Q&A Link Copied 03.19.25

Amanda Batula Says Antidepressants Changed Her Life

"I feel so much more like myself again. I really lost myself for a few years there." ByKara Cuzzone

If you’re a fan of Bravo’s Summer House, you’ve probably noticed a shift in Amanda Batula recently. On-screen she’s joking around more, and she’s willing to get dressed up and go out on the weekends.

And off screen, Batula is staying booked and busy with her recently launched swimwear line, solo press interviews, and collaborations with brands like Face Reality Skincare—things we haven’t seen from her in the past. 

It’s a far cry from the version of Batula we watched a few seasons ago, and she says the change is mostly thanks to her antidepressant. “It’s just completely changed my life. I’m able to wake up in the morning and I feel so much more like myself again. I really lost myself for a few years there.” 

Here, Batula opens up about dealing with depression, the process of trying to find the right mental health medication, and how she takes care of her mental health while filming Summer House. 

WM: Were you nervous to open up about your mental health struggles on Summer House? What made you decide to talk about it publicly, and what has the response been like? 

AB: I wasn’t nervous at all. I feel like on the show over the last nine years, I’ve literally shown every aspect of my life: the good, the bad, and the ugly. I’ve been very transparent and open, and this is just another part of who I am. 

I actually was excited to talk about it, honestly, because it felt like a sense of relief. I felt so lost for so long, and once I finally figured out that I was struggling and there was something that I could do to help myself feel better, I was excited to share and tell everyone, “Hey, this is what’s going on with me.” I was not proud to be depressed, but proud that I was able to share something and hopefully help other people. 

So there was no nervousness about talking about it, and the response was insane. After that first reunion when I shared that I was struggling and on medication, the amount of messages I got—and still get to this day—from people who thanked me for being open about it was amazing. 

People have said that me talking about how I was feeling encouraged them to make appointments with their doctors, which is so meaningful and heartwarming. It just makes me want to continue to share and be open. 

Maybe I’m not out here saving lives, I’m not a doctor, but I am helping people in some way. And if that’s the most that I can do, then that means everything to me. So I will continue being super vulnerable and open about everything that I’m dealing with.

WM: I know you’ve said that, in hindsight, you felt like your depression started as post-wedding blues and got worse from there. Can you talk about how it evolved and how long you were struggling before you realized you needed to seek help? 

AB: I think it was about two and a half years that I was really struggling. In the buildup to the wedding there’s so much excitement, so much anxiety, so much stress. You’re constantly on calls, emails, planning things, trying on your dress, just all this incredible stuff. The wedding day is so amazing. And then once it’s over, nothing happens.

Afterwards I was getting DMs from people asking me, “Oh, are you dealing with the post-wedding blues?” I’d never heard of that before. And I realized, Wait, I *am* just kind of sad and just chilling on my couch and not really doing much. So I never snapped out of that. 

Then it was winter, so I thought, OK fine, seasonal saddies. It’s just because it’s winter. I kept making excuses almost, like, Oh, it’s just the post-wedding blues. Oh, it’s just seasonal saddies. Oh, I’m just not feeling myself. Oh, it’s just my hormones. Oh, it’s just this. So that was two and a half years of, Oh, if I take care of this, it’ll fix it.

And then it was Thanksgiving, and I always go home for Thanksgiving holidays. My parents kept asking when I was coming home, and a day or two before Thanksgiving I was like, “I don’t think I’m going to make it. It’s too much.” The idea of packing and everything was overwhelming me. And that’s when it really hit that I needed help, because this is so out of my character to just not go home. I love being at my parents’ house. 

A lot of people in my close circle of friends and family realized something was going on. I was shutting down. I wasn’t communicating with people. I wasn’t going to any events or anything. So people would check in, but no one really knows what to say. My parents were the ones that were like, “You’ve got to do something about this.” So that’s when it really clicked for me that something more was going on. 

WM: Earlier this season on Summer House, you mentioned you’ve been experimenting with different mental health medications and trying to find the right fit. Can you talk about what that process has been like, and where you are in your medication journey right now? 

AB: I was taking one medication that made me feel a lot better at first. But then I started feeling so much anxiety that it was almost debilitating. I was feeling happier, but my anxiety was so bad that I couldn’t do anything. My psychiatrist told me that could be a side effect of that medication, so he put me on a different one. And I was taking only that for a few months. I also take ADHD medication, but I stopped taking everything else and was just focused on my antidepressant to see how that affected me.

Once we found the right medication and dosage, we added in some other things to really help balance myself out. I’m still working on the exact right combination and dosage, but I’m feeling so much better than I was after that first medication. I felt so good after that first medication, and the way I feel now, almost a year later, is ten times better than that. 

It’s a long game, but it’s so worth it to find the right combination and the right medication for you. But it can be a frustrating process.

WM: What are the biggest differences you’ve seen in yourself since starting antidepressants? 

AB: I text people back. I’m just happier. Doing interviews like this, I would’ve shot down every opportunity to talk to anyone about anything when I was depressed. I felt so lost and alone, and like I wasn’t good enough for anything. I was like, Why would someone want to talk to me? 

I just feel the energy and the desire to do things, even if it’s going to be embarrassing or not work out—that doesn’t cross my mind anymore. I was in a really dark place and now I’m making appointments, getting my hair cut, going to the nail salon, getting out of my apartment, doing things, making plans, meeting friends for dinner at the last minute. It’s just completely changed my life. I feel so much more like myself again. I really lost myself for a few years there.

WM: Switching gears a bit, you’ve been open about struggling with acne since you went off of birth control. How does dealing with breakouts in the public eye affect your mental health, and what are you doing to cope? 

AB: I’ve gone through so many things on reality TV, but I think that filming while breaking out was probably the most insecure and hardest time I’ve had. I’m sure so many people can relate to having one pimple on their face, and they feel like that’s the only thing everyone in the room is staring at. And I felt like that all the time.

It was happening at a time where I was dealing with depression too. So that was also probably a part of why I locked myself indoors and turned so many things down; I didn’t want people to see me. I was dealing with weight loss and fluctuation also, and there were so many negative comments about that. And then my skin on top of it, it was just so much.

Paige had worked with Face Reality Skincare and she influences me all the time. When the opportunity came up to work with them I was like, “Yes, I want to do it,” and it really helped clear up my skin.  We’re just getting started, but I’m really excited with the results I’ve seen from my Face Reality regimen so far. My breakouts are so much more surface level now, and they’re going away faster. So I’m really excited and hopeful for what’s to come.

