A whispered hushed through bated breath
This heart is yours until it’s death
May our bodies fade into the stars
Until our love is all that’s left.
WHATEVER I CAN
Life is full of choices
And full of hard decisions
But I know that you’ll come through
And that you’ll do what’s right
Don’t forget to give me a call
I’m here to lend a hand
You’re my friend
Through and through
And I’ll do whatever I can.
Sometimes words don’t mean anything. In a relationship u can tell your lover I love you but your behavior can tell not the same thing. U really love the person wen u prove it by your behavior and not your words.
Special Message
This booklet is designed to help mental health patients and their families understand how and why medications can be used as part of the treatment of mental health problems.
It is important for you to be well informed about medications you may need. You should know what medications you take and the dosage, and learn everything you can about them. Many medications now come with patient package inserts, describing the medication, how it should be taken, and side effects to look for. When you go to a new doctor, always take with you a list of all of the prescribed medications (including dosage), over-the-counter medications, and vitamin, mineral, and herbal supplements you take. The list should include herbal teas and supplements such as St. John’s wort, echinacea, ginkgo, ephedra, and ginseng. Almost any substance that can change behavior can cause harm if used in the wrong amount or frequency of dosing, or in a bad combination. Drugs differ in the speed, duration of action, and in their margin for error.
If you are taking more than one medication, and at different times of the day, it is essential that you take the correct dosage of each medication. An easy way to make sure you do this is to use a 7-day pillbox, available in any pharmacy, and to fill the box with the proper medication at the beginning of each week. Many pharmacies also have pillboxes with sections for medications that must be taken more than once a day.
This booklet is intended to inform you, but it is not a “do-it-yourself” manual. Leave it to the doctor, working closely with you, to diagnose mental illness, interpret signs and symptoms of the illness, prescribe and manage medication, and explain any side effects. This will help you ensure that you use medication most effectively and with minimum risk of side effects or complications.
Anyone can develop a mental illness-you, a family member, a friend, or a neighbor. Some disorders are mild; others are serious and long-lasting. These conditions can be diagnosed and treated. Most people can live better lives after treatment. And psychotherapeutic medications are an increasingly important element in the successful treatment of mental illness.
Medications for mental illnesses were first introduced in the early 1950s with the antipsychotic chlorpromazine. Other medications have followed. These medications have changed the lives of people with these disorders for the better.
Psychotherapeutic medications also may make other kinds of treatment more effective. Someone who is too depressed to talk, for instance, may have difficulty communicating during psychotherapy or counseling, but the right medication may improve symptoms so the person can respond. For many patients, a combination of psychotherapy and medication can be an effective method of treatment.
Another benefit of these medications is an increased understanding of the causes of mental illness. Scientists have learned much more about the workings of the brain as a result of their investigations into how psychotherapeutic medications relieve the symptoms of disorders such as psychosis, depression, anxiety, obsessive-compulsive disorder, and panic disorder.
Just as aspirin can reduce a fever without curing the infection that causes it, psychotherapeutic medications act by controlling symptoms. Psychotherapeutic medications do not cure mental illness, but in many cases, they can help a person function despite some continuing mental pain and difficulty coping with problems. For example, drugs like chlorpromazine can turn off the “voices” heard by some people with psychosis and help them to see reality more clearly. And antidepressants can lift the dark, heavy moods of depression. The degree of response–ranging from a little relief of symptoms to complete relief–depends on a variety of factors related to the individual and the disorder being treated.
How long someone must take a psychotherapeutic medication depends on the individual and the disorder. Many depressed and anxious people may need medication for a single period–perhaps for several months–and then never need it again. People with conditions such as schizophrenia or bipolar disorder (also known as manic-depressive illness), or those whose depression or anxiety is chronic or recurrent, may have to take medication indefinitely.
Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some have side effects, and others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking are some of the factors that can influence a medication’s effect.
You and your family can help your doctor find the right medications for you. The doctor needs to know your medical history, other medications being taken, and life plans such as hoping to have a baby. After taking the medication for a short time, you should tell the doctor about favorable results as well as side effects. The Food and Drug Administration (FDA) and professional organizations recommend that the patient or a family member ask the following questions when a medication is prescribed:
Medications For Mental Illness
This booklet describes medications by their generic (chemical) names and in italics by their trade names (brand names used by pharmaceutical companies). They are divided into four large categories–antipsychotic, antimanic, antidepressant, and antianxiety medications. Medications that specifically affect children, the elderly, and women during the reproductive years are discussed in a separate section of the booklet.
Lists at the end of the booklet give the generic name and the trade name of the most commonly prescribed medications and note the section of the booklet that contains information about each type. A separate chart shows the trade and generic names of medications commonly prescribed for children and adolescents.
Treatment evaluation studies have established the effectiveness of the medications described here, but much remains to be learned about them. The National Institute of Mental Health, other Federal agencies, and private research groups are sponsoring studies of these medications. Scientists are hoping to improve their understanding of how and why these medications work, how to control or eliminate unwanted side effects, and how to make the medications more effective.
A person who is psychotic is out of touch with reality. People with psychosis may hear “voices” or have strange and illogical ideas (for example, thinking that others can hear their thoughts, or are trying to harm them, or that they are the President of the United States or some other famous person). They may get excited or angry for no apparent reason, or spend a lot of time by themselves, or in bed, sleeping during the day and staying awake at night. The person may neglect appearance, not bathing or changing clothes, and may be hard to talk to–barely talking or saying things that make no sense. They often are initially unaware that their condition is an illness.
These kinds of behaviors are symptoms of a psychotic illness such as schizophrenia. Antipsychotic medications act against these symptoms. These medications cannot “cure” the illness, but they can take away many of the symptoms or make them milder. In some cases, they can shorten the course of an episode of the illness as well.
There are a number of antipsychotic (neuroleptic) medications available. These medications affect neurotransmitters that allow communication between nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to schizophrenia symptoms. All these medications have been shown to be effective for schizophrenia. The main differences are in the potency–that is, the dosage (amount) prescribed to produce therapeutic effects-and the side effects. Some people might think that the higher the dose of medication prescribed, the more serious the illness; but this is not always true.
The first antipsychotic medications were introduced in the 1950s. Antipsychotic medications have helped many patients with psychosis lead a more normal and fulfilling life by alleviating such symptoms as hallucinations, both visual and auditory, and paranoid thoughts. However, the early antipsychotic medications often have unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements, leading researchers to continue their search for better drugs.
