Mental illness has many subtypes. Its spectrum ranges from major depressive disorder, anxiety, schizophrenia and bipolar depression to post traumatic stress disorder. Because of the stigma related with mental illness, people are very reluctant in seeking professional help. Some stereotypes of seeking help include being unstable, crazy, undesirable or being deemed as social outcasts. People suffering often feel a severe sense of dejection, helplessness, and lack of self confidence because of the negative labels placed on mental illness. These feelings often lead to high-risk behaviors that affect social well being.
Some mental health conditions require lifelong use of medications while other conditions can be managed by cognitive behavioral therapy. When abnormal thoughts occur after a traumatic experience such as death of a loved one, job loss, divorce, natural disaster, or acts of violence, people initially resort to cognitive behavioral therapy. Behavioral therapy consists of psychological therapy, physical activity, contact with loved ones, and engaging in religious or community hobbies. When feelings of helplessness, excessive worry, fatigue, and little desire to do leisure activities last longer than expected, it is advised to seek medical attention where one is either referred to therapy and/or will be prescribed medication. These medications are typically easy to administer as they are either taken first thing in the morning or right before bedtime. Side effects of most medications include headache, abnormal sleep patterns, strange dreams, digestive problems, worsened mood, and suicidal ideation – side effects do vary and some generally improve with time. Some long acting medications must be taken in the morning because they are “activating” and can cause the person to be awake or feel “wired” during the day. Other medications must be taken at night due to the clinical terminology “serotonergic syndrome” referring to sedation, blurred memory, and lack of coordination especially when taking other medication that have similar effects.
Often times people stop taking their medication due to lack of information, undesirable side effects, or simply not knowing the importance of taking their medication. In certain populations some side effects may cause social anxiety and may affect other parts of one’s daily life. For instance, the drug class of choice (serotonin-norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors) for depression and anxiety carry the side effects of low libido, little ejaculation, and the inability to reach an orgasm. Some other drugs such as Trazodone, a serotonin antagonist, can cause long-lasting erection which is considered a medical emergency. These conditions may be embarrassing and can disrupt sexual relationships and ultimately leads to the abrupt discontinuation of medication.
Moreover, drugs taken for mental illness require about 6-8 weeks to notice any improvement. It takes about this much time to observe whether or not there is a need for an increased dose or the need to add on another medication from a different drug class. Before the individual begins treatment they should be advised by their pharmacist that they should expect to feel an improvement in their energy before they see an improvement in their mood. There are natural products such as St. John’s Wort and Valerian Root available over the counter at local pharmacies however these drugs are considered “likely effective” and interact with many other medications. In contrast, there are medications used to treat other chronic conditions called “prophylaxis medications” that simply mask the side effects of mental illness rather than treating the underlying cause. These drugs may be controlled substances, such as Lorazepam, Diazepam (Valium), and other hypnotics that sedate the person rather than treating the actual condition. These drugs are often taken at night and are used only for a short amount of time due to the mortality rates of these drugs.
There are a few holistic approaches to reducing the burden of mental illness. Reducing the intake on certain foods with refined sugars, carbohydrates, and red meat has had a positive effect on certain individuals. In addition, limiting alcoholic beverages and increasing water intake have been included in several studies on how to manage one’s mood and energy. Moreover, engaging in physical activities like exercise, outdoor activities, and artistic hobbies has also been suggested to help improve mental health. For some others, being active in spiritual activities may alleviate the stress of mental health. It is advised by many clinicians to obtain a personal journal to record how they are feeling each day. More importantly, those suffering from chronic mental illness such as post-traumatic stress disorder, depression, and anxiety are encouraged to engage in supportive group activities. This may include group therapy, groups hangouts, and free mental health hotlines. The outcomes of combining medication with social activities prove to be more successful than medication or therapy alone.
The downside to some of these psychotropic drugs is the misuse and abuse of prescription drugs. For instance some patients combine their antidepressants with alcohol or other illicit drugs and become more unmanageable and are likely to engage in criminal activity. There have been high profile cases where individuals combine prescription medication with illicit drugs and alcohol, which lead to suicide and homicide of loved ones. Often times, patients who abuse these medications obtain these prescriptions illegally or purchase them through “black markets”. Pharmacists are trained to detect abuse through common addictive traits such as abnormal behaviors, erratic or aggressive manners, or willingness to pay cash for medications. Pharmacists are expected to report these behaviors to other healthcare professionals and should educate relatives and caretakers on how to identify misuse of medication.
Significantly, pharmacists play a role in mental health by serving as a community leader and an expert on medication use. Medicines are a major treatment modality for many mental illnesses, and with the growing burden of mental disorders worldwide, pharmacists are ideally positioned to play a greater role in supporting people with a mental illness. Pharmacists are well versed on clinical studies as well as side effects and should encourage others to raise questions or concerns regarding their medication. They also serve as trusted professionals and can refer people to health services that provide the appropriate counseling. As pharmacists contribute to the management of mental disorders, they help achieve quality use of medicines and ultimately help decrease the burden of mental illness.
Ezinne Onukogu, PharmD, MPH has a Doctorate in Pharmacy from Touro College of Pharmacy as well as Masters of Public Health from Capella University with a concentration in social and behavioral sciences. Ezinne currently resides in New Jersey and works for an independent pharmacy where she provides services to people of different backgrounds. She is best known for using her enthusiasm to encourage patients to be active in their health and wellness while expanding her role as a pharmacist in her community.