You shouldn’t be embarrassed of your breakouts. The internet is so wild these days, with filtering and this idea of perfection that it literally made me become a hermit. It made me shut down and not want to go out. And that should not have happened. That’s another reason why I want to talk about it—my mental health and my breakouts—because we’re all dealing with it. 

WM: You’ve also mentioned that you deal with anxiety and feelings of overwhelm sometimes. What’s it like trying to take care of your mental health while filming? Are there any self-care strategies that you use in the house? 

AB: Yeah, it’s been a learning process. I know Ciara and Paige deal with the same sort of feelings, which is probably why we find ourselves in bed and on our phones all the time. I think we need that mental break, and we need to almost dissociate. We need to leave the situation that we’re in mentally and just distract ourselves with silly TikToks or whatever’s on social media.

That’s one way that we’ve been able to calm ourselves down while filming, and that’s why you do see us all in bed a lot, because it’s like, “OK, I need a break from all these people and all this drama.” Even if everyone’s having fun, sometimes the energy is so much that I’m like, “OK, I’m not here right now. I need to go lay in bed or take a really long shower.” 

And then when I come home, Mondays are my Sundays. I’m like, “Don’t talk to me. Don’t text me, don’t email me. Pretend I don’t exist because I’m doing nothing all day.” I put the dogs on my chest and I just have a day to collect myself. I allow myself that grace day to just feel all my feelings, regroup, and then go into Tuesday strong.

WM: If you could give readers who are dealing with depression one piece of advice, what would it be? 

AB: I think there’s two things that go hand in hand. The first thing would be to talk to someone—anyone. It could be your parents, a sibling, a best friend, or it could be a teacher or a co-worker. For me, it was easier to open up to people I wasn’t as close with at first.

When you say it out loud and you admit it, that feels like the first step to getting better. At least it did for me. And then those people can help hold you accountable and check in on you. If no one knows that you’re struggling, no one’s going to know to check in and help you out.

And then the second thing is to be patient. Finding the right medication and letting the medication actually do its job, it’s going to take time. It’s not something that happens overnight. It feels like it’ll take forever, but you have to be patient and it will pay off. There’s no quick fix, there’s nothing that’s going to happen instantaneously. You just have to keep working at it and it will pay off, and you will end up feeling so much better.

The post Amanda Batula Says Antidepressants Changed Her Life appeared first on Wondermind.

Stories Link Copied 02.26.25

15 People Get Real About Mental Health Medication

The harmful stigma around medication and mental health needs to end. ByCarina Hsieh Additional Reporting ByCasey Gueren

If it seems like the stigma around mental health medications is suddenly getting worse, you’re not wrong. Medications like SSRIs (selective serotonin reuptake inhibitors), mood stabilizers, anti-anxiety meds, and others have been the subject of some wild claims from Robert F. Kennedy Jr., newly appointed U.S. Secretary of Health & Human Services. During and since his confirmation hearing, RFK Jr. spread harmful misconceptions about these evidence-based mental health medications used to treat conditions like depression, anxiety, ADHD, and bipolar disorder. 

“Research has continuously demonstrated the safety and efficacy of antidepressants and antipsychotics,” Chase T.M. Anderson, MD, MS, assistant professor in child and adolescent psychiatrist at University of California at San Francisco, tells Wondermind. “Every medication has benefits and risks, so physicians have a ‘risks and benefits’ talk before prescribing and allow space for questions. After prescribing, we monitor for adverse events with regular appointments. With the children, adolescents, and young adults I work with, we meet a few days or a week after. As time goes on and symptoms improve, we space check-ins out more so they can be off living their lives.” 

Despite the fact that RFK Jr.’s criticism of these meds isn’t based in science (more on that here), spreading misinformation can lead to increased stigma and stereotypes about mental health medications and the people who take them. 

If you think you might benefit from mental health medication, it’s worth talking to your primary care provider or a mental health professional to address any concerns floating in the back of your mind. In the meantime, here’s what 15 people had to say about their experiences with mental health meds, including how medicine helped life become more vibrant again and the lowdown on side effects.

1. Think of it like any other medicine you’d need…  

“I’ve been taking [medication] to treat my OCD for about 10 years and had tried other medications when I was in high school. I used to be super embarrassed—especially in high school—that people would judge me for it, and I also [had] fears about what taking medicine meant about me. Once my condition got worse, I had a therapist tell me that it was just like taking medicine to treat anything else. Now I am so fucking grateful for it because I don’t think I would be here without it, and I certainly wouldn’t have the life that I do. It’s easy to get caught up in the idea that you shouldn’t need it, but it doesn’t make you weak.” —Olivia L., 29

2. …Or like a doctor-prescribed safety net. 

“I was on a variety of antidepressants for roughly a decade, from age 14. There were obviously downsides and side effects, but the medication provided a really important safety net whilst I sorted out [my life]. I was fortunate to have doctors who were receptive when I wanted to try different medications, especially as there is no perfect antidepressant. Being a really young person on mental health medication often gets strange looks, but I knew it was the right choice because of the difference it made.” —Oliver A.*, 25 

3. Remember that feeling 100% perfect isn’t the goal… 

“While dealing with postpartum depression and anxiety, I hit my absolute bottom. I experienced huge bouts of rage directed at myself and others, had panic attacks every single day, and was ready to pack up my car and leave my husband and baby without any notice. I talked to my doctor about being put on an antidepressant, and since then, I honestly feel more comfortable in my own skin. I’m nowhere near 100% all the time, but being on medication takes the edge off and makes me feel like I can be around people without a panic attack brewing. Since going on medication, I have had only two panic attacks, which is a win for me—I was having at least one a day for months before.” —Kori B., 29 

4. …And that it’s OK if you get frustrated. 

“I have been on psychiatric medications for a variety of mental health issues since I was 16. I haven’t felt the stigma about taking mental health medications (thankfully, I have an amazing family and support system), but I have had to go on a journey within myself to accept that I will probably be on these medications for the rest of my life and that I have a chemical imbalance in my brain that will always need this extra attention and care. 