The 1990s saw the development of several new drugs for schizophrenia, called “atypical antipsychotics.” Because they have fewer side effects than the older drugs, today they are often used as a first-line treatment. The first atypical antipsychotic, clozapine (Clozaril), was introduced in the United States in 1990. In clinical trials, this medication was found to be more effective than conventional or “typical” antipsychotic medications in individuals with treatment-resistant schizophrenia (schizophrenia that has not responded to other drugs), and the risk of tardive dyskinesia (a movement disorder) was lower. However, because of the potential side effect of a serious blood disorder–agranulocytosis (loss of the white blood cells that fight infection)-patients who are on clozapine must have a blood test every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance on clozapine difficult for many people. Clozapine, however, continues to be the drug of choice for treatment-resistant schizophrenia patients.
Several other atypical antipsychotics have been developed since clozapine was introduced. The first was risperidone (Risperdal), followed by olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs.
All these medications have their place in the treatment of schizophrenia, and doctors will choose among them. They will consider the person’s symptoms, age, weight, and personal and family medication history.
Dosages and side effects. Some drugs are very potent and the doctor may prescribe a low dose. Other drugs are not as potent and a higher dose may be prescribed.
Unlike some prescription drugs, which must be taken several times during the day, some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in “depot” forms that can be injected once or twice a month.
Most side effects of antipsychotic medications are mild. Many common ones lessen or disappear after the first few weeks of treatment. These include drowsiness, rapid heartbeat, and dizziness when changing position.
Some people gain weight while taking medications and need to pay extra attention to diet and exercise to control their weight. Other side effects may include a decrease in sexual ability or interest, problems with menstrual periods, sunburn, or skin rashes. If a side effect occurs, the doctor should be told. He or she may prescribe a different medication, change the dosage or schedule, or prescribe an additional medication to control the side effects.
Just as people vary in their responses to antipsychotic medications, they also vary in how quickly they improve. Some symptoms may diminish in days; others take weeks or months. Many people see substantial improvement by the sixth week of treatment. If there is no improvement, the doctor may try a different type of medication. The doctor cannot tell beforehand which medication will work for a person. Sometimes a person must try several medications before finding one that works.
If a person is feeling better or even completely well, the medication should not be stopped without talking to the doctor. It may be necessary to stay on the medication to continue feeling well. If, after consultation with the doctor, the decision is made to discontinue the medication, it is important to continue to see the doctor while tapering off medication. Many people with bipolar disorder, for instance, require antipsychotic medication only for a limited time during a manic episode until mood-stabilizing medication takes effect. On the other hand, some people may need to take antipsychotic medication for an extended period of time. These people usually have chronic (long-term, continuous) schizophrenic disorders, or have a history of repeated schizophrenic episodes, and are likely to become ill again. Also, in some cases a person who has experienced one or two severe episodes may need medication indefinitely. In these cases, medication may be continued in as low a dosage as possible to maintain control of symptoms. This approach, called maintenance treatment, prevents relapse in many people and removes or reduces symptoms for others.
Multiple medications. Antipsychotic medications can produce unwanted effects when taken with other medications. Therefore, the doctor should be told about all medicines being taken, including over-the-counter medications and vitamin, mineral, and herbal supplements, and the extent of alcohol use. Some antipsychotic medications interfere with antihypertensive medications (taken for high blood pressure), anticonvulsants (taken for epilepsy), and medications used for Parkinson’s disease. Other antipsychotics add to the effect of alcohol and other central nervous system depressants such as antihistamines, antidepressants, barbiturates, some sleeping and pain medications, and narcotics.
Other effects. Long-term treatment of schizophrenia with one of the older, or “conventional,” antipsychotics may cause a person to develop tardive dyskinesia (TD). Tardive dyskinesia is a condition characterized by involuntary movements, most often around the mouth. It may range from mild to severe. In some people, it cannot be reversed, while others recover partially or completely. Tardive dyskinesia is sometimes seen in people with schizophrenia who have never been treated with an antipsychotic medication; this is called “spontaneous dyskinesia.”1 However, it is most often seen after long-term treatment with older antipsychotic medications. The risk has been reduced with the newer “atypical” medications. There is a higher incidence in women, and the risk rises with age. The possible risks of long-term treatment with an antipsychotic medication must be weighed against the benefits in each case. The risk for TD is 5 percent per year with older medications; it is less with the newer medications.
Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Episodes may be predominantly manic or depressive, with normal mood between episodes. Mood swings may follow each other very closely, within days (rapid cycling), or may be separated by months to years. The “highs” and “lows” may vary in intensity and severity and can co-exist in “mixed” episodes.
When people are in a manic “high,” they may be overactive, overly talkative, have a great deal of energy, and have much less need for sleep than normal. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. Their attention span is often short, and they can be easily distracted. Sometimes people who are “high” are irritable or angry and have false or inflated ideas about their position or importance in the world. They may be very elated, and full of grand schemes that might range from business deals to romantic sprees. Often, they show poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state.
In a depressive cycle the person may have a “low” mood with difficulty concentrating; lack of energy, with slowed thinking and movements; changes in eating and sleeping patterns (usually increases of both in bipolar depression); feelings of hopelessness, helplessness, sadness, worthlessness, guilt; and, sometimes, thoughts of suicide.
Lithium. The medication used most often to treat bipolar disorder is lithium. Lithium evens out mood swings in both directions–from mania to depression, and depression to mania–so it is used not just for manic attacks or flare-ups of the illness but also as an ongoing maintenance treatment for bipolar disorder.
Although lithium will reduce severe manic symptoms in about 5 to 14 days, it may be weeks to several months before the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder. If given in the absence of lithium or another mood stabilizer, antidepressants may provoke a switch into mania in people with bipolar disorder.
A person may have one episode of bipolar disorder and never have another, or be free of illness for several years. But for those who have more than one manic episode, doctors usually give serious consideration to maintenance (continuing) treatment with lithium.
Some people respond well to maintenance treatment and have no further episodes. Others may have moderate mood swings that lessen as treatment continues, or have less frequent or less severe episodes. Unfortunately, some people with bipolar disorder may not be helped at all by lithium. Response to treatment with lithium varies, and it cannot be determined beforehand who will or will not respond to treatment.
