one will hit the right combination of receptors for you.

But it's more complicated that that. At different dosages, drugs are hitting different receptors.
The Last Psychiatrist can be a bit of a dick (hilarious to read), and they definitely get, and explain receptor binding in a way that, yes, LP is right, many Doctors don't understand. Several antidepressants just work as anti-histamines at low dosages (which I have experienced for myself!).
This, above, is the main article I thought of in response to your question.

Also not to be discounted, an additional effect is Context Dependent Memory. Someone who learns a bunch of flashcards underwater, in a wetsuit, will remember them better, underwater, with a wetsuit.
You remember being depressed more when you're depressed, and happy when you're happy - you quite literally often can't quite remember what it is like to be different. If, for whatever reason, you've picked up a bunch of extremely dysfunctional thought patterns, and are currently reinforcing them like they are the rails and your thoughts are the train, then it often doesn't hurt to wash your brain with a flood of new context-chemicals, and give you a chance to practice your new thoughts.

Also check out Crazy Meds. Much better than the PI sheet for most medications, and if Crazy Meds suggests a different starting dosage or weaning dosage to what the fact sheet says? Go with Crazy Meds. I have regretted not looking meds up on there FIRST.


(Er, I'm not actually on any meds now, turned out I had mostly resolvable health problems, like allergies. Still very ADHD etc, but coping with life).
posted by Elysum at 2:39 PM on October 19, 2015 [1 favorite]

Seconding Crazy Meds.
posted by PJMoore at 4:34 PM on October 19, 2015

Stahl has little illustrated manual-type books that are more targeted to specific disorders and I might recommend getting those over the big psychopharm textbook if you were going to purchase them:

Anxiety, Stress and PTSD
ADHD
Antidepressants
posted by chemgirl at 6:05 PM on October 19, 2015

Response by poster: Thank you. I read The Last Psychiatrist (very helpful explanation), and I'm acquiring copies of Stahl's and a Handbook of Clinical Pharmacology for Therapists. Crazy Meds looks great, too. Much appreciated. This is exactly what I needed.
posted by Alex Haist at 12:25 AM on October 20, 2015 [1 favorite]

The book Feeling Good has a pretty good explanation of SSRIs and the like, it's pretty much 1/2 the book, the other half being straight up CBT methods.
posted by SassHat at 11:31 AM on October 20, 2015