As much as I sometimes hate that I’m taking six to eight pills a day, I know how horrible I felt all the time when I wasn’t on my medications. I truly feel like I deserve a happier, more fulfilled life than that. I have had the darkest depths of depression and the highest highs of manic episodes, but I am blissfully in the middle with this particular cocktail of medications I’m on right now. I still get to experience the full range of human emotion, and I don’t have to be a victim of my mind or scared of my thoughts. These advances in medicine are to make sure we all have the best lives possible, so why not embrace the fact that, yeah, I might be a little ‘off’ on my own, but I have so many resources available to me that can make my life so much better.” —Morgan S., 28 

5. Sometimes therapy isn’t enough.  

“I just started taking medication for depression this year, and I can’t believe I was living for years with the condition and its anxious symptoms when I didn’t have to. As an Asian American, mental health—and especially medication for it—isn’t something that’s talked about in my family. My parents thought I just needed to learn stress relief techniques and go to therapy, but that wasn’t enough. I realized [medication] was a viable and not uncommon option once my partner pointed out that many of my friends were on antidepressants and I asked them about their positive experiences with medication. I cried the first time I took a pill because I felt I was broken, but now I feel I can get so much more of my work done and enjoy being present with others without the compulsion to stay in my room and cry over stressful scenarios I’ve made up in my mind.” —Lauren C., 24 

6. It might take some time to get used to the medication…

“The process of deciding whether or not to start using medication to treat my anxiety and depression was stressful, but my psychiatrist, therapist, and close friends reassured me that it was a valid option to take on, seeing as my condition was worsening earlier in the year. What held me back the most was being seen as weak or broken. I felt like it was my fault for making choices that led me to become ill. But with time, I began to accept the fact that it was just biology, like how diabetics take insulin shots to regulate their blood sugar…taking a selective serotonin reuptake inhibitor (SSRI) would help regulate the chemicals in my brain too. Adjusting to the medication was difficult for me—I dealt with nausea, poor sleep, and stomach problems while getting used to it and changing my dosage. But ultimately, even though the process wasn’t easy, it was also easily one of the best decisions I made all year.” —Rachel H.*, 23, 

7. …And one day, you and your doc might decide to switch it up. 

“I started taking an antidepressant back in 2017 while I was dealing with an excessive amount of panic and anxiety attacks. At first, I was skeptical that a small pill could take away my anxiety attacks, which had been causing me so much stress in my life. I took it anyway, starting off at a low dose and having the dosage raised by a small amount every month. I had a negative experience when my dose reached a certain level, but eventually, my body adjusted. It took a few months to really feel the positive effects of this SSRI, but when I did, it significantly improved my mental health, albeit with the occasional depressive episode. Antidepressants affect everyone differently, and for the most part it truly helped ease the cloud of excessive panic and anxiety attacks that followed me around. I’ve since stopped taking medication after speaking with my provider.” —Nina B., 29 

8. You might have to make some sacrifices… 

“My Sunday scaries used to involve a weekly panic attack about going back to work and the upcoming week ahead. Post medication, I haven’t had any panic attacks and can rationalize that anxiety in a realistic manner without spiraling into a panic. My sex drive and motivation are shot, but my Sunday evenings are better.” —Sera T. 29

9. …But the benefits can be worth it.  

“I avoided getting medicated for potential ADHD for years because my parents didn’t want ‘yet another thing wrong about me.’ I eventually got diagnosed at 30, and since taking medication, I am SO much more productive and honest with people. Some people think medication is a trap that makes you weak. I would say it makes me a stronger person who wants to live their life.” —Rin B., 31

10. It could save your life. 

“I have been lucky in my experience with medications to treat my depression. In high school, I was suicidal, and my mom forced me to see a doctor, which I resented, but it undoubtedly saved my life. I had the fortunate experience of the first med I tried working for me. It took time to find the right dose, but I’ve been on it for a decade now and can’t imagine my life without it. I grew up in a very small town where I think there was likely a lot of mental health stigma, but I have always been very open about it, and I think that worked to my advantage as a teenager and into adulthood. I feel awful on the rare occasions I forget my meds, but, in general, they make me feel like the life I want to build is possible.” —Lexie N., 26

11. It can help you tick off that to-do list.  

“When I actually remember to take my [ADHD meds], I feel like I log back into reality. I have combined type ADHD (as well as autism), and I didn’t realize how much I mentally checked out to cope with the simultaneously buzzing and boring world around me. So much of my body suddenly switched on [the first time I took my meds], and I was finally capable of putting my mind to something and doing it.” —Gates H.*, 27

12. It doesn’t make you weak. 

“In January 2022, I took a leave of absence from grad school for my mental health and began taking psychiatric medications. I spun a harmful narrative about myself that taking a break meant I was less intelligent and capable. The stigma surrounding medications certainly contributed, given the stereotype that if you take meds, you lack ‘mental toughness.’ Now, I’m happy to share my experiences with meds and how they have helped me build stability and resilience.” —Paige T., 26

13. And life might become more vibrant.  

“In 2015, during a period of depression and anxiety, my doctor told me that the most effective treatment for anxiety and depression was talk therapy in tandem with medication, so I started off on a low dose of medication. It was incredibly affirming to be diagnosed with generalized anxiety disorder (GAD) and depression because it suggested my pain wasn’t all in my head and was valid. Even so, I was so ashamed that they prescribed psychiatric medication. About two weeks after taking my meds, I felt a 180-degree shift in my mental state. I describe in my book how colors started looking brighter, music started to sound better, and I felt taller both physically and emotionally. Seven years later, I’m in the process of successfully tapering off, but I’ll always be grateful for the way medication rewired some of the chemistry in my brain in a way I wasn’t able to do on my own.” —Marissa M., 30

14. And you can dedicate more energy to other areas of your life.

“I was diagnosed with GAD and depression in late 2019. My psychiatrist placed me on medication as a form of treatment, but I felt the effects of my diagnoses long before then. After years of reducing my symptoms to a ‘personality trait,’ getting a psychiatric diagnosis, treatment, and validation led to what felt like an alteration in my worldview. My depressive symptoms and severe anxiety became much more manageable, and my medication gave me the opportunity to dedicate more time and energy to practicing other forms of mental health and wellness that enhanced the effects of my medication.” —Noelle S., 23 

15. High achievers can benefit from it too. 

“When I was 25, I was a thriving, high-achieving, successful student turned post-grad professional, but my anxiety was crippling me. My primary care doctor prescribed medication to treat generalized anxiety and depression, which at the time, sounded absolutely terrifying. I begrudgingly took my prescribed dosage, which initially felt like admitting ‘defeat.’ 

Once I [found the right dosage], I felt like the medication had finally taken the edge off of life that my brain chemistry so deeply wanted. I’m deeply fortunate that the first prescribed medication worked for me, as I know it can take frustrating trial and error to find what works best for you.” —Taylor O., 32

*Name has been changed. 

Quotes have been edited and condensed for length and clarity.

The post 15 People Get Real About Mental Health Medication appeared first on Wondermind.