Regular blood tests are an important part of treatment with lithium. If too little is taken, lithium will not be effective. If too much is taken, a variety of side effects may occur. The range between an effective dose and a toxic one is small. Blood lithium levels are checked at the beginning of treatment to determine the best lithium dosage. Once a person is stable and on a maintenance dosage, the lithium level should be checked every few months. How much lithium people need to take may vary over time, depending on how ill they are, their body chemistry, and their physical condition.
Side effects of lithium. When people first take lithium, they may experience side effects such as drowsiness, weakness, nausea, fatigue, hand tremor, or increased thirst and urination. Some may disappear or decrease quickly, although hand tremor may persist. Weight gain may also occur. Dieting will help, but crash diets should be avoided because they may raise or lower the lithium level. Drinking low-calorie or no-calorie beverages, especially water, will help keep weight down. Kidney changes–increased urination and, in children, enuresis (bed wetting)–may develop during treatment. These changes are generally manageable and are reduced by lowering the dosage. Because lithium may cause the thyroid gland to become underactive (hypothyroidism) or sometimes enlarged (goiter), thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone may be given along with lithium.
Because of possible complications, doctors either may not recommend lithium or may prescribe it with caution when a person has thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies. Special caution should be taken during the first 3 months of pregnancy.
Anything that lowers the level of sodium in the body–reduced intake of table salt, a switch to a low-salt diet, heavy sweating from an unusual amount of exercise or a very hot climate, fever, vomiting, or diarrhea–may cause a lithium buildup and lead to toxicity. It is important to be aware of conditions that lower sodium or cause dehydration and to tell the doctor if any of these conditions are present so the dose can be changed.
Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics–substances that remove water from the body–increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat, and, ultimately, seizures. A lithium overdose can be life-threatening. People who are taking lithium should tell every doctor who is treating them, including dentists, about all medications they are taking.
With regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives.
Anticonvulsants. Some people with symptoms of mania who do not benefit from or would prefer to avoid lithium have been found to respond to anticonvulsant medications commonly prescribed to treat seizures.
The anticonvulsant valproic acid (Depakote, divalproex sodium) is the main alternative therapy for bipolar disorder. It is as effective in non-rapid-cycling bipolar disorder as lithium and appears to be superior to lithium in rapid-cycling bipolar disorder.2 Although valproic acid can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases valproic acid has caused liver dysfunction, liver function tests should be performed before therapy and at frequent intervals thereafter, particularly during the first 6 months of therapy.
Studies conducted in Finland in patients with epilepsy have shown that valproic acid may increase testosterone levels in teenage girls and produce polycystic ovary syndrome (POS)in women who began taking the medication before age 20.3,4 POS can cause obesity, hirsutism (body hair), and amenorrhea. Therefore, young female patients should be monitored carefully by a doctor.
Other anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder. Some studies suggest particular efficacy of lamotrigine in bipolar depression. At present, the lack of formal FDA approval of anticonvulsants other than valproic acid for bipolar disorder may limit insurance coverage for these medications.
Most people who have bipolar disorder take more than one medication. Along with the mood stabilizer–lithium and/or an anticonvulsant–they may take a medication for accompanying agitation, anxiety, insomnia, or depression. It is important to continue taking the mood stabilizer when taking an antidepressant because research has shown that treatment with an antidepressant alone increases the risk that the patient will switch to mania or hypomania, or develop rapid cycling.5 Sometimes, when a bipolar patient is not responsive to other medications, an atypical antipsychotic medication is prescribed. Finding the best possible medication, or combination of medications, is of utmost importance to the patient and requires close monitoring by a doctor and strict adherence to the recommended treatment regimen.
Major depression, the kind of depression that will most likely benefit from treatment with medications, is more than just “the blues.” It is a condition that lasts 2 weeks or more, and interferes with a person’s ability to carry on daily tasks and enjoy activities that previously brought pleasure. Depression is associated with abnormal functioning of the brain. An interaction between genetic tendency and life history appears to determine a person’s chance of becoming depressed. Episodes of depression may be triggered by stress, difficult life events, side effects of medications, or medication/substance withdrawal, or even viral infections that can affect the brain.
Depressed people will seem sad, or “down,” or may be unable to enjoy their normal activities. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening.
Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson’s disease, Alzheimer’s disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person’s quality of life can be greatly improved.
Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not “uppers” or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed.
The doctor chooses an antidepressant based on the individual’s symptoms. Some people notice improvement in the first couple of weeks; but usually the medication must be taken regularly for at least 6 weeks and, in some cases, as many as 8 weeks before the full therapeutic effect occurs. If there is little or no change in symptoms after 6 or 8 weeks, the doctor may prescribe a different medication or add a second medication such as lithium, to augment the action of the original antidepressant. Because there is no way of knowing beforehand which medication will be effective, the doctor may have to prescribe first one and then another. To give a medication time to be effective and to prevent a relapse of the depression once the patient is responding to an antidepressant, the medication should be continued for 6 to 12 months, or in some cases longer, carefully following the doctor’s instructions. When a patient and the doctor feel that medication can be discontinued, withdrawal should be discussed as to how best to taper off the medication gradually. Never discontinue medication without talking to the doctor about it. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing more episodes.
Dosage of antidepressants varies, depending on the type of drug and the person’s body chemistry, age, and, sometimes, body weight. Traditionally, antidepressant dosages are started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects. Newer antidepressants may be started at or near therapeutic doses.
Early antidepressants. From the 1960s through the 1980s, tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin. Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment. Other antidepressants introduced during this period were monoamine oxidase inhibitors (MAOIs). MAOIs are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. This has deterred many clinicians and patients from using these effective medications, which are in fact quite safe when used as directed.
The past decade has seen the introduction of many new antidepressants that work as well as the older ones but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).
The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include venlafaxine (Effexor) and nefazadone (Serzone).
Cases of life-threatening hepatic failure have been reported in patients treated with nefazodone (Serzone). Patients should call the doctor if the following symptoms of liver dysfunction occur – yellowing of the skin or white of eyes, unusually dark urine, loss of appetite that lasts for several days, nausea, or abdominal pain.
Other newer medications chemically unrelated to the other antidepressants are the sedating mirtazepine (Remeron) and the more activating bupropion (Wellbutrin). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.
Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants. Side effects of antidepressant medications.
Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows:
The newer antidepressants, including SSRIs, have different types of side effects, as follows:
The small number of people for whom MAOIs are the best treatment need to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the individual should carry at all times. Other forms of antidepressants require no food restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to the risk of serotonin syndrome.