Pro Tips Link Copied 10.11.24

6 Things Your Psychiatrist Wants You to Know

We don’t just hand out meds to everyone we see. ByJessi Gold, MD, MS

Despite what you may have heard, psychiatrists aren’t all old white dudes in bowties, but they’re also (hopefully) not boundary-less people who blur the lines between personal and professional with their clients (thanks every TV show ever!). I’ve been a psychiatrist for nearly 10 years and I hear these misconceptions all the time, so I figured I should clear some of them up for you.

For starters, we’re not all the perfect picture of mental health all the time. I just released my first book, How Do You Feel?, which is inherently about taking care of ourselves as we care for others, and making time for you in the delicate balance of work and life. But even in this process of book promo, which should be exciting, I struggled. I had planned to be busy with my book and my new job as Chief Wellness Officer for the University of Tennessee System, but I hadn’t planned for my dog, Winnie, to be unexplainably sick, causing us both to lose sleep. I was trying to do press and prepare for this book release, acting like everything was fine. 

It wasn’t. I realized that to be true to my book and its mission (and, honestly, to myself and my core value of authenticity), I had to say that out loud. And I had to give myself time and space to be sad or anxious, even if it felt like I had no time or space for it.

Maybe it surprises you to hear that from a psychiatrist, but maybe that’s the point. We need to talk more about what it means to do the job, and how it affects us. I am happy to start.

So, whether you currently see a psychiatrist or you’re curious about what it’s like, here are a few things I think you should know: 

1. We don’t just hand out mental health medications to everyone we see. 

A lot of people who don’t have experience with psychiatrists (or who have had bad experiences with one), think our job consists of seeing you for five minutes, asking you a few questions, giving you drugs, and saying bye. And I’ve always hated that perception because that’s not what I do or what I was trained to do. 

Providing medication is part of what we do and is something that differentiates us from other mental health providers (see: psychiatrists vs. psychologists), but it’s not all we do. Most psychiatrists don’t offer traditional psychotherapy (or hour-long sessions of talk therapy) because of insurance reimbursement limitations, and because there are fewer psychiatrists than there are therapists. So, yes, the people I see are people who need mental health medications, but if someone doesn’t need medications, I’m not going to prescribe them. I might suggest they see a therapist instead, unless they’re OK with checking in on a less frequent basis.

2. Even if we aren’t your therapist, we do want to hear what else is going on in your life. 

A lot of psychiatry sessions also involve some therapy. Because you can’t just medicate life experiences away. For instance, if you come in and say, “I don’t know if this med is working, and also my boyfriend just broke up with me,” my job is not to just increase the dose. My job is to talk to you about how this breakup is affecting you and help you consider if and when to adjust your medication to your current situation. I’ll also teach skills, hand you cognitive behavioral therapy worksheets, and help you challenge thoughts, feelings, and behaviors when it makes sense. Side effects matter, sure, but so does your lived experience. Understanding a patient’s story is central to finding a treatment plan that works. 

Also, there’s no problem that’s too small to bring up. Sometimes I wonder if patients think we have competitive trauma Olympics, and that their problems have to be at a certain level to qualify to be brought up in a session. I’ve had patients say, “Gosh, I’m so boring for you.” And while you never need to worry about that, you should also know that we appreciate a “boring” session every once a while!  

3. We fully acknowledge that there is no magic pill for your mental health. 

Sometimes people come to me convinced that a certain medication will fix them. Unfortunately, our medications are imperfect in so many ways, even though I have seen them save lives. Finding the right mental health medication is a lot of trial and error, and we make decisions based on the specific person we’re seeing. Your health, your medical history, your lifestyle, your genetics, and your vulnerability to certain side effects (among other things) all come into play. 

Time is also a big factor. According to the data, it’s recommended that you stay on one dose for six to eight weeks before messing with it. As a psychiatrist, it’s really hard to tell someone that it might be a few weeks before they feel a difference—or before we can reassess the dose or the type of medication. Especially when they are incredibly depressed and finals are next week. And yet, we try to find the balance.

In the meantime, we might make regular check ups with you to assess for side effects and hear how things are going, supporting you along the way. We might not always change a med or a dose, but we can still help (or at least validate your frustration!).

4. We’re not your friend, but we also don’t hate you. 

Despite what you may see in TV shows and movies, your psychiatrist probably won’t take you out for coffee and a hike—and that doesn’t mean they don’t like you! But boundaries are key to successful therapy and psychiatry. I think about my patients all the time, but it’s not because they’re my friends, it’s because I care about them as people. And you can care about people and want to help them succeed without wanting to go have a drink with them or wanting to hang out with them. Even if you seem friendly with your therapist, there is an inherent unequal power dynamic there. 

If you see us in public, know that we’re not going to blow up your spot and that we’ll follow whatever lead you set (all mental health professionals are taught this, by the way). So you can choose to come up to us and say hi or ignore us entirely. I’ve had it all ways, so just know we don’t ignore because we hate you—we ignore because we’re supporting your privacy.

5. Don’t be embarrassed to bring up something you saw on social media. But do keep an open mind. 

I get it, you’re scrolling on TikTok and the algorithm shows you video after video about the same mental health condition or symptoms you can relate to. So you go to a psychiatrist and tell them you’re pretty sure you have this diagnosis and need this medication. 

I appreciate that you researched this, that you got curious about yourself, and that you’re bringing this to a doctor—which is a very important step because a lot of people just take the label and run with it. But, when you take that step, be aware that we might not tell you what you want to hear, and that might feel invalidating but that’s never our intention. 

When someone comes to me with a diagnosis they heard about on social media, I’ll ask them what it was about the videos that resonated with them. I really value the fact that you have access to more mental health information, but the way that something is talked about on social media (or even in your conversations with friends) isn’t always how we would talk about it clinically. And that doesn’t mean that we’re questioning your experience or what you heard or saw. 

I love when my patients are informed and curious, but I also know that the internet can be a noisy, crowded place with a lot of opinions and personal anecdotes that don’t always line up neatly with the data. So if you saw something online that resonated with you, don’t be afraid to bring it up in a session, and try to keep an open mind. 

6. Psychiatrists are real people with real problems too. But that doesn’t mean we can’t be there for you. 

Your psychiatrist probably sees a therapist and/or psychiatrist too. We all need to unload on someone, and even the professionals can’t (and shouldn’t) treat themselves. I’ve learned that just because you know and believe in something, that doesn’t mean you can easily apply it to yourself. I don’t stigmatize patients who are on medications, but it turns out I stigmatized myself and had to work on that. Similarly, I was really burned out and I—just like many other people—was convinced it had to be a physical illness, despite the fact that I swim in mental illness all day and give talks on burnout weekly

You might read my book and think, Geez, mental health pros are not OK. My problem’s not important enough to add to theirs, or My problem’s too much and they’re not going to be able to handle it. But here’s what I want you to remember: We do this job because we chose this job. And if we show up, it’s because we can. 