Medications of any kind–prescribed, over-the-counter, or herbal supplements–should never be mixed without consulting the doctor; nor should medications ever be borrowed from another person. Other health professionals who may prescribe a drug-such as a dentist or other medical specialist-should be told that the person is taking a specific antidepressant and the dosage. Some drugs, although safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Alcohol (wine, beer, and hard liquor) or street drugs, may reduce the effectiveness of antidepressants and their use should be minimized or, preferably, avoided by anyone taking antidepressants. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants. The potency of alcohol may be increased by medications since both are metabolized by the liver; one drink may feel like two.
Although not common, some people have experienced withdrawal symptoms when stopping an antidepressant too abruptly. Therefore, when discontinuing an antidepressant, gradual withdrawal is generally advisable.
Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor and/or the pharmacist.
Everyone experiences anxiety at one time or another–“butterflies in the stomach” before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomachache, nausea, faintness, and breathing problems.
Anxiety is often manageable and mild, but sometimes it can present serious problems. A high level or prolonged state of anxiety can make the activities of daily life difficult or impossible. People may have generalized anxiety disorder (GAD) or more specific anxiety disorders such as panic, phobias, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD).
Both antidepressants and antianxiety medications are used to treat anxiety disorders. The broad-spectrum activity of most antidepressants provides effectiveness in anxiety disorders as well as depression. The first medication specifically approved for use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil). The SSRIs, fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) have now been approved for use with OCD. Paroxetine has also been approved for social anxiety disorder (social phobia), GAD, and panic disorder; and sertraline is approved for panic disorder and PTSD. Venlafaxine (Effexor) has been approved for GAD.
Antianxiety medications include the benzodiazepines, which can relieve symptoms within a short time. They have relatively few side effects: drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous for people taking benzodiazepines to drive or operate some machinery. Other side effects are rare.
Benzodiazepines vary in duration of action in different people; they may be taken two or three times a day, sometimes only once a day, or just on an “as-needed” basis. Dosage is generally started at a low level and gradually raised until symptoms are diminished or removed. The dosage will vary a great deal depending on the symptoms and the individual’s body chemistry.
It is wise to abstain from alcohol when taking benzodiazepines, because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. It is also important to tell the doctor about other medications being taken.
People taking benzodiazepines for weeks or months may develop tolerance for and dependence on these drugs. Abuse and withdrawal reactions are also possible. For these reasons, the medications are generally prescribed for brief periods of time–days or weeks–and sometimes just for stressful situations or anxiety attacks. However, some patients may need long-term treatment.
It is essential to talk with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is stopped abruptly. Symptoms may include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, or in extreme cases, seizures. A withdrawal reaction may be mistaken for a return of the anxiety because many of the symptoms are similar. After a person has taken benzodiazepines for an extended period, the dosage is gradually reduced before it is stopped completely. Commonly used benzodiazepines include clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
The only medication specifically for anxiety disorders other than the benzodiazepines is buspirone (BuSpar). Unlike the benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an antianxiety effect and therefore cannot be used on an “as-needed” basis.
Beta blockers, medications often used to treat heart conditions and high blood pressure, are sometimes used to control “performance anxiety” when the individual must face a specific stressful situation–a speech, a presentation in class, or an important meeting. Propranolol (Inderal, Inderide) is a commonly used beta blocker.
Medications For Special Groups
Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.
In general, the information throughout this booklet applies to these groups, but the following are a few special points to keep in mind.
The 1999 MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 21 percent of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder that caused at least some impairment. When diagnostic criteria were limited to significant functional impairment, the estimate dropped to 11 percent, for a total of 4 million children who suffer from a psychiatric disorder that limits their ability to function.6
It is easy to overlook the seriousness of childhood mental disorders. In children, these disorders may present symptoms that are different from or less clear-cut than the same disorders in adults. Younger children, especially, and sometimes older children as well, may not talk about what is bothering them. For this reason, it is important to have a doctor, another mental health professional, or a psychiatric team examine the child.
Many treatments are available to help these children. The treatments include both medications and psychotherapy–behavioral therapy, treatment of impaired social skills, parental and family therapy, and group therapy. The therapy used is based on the child’s diagnosis and individual needs.
When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, and others who have charge of the child) is essential. Children should be watched and questioned for side effects because many children, especially younger ones, do not volunteer information. They should also be monitored to see that they are actually taking the medication and taking the proper dosage on the correct schedule.
Childhood-onset depression and anxiety are increasingly recognized and treated. However, the best-known and most-treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD). Children with ADHD exhibit symptoms such as short attention span, excessive motor activity, and impulsivity which interfere with their ability to function especially at school. The medications most commonly prescribed for ADHD are called stimulants. These include methylphenidate (Ritalin, Metadate, Concerta), amphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), and pemoline (Cylert). Because of its potential for serious side effects on the liver, pemoline is not ordinarily used as a first-line therapy for ADHD. Some antidepressants such as bupropion (Wellbutrin) are often used as alternative medications for ADHD for children who do not respond to or tolerate stimulants.
Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called “off-label.” Most medications prescribed for childhood mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that “safety and efficacy have not been established in pediatric patients.” The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.
The use of the other medications described in this booklet is more limited with children than with adults. Therefore, a special list of medications for children, with the ages approved for their use, appears immediately after the general list of medications. Also listed are NIMH publications with more information on the treatment of both children and adults with mental disorders.
Persons over the age of 65 make up almost 13 percent of the population of the United States, but they receive 30 percent of prescriptions filled. The elderly generally have more medical problems, and many of them are taking medications for more than one of these conditions. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.
The elderly are also more likely to take too much of a medication accidentally because they forget that they have taken a dose and take another one. The use of a 7-day pill-box, as described earlier in this brochure, can be especially helpful for an elderly person.
The elderly and those close to them–friends, relatives, caretakers–need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications–not only those prescribed but also over-the-counter preparations and home, folk, or herbal remedies–the possibility of adverse drug interactions is high.