There might even be times when your psychiatrist discloses something that’s going on with them (like if they have to take time off for a death in the family) or times when you know they’re going through it too (like in a worldwide pandemic). It’s natural and normal to ask how we’re doing, but you also don’t have to—this time is yours, and if we showed up to work, it’s because we feel equipped to help you. 

And, personally, I would want to see a psychiatrist who got meds if they needed meds and got therapy if they needed therapy, because it shows that they actually are taking care of themselves too. 

It might have taken me a little while to practice what I preach, but it has made me a much better doctor for it.

The post 6 Things Your Psychiatrist Wants You to Know appeared first on Wondermind.

Explainer Link Copied 06.06.24

Why Is Mental Health Care Still So Damn Expensive?

If you feel like your health insurance hates you, that tracks. Here’s how the government is trying to fix that—and how to deal right now. ByMolly Longman

A thing you’ve probably heard: Using health insurance to pay for therapy is hard. You also might’ve gotten wind that bigger mental health expenses, like in-patient treatment and substance misuse programs, are equally challenging to get covered—even when those services literally save lives. 

In case you haven’t noticed, those barriers mean it’s often way more expensive, time-consuming, and frustrating to treat a mental health issue than it is to treat a physical health concern—regardless of how good (or crappy) your insurance is.

Still, the U.S. government has been trying to get insurance companies to cover mental health like physical health, or what insurance people call “parity,” for decades. I know! In 2008, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA)—a law that’s been updated a bunch of times since—to make it harder for insurance companies to cheap out on mental health benefits. 

And yet, between 2022 and 2023, 3 in 4 insured adults who sought mental health treatment hit a major coverage roadblock, like having their mental health care claims denied, needing pre-authorization for coverage, or not being able to find a provider who took their insurance, according to a Kaiser Family Foundation (KFF) survey. 

But then, late last year, the Biden administration announced plans to make bigger changes to the MHPAEA, cracking down on insurance companies that use loopholes to skimp on mental health benefits. You might’ve seen the headlines last fall, but here’s the recap: Lawmakers are asking insurers to collect data that proves they’re following the parity rules and making mental benefits easier to access. 

Sounds great in theory! But…how’s that going? Here, we’ll get into the plan to fix the existing law, why that’s (obviously) proving to be harder than it should be, and how to hack the coverage you have now. 

Why mental health coverage is still expensive, confusing, and terrible

Since the MHPAEA was passed and amended over the years, insurance plans with drastically different copays and deductibles for mental health care versus physical health care had to make changes or face lawsuits from people who were denied coverage as well as tax penalties from the treasury department (up to $100 per day per patient) and the department of labor.

While that made a difference, it wasn’t enough to force all health insurance companies to treat mental health deductibles, copays, and whatnot the same as physical ones. That’s why, 15 years later, seeing a therapist still isn’t as simple or affordable as, say, seeing a dermatologist for a $50 copay.

It’s also why the new rules are trying to address the harder-to-quantify, less-obvious issues that make health insurance so bad at taking care of mental health, says David Lloyd, chief policy officer at Inseparable, a nonprofit mental health advocacy organization that aims to make mental health care more accessible. .

Here’s what those proposed new rules would mean: 

• Insurance companies need to collect more data on “nonquantitative treatment limitations” (NQTLs), like how many members need prior authorizations to access care, how many go out of network for care, and how many in-network providers currently take new patients.
• Insurance companies have to use a specific “mathematical test” to calculate whether they’ve achieved ~parity~ or not. 
• Government agencies overseeing insurance laws can request this data at any point—and so can people enrolled in that insurance plan. 
• You can request the plan’s data and complain to regulators if you find something wrong, Lloyd adds.

“These new rules [are meant to] address the fundamental issue: Plans are putting barriers in place that result in less mental health and addiction care,” says Lloyd. And yet, because this shit is complicated, these new guidelines still leave a lot to be desired by mental health pros and insurance companies alike. Here are some of the biggest pain points.

There are still plenty of loopholes.

The new proposal is essentially telling insurance companies: OK, show us—with real-world numbers and data we’re now mandating you collect—what mental health services you’ve ~actually~ been covering and how accessible that coverage is to your average person. 

But, even if they get busted, there’s still wiggle room, according to the Mental Health Liaison Group (MHLG), made up of organizations like the American Psychiatric Association, Anxiety and Depression Association of America, and National Alliance on Mental Illness. 

The first one: Insurance companies can use confidential “independent professional medical or clinical standards” or their own clinical guidelines to deny coverage. Meaning, even if they’re breaking Biden’s new rules, they can claim their top-secret, proprietary standards justify it—and that would be reason enough. 

That lil loophole could undermine the new rules and maybe weaken the existing law, the liaison group wrote in their comments on Biden’s new requirements. 

Another exception: Insurance companies can say that they’re denying claims, limiting coverage, or breaking any of the parity rules to fight “fraud, waste, and abuse.” According to MHLG, this language is so broad that insurance companies can take advantage of it—and they already are. “We know that many health plans have sought to exploit claims of ‘fraud, waste, and abuse’ to deny or otherwise limit access to medically necessary care,” they write. 

Finally, those fines of $100 per day per policyholder (aka you and the people on your plan who are denied mental health coverage) seem intense, but there’s still a ton of bureaucratic red tape keeping the Department of Labor from issuing fines when insurance companies break the rules. And, even when they are fined, insurers seem to see these fines as “the cost of doing business,” says Lauren Finke, MPP, senior director of policy for  The Kennedy Forum, an organization advocating for better mental health care standards. It’s like a teacher telling you to do homework that only counts for only 1% of your grade—it’s not worth your time, Finke says.

Insurance companies get to self-police.

Turns out, the existing mental health parity laws already mandate that insurance companies audit themselves and send in their compliance receipts “upon request.” In the new proposed rules, the lawmakers acknowledge that a lot of companies often don’t track parity data or analyze it the way they’re supposed to until the government asks for it. Plus, when they do hand it over, a lot of the time the data doesn’t track all the things regulators asked for. Basically, they’re half-assing parity oversight. 