Women During The Childbearing Years
Because there is a risk of birth defects with some psychotropic medications during early pregnancy, a woman who is taking such medication and wishes to become pregnant should discuss her plans with her doctor. In general, it is desirable to minimize or avoid the use of medication during early pregnancy. If a woman on medication discovers that she is pregnant, she should contact her doctor immediately. She and the doctor can decide how best to handle her therapy during and following the pregnancy. Some precautions that should be taken are:7
The decision to use a psychotropic medication should be made only after a careful discussion between the woman, her partner, and her doctor about the risks and benefits to her and the baby. If, after discussion, they agree it best to continue medication, the lowest effective dosage should be used, or the medication can be changed. For a woman with an anxiety disorder, a change from a benzodiazepine to an antidepressant might be considered. Cognitive-behavioral therapy may be beneficial in helping an anxious or depressed person to lower medication requirements. For women with severe mood disorders, a course of electroconvulsive therapy (ECT) is sometimes recommended during pregnancy as a means of minimizing exposure to riskier treatments.
After the baby is born, there are other considerations. Women with bipolar disorder are at particularly high risk for a postpartum episode. If they have stopped medication during pregnancy, they may want to resume their medication just prior to delivery or shortly thereafter. They will also need to be especially careful to maintain their normal sleep-wake cycle. Women who have histories of depression should be checked for recurrent depression or postpartum depression during the months after the birth of a child.
Women who are planning to breastfeed should be aware that small amounts of medication pass into the breast milk. In some cases, steps can be taken to reduce the exposure of the nursing infant to the mother’s medication, for instance, by timing doses to post-feeding sleep periods. The potential benefits and risks of breastfeeding by a woman taking psychotropic medication should be discussed and carefully weighed by the patient and her physician.
A woman who is taking birth control pills should be sure that her doctor knows this. The estrogen in these pills may affect the breakdown of medications by the body–for example, increasing side effects of some antianxiety medications or reducing their ability to relieve symptoms of anxiety. Also, some medications, including carbamazepine and some antibiotics, and an herbal supplement, St. John’s wort, can cause an oral contraceptive to be ineffective.
To find the section of the text that describes a particular medication in the lists below, find the generic (chemical) name and look it up on the first list or find the trade (brand) name and look it up on the second list. If the name of the medication does not appear on the prescription label, ask the doctor or pharmacist for it. (Note: Some drugs are marketed under numerous trade names, not all of which can be listed in a short publication like this one. If your medication’s trade name does not appear in the list–and some older medicines are no longer listed by trade names–look it up by its generic name or ask your doctor or pharmacist for more information.) Stimulant medications that are used by both children and adults with ADHD are listed in the children’s medications chart).
Alphabetical List Of Medications By Generic Name
| Generic Name | Trade Name |
| Antipsychotic Medications | |
| chlorpromazine | Thorazine |
| chlorprothixene | Taractan |
| clozapine | Clozaril |
| fluphenazine | Permitil, Prolixin |
| haloperidol | Haldol |
| loxapine | Loxitane |
| mesoridazine | Serentil |
| molindone | Lidone, Moban |
| olanzapine | Zyprexa |
| perphenazine | Trilafon |
| pimozide (Tourette’s) | Orap |
| quetiapine | Seroquel |
| risperidone | Risperdal |
| thioridazine | Mellaril |
| thiothixene | Navane |
| trifluoperazine | Stelazine |
| trifluopromazine | Vesprin |
| ziprasidone | Geodon |
| Antimanic Medications | |
| carbamazepine | Tegretol |
| divalproex sodium (valproic acid) | Depakote |
| gabapentin | Neurontin |
| lamotrigine | Lamictal |
| lithium carbonate | Eskalith, Lithane, Lithobid |
| lithium citrate | Cibalith-S |
| topimarate | Topamax |
| Antidepressant Medications | |
| amitriptyline | Elavil |
| amoxapine | Asendin |
| bupropion | Wellbutrin |
| citalopram (SSRI) | Celexa |
| clomipramine | Anafranil |
| desipramine | Norpramin, Pertofrane |
| doxepin | Adapin, Sinequan |
| escitalopram (SSRI) | Lexapro |
| fluvoxamine (SSRI) | Luvox |
| fluoxetine (SSRI) | Prozac |
| imipramine | Tofranil |
| isocarboxazid (MAOI) | Marplan |
| maprotiline | Ludiomil |
| mirtazapine | Remeron |
| nefazodone | Serzone |
| nortriptyline | Aventyl, Pamelor |
| paroxetine (SSRI) | Paxil |
| phenelzine (MAOI) | Nardil |
| protriptyline | Vivactil |
| sertraline (SSRI) | Zoloft |
| tranylcypromine (MAOI) | Parnate |
| trazodone | Desyrel |
| trimipramine | Surmontil |
| venlafaxine | Effexor |
| Antianxiety Medications (All of these antianxiety medications except buspirone are benzodiazepines) |
|
| alprazolam | Xanax |
| buspirone | BuSpar |
| chlordiazepoxide | Librax, Libritabs, Librium |
| clonazepam | Klonopin |
| clorazepate | Azene, Tranxene |
| diazepam | Valium |
| halazepam | Paxipam |
| lorazepam | Ativan |
| oxazepam | Serax |
| prazepam | Centrax |
Alphabetical List Of Medications By Trade Name
| Trade Name | Generic Name |
| Antipsychotic Medications | |
| Clozaril | clozapine |
| Geodon | ziprasidone |
| Haldol | haloperidol |
| Lidone | molindone |
| Loxitane | loxapine |
| Mellaril | thioridazine |
| Moban | molindone |
| Navane | thiothixene |
| Orap (Tourette’s) | pimozide |
| Permitil | fluphenazine |
| Prolixin | fluphenazine |
| Risperdal | risperidone |
| Serentil | mesoridazine |
| Seroquel | quetiapine |
| Stelazine | trifluoperazine |
| Taractan | chlorprothixene |
| Thorazine | chlorpromazine |
| Trilafon | perphenazine |
| Vesprin | trifluopromazine |
| Zyprexa | olanzapine |
| Antimanic Medications | |
| Cibalith-S | lithium citrate |
| Depakote | valproic acid, divalproex sodium |