It’s not clear how the new rules will fix that. Insurers still don’t have to turn over data until the regulators ask for it. And, if they’re failing, they have 45 days to explain why they’re making it harder to get mental health care coverage than physical. After that, the proposed rules say that the insurance company “may not” force insured folks to follow their policies that break the new rules, according to the 2023 proposal. The insurance company also has to fix those restrictions. 

Some things we still don’t know: How often will the government ask insurance companies for this info? Is it at random? If so, what happens if companies aren’t compliant and no one knows except the company? And what happens to your denied mental health care claims in the meantime? It’s easy to see why mental health orgs are skeptical about the enforcement of all this. 

The proposed rules also want everyone to have access to the data proving their provider is meeting parity standards—and that’s a good thing, says Kaye Pestaina, vice president at KFF and co-director of their program for patient and consumer protection. Of course, most of us don’t know what we should be looking for in the first place, Pestaina adds. 

What would really help consumers, Pestaina explains, is more publicly available, easy-to-read information about exactly how much different insurance plans will cover for mental health care and which plans actually have available therapists in your area. Also, um, those plans would need to exist, be affordable, and hopefully be subsidized by your employer…

Insurance companies and therapists blame each other for the lack of coverage. 

One of the most helpful parts of these new proposed rules is a bit that requires insurance companies to take “appropriate action” to create a balance of in-network physical health providers and mental health providers. Meaning, in theory, you’d have an equally easy time finding a therapist who takes your insurance as you would finding a dermatologist. 

That said, these new rules also include an out for insurance companies that don’t meet the in-network provider parity standard. Companies can claim that, despite their best efforts, there aren’t enough mental health pros in their area or there aren’t enough willing to join their plan. In other words, “Not our fault! We tried! Sorry!” When that’s the case, there are no consequences in this rule for insurance companies lacking available mental health pros, according to the proposed rules.

To be fair, the insurance companies have to prove they’re attempting to make their mental health care provider network as accessible as their physical health provider network once a year, says Lloyd. Of course, it’s not super clear what happens if companies’ non-compliance goes undetected.

You might be wondering why it would be hard to convince mental health pros to join an insurance network. We’re so glad you asked! The short answer: Getting reimbursed by insurance companies is a huge headache for mental health providers, which is why so many therapists don’t take insurance. 

JaNaè Taylor, PhD, psychotherapist and founder of Minding My Black Business, says, in her experience, insurance plans don’t always follow through on paying providers their portion of the service. “[They] are inconsistent and lowball us with their reimbursement rates,” she notes. A lot of the time that’s because insurance companies don’t recognize mental health care as a preventive, medically necessary measure, Dr. Taylor adds.

When insurance plans don’t pay their part, providers end up in the hole and you may get an unexpected bill, explains Pestaina from KFF. Since someone needs to take that financial hit, this makes for unhappy clients and therapists, she adds. It also means fewer therapists want to deal with insurance at all, Dr. Taylor says.

Juan Romero-Gaddi, MD, psychiatrist, therapist, and founder of Equal Mental Health, adds that there is indeed a provider shortage. Reimbursement issues and the administrative work needed to accept insurance means therapists often make more money by not taking insurance, explains Lloyd from Inseparable. Because the U.S. mental health care industry is famously low on providers, per KFF, that exacerbates the issue of uncovered mental health care, Lloyd adds.

But, hey, we’ll take what we can get when it comes to mental health parity.

Despite the significant loopholes, the hope is that these rules keep insurance companies honest about their mental health parity status and force them to fix existing problems. Eventually, that could mean fewer prior authorizations, more mental health providers who take your insurance, fewer surprise denials of coverage after you’ve already received a service, and (hopefully) less expensive mental health care in general, Lloyd says. 

It could take a while to see those effects though. The rules still aren’t finalized, and may not be till later this year. When they are, Pestaina says the rules aren’t enforceable until 2025. But who knows! Maybe plans will start auditing sooner to get ahead. It could happen!

How to navigate the situation we’ve got.

We’re here to say: Don’t give up! We asked experts for the best ways to manage the current system, so you can use your insurance to cover more of your mental health care costs right now.

Get a health savings account.

Some employee benefit programs include health savings accounts (HSA), which is a pre-tax account where you can save money to use on medical-related purchases like sunscreen, doctor’s appointments, and therapy, says Jessica B. Stern, PhD, a clinical psychologist and assistant professor at New York University Langone Health. Though the savings aren’t huge, having tax-free dollars to put toward mental health expenses is better than nothing. Obviously, the more money you make, the more you’ll save in taxes, but if you use the account it can’t hurt. Just make sure you spend it within the year, otherwise you’ll lose it to the government. 

Don’t wait to find care.

If you need a new provider, the first step is finding someone who takes your insurance and is actually taking new clients. In theory, you should be able to go through your insurance’s database, click on anyone who looks interesting, and try to book an appointment. In reality, those sites might be very out of date, meaning you might need to try other online therapist directories and do a lot of calling and cross-referencing between Google and your insurance company.  This process can be long, drawn out, and frustrating as hell. And if you’re really struggling with stress, anxiety, depression, burnout, or any mental health symptom that makes this process feel like torture, you likely won’t have the energy to get it done. So, if you can, start searching before you really need an assist.

Cross check your insurance database. 

You probably should start by, yes, checking out your insurance company’s database of providers. But it can also help to look at other online provider portals like ZocDoc or Psychology Today for more info on their specialities, availability, and insurance coverage. Scrolling through multiple sites to confirm the facts about one therapist is annoying, but in the long run it could be faster than calling to make an appointment and being told they’re booked up or not taking insurance or both. 

Get the codes.

Once you find an in-network mental health pro you like, take the extra step of asking them how they might bill your insurance, says Dr. Stern. You’re asking specifically for the “billing code,” says Dr. Stern, which will help you verify how your insurance company is going to treat that visit. For instance, your insurance might cover in-person therapy visits one way and teletherapy visits another—annoying! Or they might only cover 10 sessions of either. Knowing this ahead of time can potentially help you avoid a big bill down the line. 

Dr. Stern says you could try something like, “I’m interested in working with you for [therapy/medication management/assessment], but I just want to confirm my coverage of this service with my insurance company. Would you mind sharing the potential or likely billing codes you might use for our work together?”

Then, run those codes by your insurance company via their customer service line, Dr. Stern adds. If they’re all clear, great! If not, you can ask what the limitations are, what they do cover, and then ask them to send you an email with all this info in it so you can refer back. (Heads up: These details can change, so don’t assume this coverage will be solid indefinitely.)

Look into your out-of-network benefits.