| Eskalith | lithium carbonate |
| Lamictal | lamotrigine |
| Lithane | lithium carbonate |
| Lithobid | lithium carbonate |
| Neurontin | gabapentin |
| Tegretol | carbamazepine |
| Topamax | topiramate |
| Antidepressant Medications | |
| Adapin | doxepin |
| Anafranil | clomipramine |
| Asendin | amoxapine |
| Aventyl | nortriptyline |
| Celexa (SSRI) | citalopram |
| Desyrel | trazodone |
| Effexor | venlafaxine |
| Elavil | amitriptyline |
| Lexapro (SSRI) | escitalopram |
| Ludiomil | maprotiline |
| Luvox (SSRI) | fluvoxamine |
| Marplan (MAOI) | isocarboxazid |
| Nardil (MAOI) | phenelzine |
| Norpramin | desipramine |
| Pamelor | nortriptyline |
| Parnate (MAOI) | tranylcypromine |
| Paxil (SSRI) | paroxetine |
| Pertofrane | desipramine |
| Prozac (SSRI) | fluoxetine |
| Remeron | mirtazapine |
| Serzone | nefazodone |
| Sinequan | doxepin |
| Surmontil | trimipramine |
| Tofranil | imipramine |
| Vivactil | protriptyline |
| Wellbutrin | bupropion |
| Zoloft (SSRI) | sertraline |
| Antianxiety Medications (All of these antianxiety medications except BuSpar are benzodiazepines) |
|
| Ativan | lorazepam |
| Azene | clorazepate |
| BuSpar | buspirone |
| Centrax | prazepam |
| Librax, Libritabs, Librium | chlordiazepoxide |
| Klonopin | clonazepam |
| Paxipam | halazepam |
| Serax | oxazepam |
| Tranxene | clorazepate |
| Valium | diazepam |
| Xanax | alprazolam |
| Trade Name | Generic Name | Approved Age |
| Stimulant Medications | ||
| Adderall | amphetamine | 3 and older |
| Adderall XR | amphetamine (extended release) | 6 and older |
| Concerta | methylphenidate (long acting) | 6 and older |
| Cylert* | pemoline | 6 and older |
| Dexedrine | dextroamphetamine | 3 and older |
| Dextrostat | dextroamphetamine | 3 and older |
| Focalin | dexmethylphenidate | 6 and older |
| Metadate ER | methylphenidate (extended release) | 6 and older |
| Ritalin | methylphenidate | 6 and older |
| *Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD. | ||
| Antidepressant and Antianxiety Medications | ||
| Anafranil | clomipramine | 10 and older (for OCD) |
| BuSpar | buspirone | 18 and older |
| Effexor | venlafaxine | 18 and older |
| Luvox (SSRI) | fluvoxamine | 8 and older (for OCD) |
| Paxil (SSRI) | paroxetine | 18 and older |
| Prozac (SSRI) | fluoxetine | 18 and older |
| Serzone (SSRI) | nefazodone | 18 and older |
| Sinequan | doxepin | 12 and older |
| Tofranil | imipramine | 6 and older (for bedwetting) |
| Wellbutrin | bupropion | 18 and older |
| Zoloft (SSRI) | sertraline | 6 and older (for OCD) |
| Antipsychotic Medications | ||
| Clozaril (atypical) | clozapine | 18 and older |
| Haldol | haloperidol | 3 and older |
| Risperdal (atypical) | risperidone | 18 and older |
| Seroquel (atypical) | quetiapine | 18 and older |
| Mellaril | thioridazine | 2 and older |
| Zyprexa (atypical) | olanzapine | 18 and older |
| Orap | pimozide | 12 and older/Tourette’s |
| Mood Stabilizing Medications | ||
| Cibalith-S | lithium citrate | 12 and older |
| Depakote | valproic acid | 2 and older (for seizures) |
| Eskalith | lithium carbonate | 12 and older |
| Lithobid | lithium carbonate | 12 and older |
| Tegretol | carbamazepine | any age (for seizures) |
This is the 4th edition of ‘Medications’. It was revised by Margaret Strock, staff member in the Information Resources and Inquiries Branch, Office of Communications and Public Liaison, National Institute of Mental Health (NIMH). Scientific review was provided by Wayne Fenton, M.D., Henry Haigler, M.D., Ellen Leibenluft, M.D., Matthew Rudorfer, M.D., and Benedetto Vitiello, M.D. Editorial assistance was provided by Lisa Alberts and Ruth Dubois.
Frequent visitors to this website know that I write an advice column, “Ask Dr. Dombeck”. A typical question I tend to see again and again is, “How can I best manage my (condition)?”. Because I strive to be an ethical advice-giver, and because there are severe limitations of information in the online question and answer format, I usually recommend that the writer visit his or her doctor to get an accurate diagnosis of the problem, and then follow the doctor’s treatment recommendations. There is simply no substitute for a face-to-face personal relationship with one’s own physician, psychologist or psychotherapist.
Beyond this necessary ‘stock’ answer, I often try to provide a further pearl or two of wisdom that the writer might consider. Specifically, I tend to recommend activities known to be generally helpful in promoting mental health and peace of mind including socialization, exercise and relaxation. It occurred to me that it is fully possible to get the benefits of all three of these recommendations by performing only a single activity which is called Yoga.
Yoga?
Despite the fact that over the last maybe twenty years, Yoga has gone from a marginal activity to an almost mainstream one here in the West, my impression is that Yoga is still not altogether well understood. Most everyone has heard of Yoga, but not everyone really knows what it involves.
Yoga originated in India several thousand years ago as a system of physical and spiritual practices. It was formalized in the second century BC in the form of the Yoga Sutras, attributed to the scholar Pantanjali. The word ‘Yoga’ means ‘union’ or ‘yoke’ or ‘joining’. Originally, Yoga was (and is in places where it is practiced as such) a method for joining a regular imperfect human being with the divine principle, or God. You could liken it to a form of prayer which serves a similar purpose, only prayer tends to be verbal, while Yoga tends to involve action.
Importantly, the bulk of the religious aspect of Yoga has not traveled to America, probably because it is more esoteric and mystical than the materialist and practical Western mind can easily appreciate. What has successfully traveled to America is a highly developed disciplined system of physical exercise that offers many benefits (physical, social, psychological and ‘spiritual’) to those who practice it. Personally, I see this ‘stripping’ off of the parts of Yoga that Americans can’t easily appreciate as a good thing. While probably regarded as a bit of an abomination by yogis back in India, the secularization of Yoga has made accessible a set of powerful techniques for tangible self-improvement that would otherwise not be available.