Sometimes, you’ve gotta go outside your insurance plan. Whether it’s because you’ve gone over your insurance’s treatment allowance or found a provider who won’t budge on the insurance bit, you should know what it will cost you to get that care. 

First thing to figure out: if you have an out-of-network deductible and how much it is. If you have one of these (FYI: they’re usually higher than your in-network deductible), that means that your insurance will pick up some of the bill for out-of-network costs once you hit that predetermined number. Once you know that, calculate how much your mental health care is going to cost so you can do a little loud budgeting.

For some, that could look like this: Your out-of-network deductible is $5,000. Once you’ve paid that much on your own, your insurance kicks in and reimburses you for 70% of every out-of-network bill after that. Let’s say your therapist doesn’t take your insurance and charges $150 a session. That would mean you’d need to hit that $5,000 out-of-network deductible before you start paying $45 for those sessions instead. It’s not always that simple, so make sure you’ve got all the details on how to get reimbursed by your insurance company.

The post Why Is Mental Health Care Still So Damn Expensive? appeared first on Wondermind.

Explainer Link Copied 02.29.24

Do You Need Meds for Major Depressive Disorder?

Also, why are there SO MANY kinds? ByAmy Marturana Winderl

Living with major depressive disorder (MDD) can be rough. Also referred to as clinical depression, MDD can make you feel consistently bummed out and uninterested or unexcited about things that normally bring you joy. That can also come with a side of guilt or worthlessness, low energy, fatigue, and a struggle to concentrate or sleep. Sometimes, MDD can lead to suicidal thoughts too.

That’s why, for lots of people, major depressive disorder medication can be a life-changing (and life-saving) tool to manage those symptoms. Of course, medication isn’t the only way to treat MDD. Therapy, like cognitive behavioral therapy (CBT), can help shift your thought patterns, behaviors, and ultimately your mood. But depending on how severe your depression is, therapy may not make enough of a difference on its own, says Sagar Parikh, MD, professor of psychiatry at the University of Michigan and associate director of the University of Michigan Depression Center.

Sometimes it’s too hard to even make it to a therapist’s office when you’re depressed, Dr. Parikh says. If that’s the case, or you’re just looking for faster relief, medication can be very helpful. “[Medication for major depressive disorder] makes it easier to do things, whether that’s attending psychotherapy or simply getting out of bed,” he explains.

Love that for us, but you should know that there are approximately one zillion different meds that can help with MDD, and various kinds work in different ways. Yep, that’s overwhelming, but your doctor can help you figure out where to begin. In the meantime, if you’re curious about what’s out there, we’re breaking down the basics of major depressive disorder medication. Shall we?

Does everyone with major depressive disorder need medication?

Nope! Mental health meds are just one tool in your larger treatment arsenal for depression. Dr. Parikh says that for her average patient with MDD, there’s about a 50/50 chance that they’ll do better with an antidepressant. While some docs might suggest a prescription right away, others could recommend starting with lifestyle changes like therapy, exercise, and more time outside. If those basics aren’t doing much, then medication could make sense. 

Usually, some combo of medication, therapy, and complementary treatments like yoga or acupuncture work well, says psychiatrist Elspeth Ritchie, MD, chair of psychiatry at MedStar Washington Hospital Center. But, just like any mental health condition, what’s good for one person doesn’t always work for another. 

If you’ve been down the therapy and medication route and still aren’t feeling better, talk with your care team about other options for people who are resistant to depression medication and need more help, per the National Institutes of Health.

What types of medications for major depressive disorder are out there? 

As we said, when it comes to MDD meds, you’ve got lots of options. It’s kind of impossible to know which type or specific brand will be your perfect match, so doctors typically start with an SSRI, one of the more common medications that are usually effective with relatively few side effects, Dr. Parikh says. After a few weeks, they’ll check in to see if you’re noticing any relief or rough side effects, at which point they can adjust the dosage or consider a different medication entirely.

According to the NIH and U.S. Food and Drug Administration (FDA), the main types of medication for MDD are:

• SSRIs: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants and usually the first thing your doctor will try. Examples include fluoxetine, sertraline, citalopram, escitalopram, and paroxetine. 
• SNRIs: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to people who have depression and pain disorders happening at the same time. Examples include duloxetine, venlafaxine, levomilnacipran, and desvenlafaxine.
• Tricyclic Antidepressants: These medications tend to have more side effects than SSRIs and SNRIs, so they’re typically only used if you don’t respond to the other drugs first, according to the Mayo Clinic. Examples include amitriptyline, desipramine, amoxapine, doxepin, and nortriptyline. 
• MAOIs: Monoamine oxidase inhibitors (MAOIs) are not prescribed very often because they require a special diet (as weird as that sounds) to avoid dangerous side effects. But they’re an option for people who haven’t had success with other depression meds. Some research also suggests that people with atypical depression may benefit from MAOIs. Examples include isocarboxazid, phenelzine, and tranylcypromine.
• Atypical Antidepressants: This category is sort of a catch-all for depression medications that don’t exactly fit into those other categories, but can be effective either alone or in addition to another medication. Examples include bupropion, mirtazapine, nefazodone, trazodone, and vortioxetine.
• Mood Stabilizers and Antipsychotics: Sometimes other mental health medications, like antipsychotics, can help improve mood and sort of bolster the effects of antidepressants, Dr. Parikh explains. Examples include aripiprazole, quetiapine, and risperidone.

How do medications for major depressive disorder work?

In general, most MDD medications work by increasing the amount of certain chemical messengers in the brain (neurotransmitters) that regulate our brain function and moods. Serotonin, norepinephrine, and dopamine are the biggies usually implicated in depression.

Still, it’s not clear exactly how this improves MDD symptoms. “We know a lot, but we don’t know everything about how they work,” Dr. Ritchie says. For example, SSRIs increase how much of the feel-good chemical (serotonin) stays hanging out in your brain, but why that changes your mood is still a bit of a mystery, Dr. Ritchie explains. 

Still, researchers know that these and other medications affect brain chemicals in a way that helps relieve MDD symptoms. That’s the most important part, right?

What can you expect if you start taking medication for major depressive disorder?

MDD medications can take a little time to start working. “I usually give someone two to three weeks so they won’t get discouraged,” Dr. Ritchie says. Once they kick in, MDD medications can help relieve most symptoms of depression, including things like fatigue and not being able to concentrate, Dr. Parikh says. Those little things can be a massive help when it’s a struggle to just get out of bed and brush your teeth in the morning. You might even feel energized and motivated enough to start making more changes that can help you feel better.