American Yoga then is really about one subset of Yoga proper; Hatha Yoga (or the Yoga of physical postures). Hatha Yoga is specifically concerned with the learning of special physical postures which are typically named in imitation of the way animals and structures move. Some examples include ‘cat pose’, ‘downward-facing dog pose’, ‘mountain pose’, ‘boat pose’ and ‘corpse pose’. There are a lot of these postures, and they are harder to get into than they look. Where very basic practice might focus on learning individual poses, more advanced students learn to link different poses together so that they flow into one another gracefully and, in so doing, complement one another. A good example is the ‘Sun Salutation’ posture flow which combines standing, lunging, and arching poses into a graceful flow.
Yoga lends itself to being non-competitive. There are no Yoga teams, and no Yoga trophies to win. There are no Yoga belts to earn. You simply practice Yoga because it is good for you and helps you to feel good while you are practicing it, and you get better at it (more able to do advanced poses) at your own pace. Each posture or pose is designed to one degree or another to help the person performing them to improve their physical strength, their bodily flexibility and range of motion, and their balance. My understanding is that these desirable attributes originally helped spiritually-minded yogis to be healthy enough to not have to worry about bodily pain so as to better concentrate on God. Here in America the same attributes help us to be more physically healthy, to concentrate better, to relax more fully, and to gain greater control over our emotions.
Yoga Benefits For Mental Health
I’m a clinical psychologist by education. When I recommend Yoga as a great practice to take up in order to promote one’s health, I’m thinking more about the mental benefits than the physical ones although both are present. To my mind, Yoga offers the following benefits:
By emphasizing gentle stretching of the joints and spine, Yoga promotes increased range of motion, and joint health. It helps work out muscular kinks and minor problems that might otherwise lead to back pain or stiffness. In promoting joint and spinal flexibility, Yoga also seems to promote a certain kind of mental freedom; there is a definitive feeling of mental ease and comfort that you experience at the end of a Yoga class that is linked to being free to move muscles that were tight before the class started. It doesn’t always last long, but it is very real and very soothing while it lasts.
As with any physical workout, Yoga practice concentrates your mind on the physical sensations and on the perfection of the postures. The immersive concentration factor Yoga provides works as a helpful tonic for anxious and obsessional people. The practice of Yoga (or most any other demanding physical exercise) can be a great distraction from worry as it forces the mind to attend to the body and the breathing; the moment.
Yoga is a very effective stress reduction and relaxation tool. Performance of various postures requires the tensing and stretching and then relaxing of muscle groups and joints, which effectively produces relaxation in much the same way that a massage or Progressive Muscle Relaxation (a technique used by behavioral psychologists) does. Yoga practice also draws attention towards breathing, which produces a meditative and soothing state of mind. Yoga methods for stress reduction and self-soothing are generally cheaper than other professional interventions (Yoga can be done for free if you know what you’re doing, and classes are no more expensive than group psychotherapy prices), pretty much safe, free of side effects, and empowering in comparison to medication alternatives.
On a more theoretical note: In the last decade, leading therapists have discovered that coupling a self-soothing, relaxation-inducing group of techniques with action oriented (cognitive behavioral) therapy often produces better results for difficult-to-treat patient populations than action-oriented therapies alone. I’m thinking of Linehan’s Dialectical Behavioral Therapy (aimed primarily at Borderline Personality Disorder patients), and Hayes’ Acceptance and Committment Therapy as examples. Yoga techniques promoting relaxation, self-soothing and body awareness skills are a good fit with these newer therapeutic approaches, and might prove helpful in getting impulsive and chaotically driven patients to engage the structured tools and techniques of cognitive therapy that could help them progress.
Not For Everyone
As practiced in the West, Yoga is basically a form of exercise. Many of the things about Yoga that promote mental health can also be gained from other forms of exercise, as Psychologist Kate Hays will tell you. This is important to keep in mind, becuause not every personality will click with Yoga. To my mind, Yoga works best for people who are anxious or depressed or frantic or impulsive or obsessional and who are looking for stress relief, self-soothing and a calm way to get in some gentle exercise. More competitive persons may find Yoga boring, but might derive similar benefits from some other form of exercise more to their liking.
If You’re Thinking About Attending A Yoga Class…
For your best bet, look for a teacher who has been teaching for a while and who is certified by a national or internationally recognized Yoga school (like the Kripalu Center in Lenox, MA or the Iyengar Foundation). Tell the teacher you are interested in ‘gentle beginners hatha Yoga’.
A Closing Anecdote
One of the things I like best about my own personal Yoga practice is how it has helped teach me patience. When I first started classes in the Spring of 1997, I was unable to touch my toes. This galled me as many people around me were able to do this. I had a wise teacher named Stella at the time, and I recalled her noticing how I was straining to get to the floor. She talked to me about it one night, telling me that Yoga was more about experiencing where you are now than about where you should be. She told me I should relax because the floor would be there when my body was ready to reach it. Sure enough, a few weeks later it was.
A balanced diet and regular physical activity are the building blocks of good health. Poor eating habits and too little physical activity can lead to overweight and related health problems. By eating right and being active, you can stay at or reach a healthy weight. Do it for yourself and your family!
What is a healthy diet?
The basis of a healthy diet is eating a wide variety of foods. Every day, you should try to eat*:
The larger number of servings is for active men. Eat a smaller number of servings if you are a woman, inactive, or trying to lose weight.
* Servings and serving sizes are from the U.S. Department of Agriculture/Department of Health and Human Services Food Guide Pyramid
You can not always measure your food. Here are some ways to help you estimate serving sizes.
1/2 cup of rice or pasta = size of ice cream scoop
1 cup of salad greens = size of a baseball
1/2 cup of chopped fruit or vegetables = size of a lightbulb
1 1/2 ounces of cheese = size of four dice
3 ounces of meat or fish = size of a deck of cards or cassette tape
2 tablespoons peanut butter = size of a ping pong ball
Tips for healthy eating
Quick breakfast ideas
Easy snack ideas
What are the health risks of being overweight?
Extra weight can put you at higher risk for:
What makes people overweight?
People gain weight when the number of calories they eat is more than the number of calories their bodies use. Many factors can play a part in weight gain.
Habits. Eating too many calories can become a habit. So can choosing activities like watching TV instead of being physically active. Over time, these habits can lead to weight gain. Genes. Overweight and obesity tend to run in families. Although families often share diet and physical activity habits that can play a role in obesity, their shared genes increase the chance that family members will be overweight.
Illness. Some diseases can lead to weight gain or obesity. These include hypothyroidism, Cushing’s syndrome, and depression. Talk to your health care provider if you think you have a health problem that could be causing you to gain weight.
Medicine.Some medicines can lead to weight gain. Ask your health care provider or pharmacist about the side effects of any medication you are taking.
The world around you.You can find food and messages about food at home, at work, at shopping centers, on TV, and at family and social events. People may eat too much just because food is always there. On top of that, our modern world— remote controlled televisions, drive-in banks, and escalators— it easy to be physically inactive.
Emotions. Many people eat when they are bored, sad, angry, or stressed, even when they are not hungry.
Although you may not be able to control all the factors that lead to overweight, you can change your eating and physical activity habits.
If you need to lose weight
Losing as little as 5 to 15 percent of your body weight over 6 months or longer can do much to improve your health. For example, if you weigh 200 pounds, losing 5 percent of your body weight means losing 10 pounds. Losing 15 percent of your body weight means losing 30 pounds. A safe rate of weight loss is 1/2 to 2 pounds per week.
Try some of these ideas to support your weight loss efforts:
Getting active
You do not have to be an athlete to benefit from regular physical activity. Even modest amounts of physical activity can improve your health. Start with small, specific goals such as walking 10 minutes a day, 3 days a week and slowly build up from there. Keep an activity log to track your progress.
Try these activities to add more movement to your daily life:
Are you ready to be even more active?
As you become more fit, slowly increase your pace, the length of time you are active, and how often you are active. Before starting a vigorous physical activity program, check with your health care provider if you are a man and over age 40 or a woman and over age 50, or have chronic health problems.
For a well-rounded workout plan, combine aerobic activity, muscle-strengthening exercises, and stretching. Do at least 30 minutes a day of moderate physical activity on most or all days of the week. Add muscle-strengthening activities to your aerobic workout two to three times a week.
To reduce the risk of injury, do a slow aerobic warm-up, then stretch before aerobic or strengthening activities. Follow your workout with a few more minutes of stretching. See WIN’s brochure Walking-A Step in the Right Direction for stretching exercises.
Aerobic activity is any activity that speeds up your heart and breathing while moving your body at a regular pace. If you have been inactive for a while, you may want to start with easier activities such as walking at a gentle pace. This lets you build up to more intense activity without hurting your body.
Regular aerobic activity can help to:
Choose aerobic activities that are fun. People are more likely to be active if they like what they are doing. It also helps to get support from a friend or a family member. Try one of these activities or others you enjoy:
Strengthening activities include lifting weights, using resistance bands, and doing push-ups or sit-ups. Besides building stronger muscles, strengthening activities may help you to:
Use more calories. Not only does the exercise burn calories, but having more muscle means you will burn more calories-even when you are sitting still.
Reduce injury. Stronger muscles improve balance and support your joints, lowering the risk of injury.
Maintain strong bones. Doing strengthening exercises regularly helps build bone and may prevent bone loss as you age.
Strengthening exercises should focus on working the major muscle groups of the body, such as the chest, back, and legs. Do exercises for each muscle group two or three times a week. Allow at least 1 day of rest for your muscles to recover and rebuild before another strengthening workout. (It is safe to do aerobic activity every day.)
Be good to yourself
Many people feel stress in their daily lives. Stress can cause you to overeat, feel tired, and not want to do anything. Regular physical activity can give you more energy. Try some of these other ideas to help relieve stress and stay on track with your fitness and nutrition goals:
Additional Reading
Dietary Guidelines for Americans
U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2000.
Phone: 1-888-878-3256.
http://www.health.gov/dietaryguidelines/
Exercise and Weight Control
The President’s Council on Physical Fitness and Sports.
http://www.fitness.gov/
Healthy Weight, Healthy Living
Shape Up America!
http://www.shapeup.org/
Walking…A Step in the Right Direction
Weight-control Information Network (WIN), 2001.
Phone: 1-877-946-4627.
http://win.niddk.nih.gov/publications/walking.htm
http://win.niddk.nih.gov/publications/caminar.htm
Additional Resources
American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995
Phone: 1-800-877-1600
http://www.eatright.org/
National Heart, Lung, and Blood Institute
Phone: 1-800-575-9355
http://www.nhlbi.nih.gov /
National Diabetes Education Program
Phone: 1-800-438-5383
http://ndep.nih.gov/
President’s Council on Physical Fitness and Sports
Department W
200 Independence Ave., SW
Room 738-H
Washington, D.C. 20201-0004
Phone: (202) 690-9000
http://www.fitness.gov/
Shape Up America!
http://www.shapeup.org/
Food and Nutrition Information Center
U.S. Department of Agriculture
Agricultural Research Service
National Agricultural Library, Room 105
10301 Baltimore Avenue
Beltsville, MD 20705-2351
Phone: (301) 504-5719
http://www.nal.usda.gov/fnic/
Welcome to our Wellness topic area, which is all about how people can enhance the quality of their lives and avoid serious illness by making simple but sometimes surprisingly difficult changes to their lifestyles. Wellness is a broad topic that includes disease prevention (the taking of steps to avoid getting ill at a future date), stress reduction, and even personal, social and spiritual growth.
At least as applied to healthcare, wellness is a new idea. The western world’s healthcare establishment has historically always focused on illness, and curing illness. Until quite recently, very little attention was ever paid to helping people who are not ill, disordered or diseased in some way learn how to further enhance the quality of their lives, or prevent the onset of future illness. To this day, medical doctors, psychologists and other health professionals are primarily taught categories of disease and how to fix those diseases. The healthcare insurance system is geared almost completely towards paying for interventions designed to fix disease. It is easy to get an insurance carrier to pay thousands of dollars for coronary bypass surgery. It is much harder to get them to pay for gym memberships and nutritional counseling that might have helped avoid the need for such surgery in the first place. Awareness that an “ounce of prevention is truly worth a pound of cure” is only slowly dawning. You can get ahead of this curve by reading and taking seriously the following information:
Somewhere in time the truth shines through. And the spirit knows what it has to do. Somewhere in you there’s a power with no name. It can rise to meet the moment and burn like a flame. And you can be stronger than anything you know. Hold on to what you see.
Don’t let it go. JMR
We unwilling led by the unknowing are doing the impossible.
For the ungrateful
We have done so much for so long for so little.
We are now qualified to do anything with nothing.
JMR
When the tide of life turns against you
And the current upsets your boat
Don’t waste tears on what might have been
Just lie on your back and float.
JMR
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