Of course, most medications have side effects too, and MDD meds are no exception. In general, SSRIs and SNRIs have the most mild ones, while tricyclic antidepressants and MAOIs have more persistent or potentially severe ones. That’s why the latter aren’t prescribed as often. 

Common side effects of MDD medications often include feeling sick to your stomach, sleepiness, a cotton-mouth kind of feeling, sexual issues, sweating, and other random and annoying struggles, per the FDA. 

Do you need to stay on depression meds forever?

Not necessarily. Even if medication is the right choice for you now, it’s cool if that changes too. If you feel well and have had no major depressive episodes for about a year, it may be a good time to start working your way off them, says Dr. Parikh.

Whatever you do, please don’t stop taking them cold turkey, Dr. Parikh warns. “Antidepressants are not addictive,” he says, “but you can get withdrawal effects if you stop them abruptly.” Think: flu-like symptoms, like fatigue, achiness, and headaches. There’s actually a name for it—antidepressant discontinuation syndrome—and, according to research in the Canadian Medical Association Journal, about 20 percent of people on antidepressants experience it. Insomnia, nausea, balance problems, hyperarousal (irritability, agitation, anxiety, the works), and sensory disturbances (like something called a brain zap which, yes, feels like an electric shock in your noggin) can also happen.

So, yeah, you definitely don’t want to just wake up one day and stop taking your MDD meds. Instead, your doctor can help you taper off the dosage over time (usually a couple of months) until you reach nada. “The most important thing about tapering is that you should have also done something else to improve your life,” Dr. Parikh says. Things like starting psychotherapy can teach you important coping strategies and habits that get you through mood changes sans medication.

But if you’re happy and living your best life on your meds and don’t want to rock the boat, you probably don’t need to. Dr. Ritchie says that, in general, it’s good to reassess after about a year and make sure you’re happy with your treatment. If you’re doing well and aren’t having side effects, you can keep doing you. “In general, the long-term effects of the newer classes of antidepressants are low and mild and not dangerous,” explains Dr. Ritchie. “However, you should always talk to your doctor about what those side effects might be or [how they’re impacting you].” If anything feels off, you can always adjust the medication or the dosage, she adds. 

The bottom line: Medication isn’t the right fit for everyone with MDD, but for many people, it can make a huge difference in depression symptoms—especially when paired with therapy. If you’re not sure what to do about your depression symptoms, check in with a mental health or primary care provider to see what your options are.

The post Do You Need Meds for Major Depressive Disorder? appeared first on Wondermind.

Explainer Link Copied 02.21.24

A Nice Lil Intro to Antipsychotics

These meds might sound scary, but they’re really helpful. BySam Brodsky

For years, Esmé Weijun Wang, author of The Collected Schizophrenias, heard things that weren’t there and believed things that weren’t based in reality. Eventually she was diagnosed with schizoaffective disorder. While these hallucinations and delusions—symptoms of psychosis—aren’t totally gone now, she doesn’t have them as much anymore thanks to antipsychotic medications, she tells Wondermind. “For the most part, medication has helped me a lot,” she says. “I’m really grateful.”  

For people like Wang who’ve had hallucinations or delusions, it may be hard to sort out what’s real from what’s not. But antipsychotic meds can help them do life without those things getting in the way. If you’re hearing voices or truly believing that someone’s trying to hurt you when they aren’t, it’s going to be super difficult to go about your day, says psychiatrist Kamleh Shaban, MD. Antipsychotics “turn down this ‘noise,’” she explains. (It’s in the name after all: antipsychotics.) 

But these meds don’t only make psychosis better. For example, antipsychotics can also help people who don’t have psychosis deal with mood symptoms that are really messing with them, according to experts. (More on that in a bit.) 

So, if you’re just curious about antipsychotic medications, think you might need them, or have an important person in your life who’s about to start them, we’re here to talk about the basics. Here’s how they work, side effects to look out for, and how long you can expect to be on them. Your doctor will ultimately help you suss out what makes the most sense for the symptoms you’re having, but this is a good place to start.  

What are antipsychotics?

Like we said, these meds treat outside-of-reality symptoms like hallucinations and delusions. This means they help people with conditions that can come with psychosis, like schizophrenia, bipolar disorder, and even severe depression, according to the National Institute of Mental Health (NIMH).

But you don’t actually need to experience psychosis to be on antipsychotics. These meds can also help stabilize the high highs and low lows of people with mood disorders, says Dr. Shaban. They’re prescribed to treat dementia and Tourette syndrome too, says psychiatrist Efraim Keisari, MD. And some are even FDA-approved to help with irritability in autism spectrum disorder. So don’t be shocked if you aren’t seeing or hearing weird things and your doctor brings up antipsychotics.

And, just so you know, there are two main classes of antipsychotics: older ones (called first-generation or typical antipsychotics), like haloperidol and chlorpromazine, and newer ones (called second-generation or atypical antipsychotics), like aripiprazole and risperidone. These newer ones can treat more kinds of symptoms compared to the older drugs, according to the NIMH.

So how do antipsychotics work? 

The specifics are still sort of murky, to be honest. That said, experts think that these meds prevent an overproduction of dopamine in certain parts of the brain that causes psychotic symptoms, Dr. Shaban explains. They do this by blocking some of the brain’s dopamine receptors, sorta like putting in earplugs, says Dr. Keisari.

The same dopamine-blocking powers can potentially help stabilize your mood if you’re manic—or at least that’s the theory, says Dr. Shaban. At the same time, atypical antipsychotics can be a green light for dopamine in certain parts of the brain, letting it be released instead of blocked, which might contribute to improved mood, she explains. Sometimes taking one of those atypical antipsychotics can also help your depression in a way your antidepressant can’t by affecting a few different types of receptors in your brain, Dr. Keisari says.

What are the side effects of antipsychotics?

It’s possible you won’t have too many side effects when starting antipsychotics, depending on what dose and medication you’re on, says Dr. Keisari. But there are  ones to know about.

Muscle jerks or cramps you can’t control are more likely to happen with first-gen antipsychotics, says Dr. Shaban. (FYI, this is one reason why a lot of psychiatrists prefer to prescribe second-gens now, Dr. Keisari notes.) But you’re more likely to experience higher cholesterol and weight gain (aka metabolic side effects) from certain second-gen antipsychotics rather than the older meds, says Dr. Shaban. Plus, you can have a dry mouth, constipation, blurry vision, and trouble peeing because of some first- and  second-gen antipsychotics, says Dr. Keisari. 

Because of potential side effects, psychiatrists may send you for bloodwork. For example, they’ll usually have you get blood sugar and cholesterol labs done every three to six months if you’re on antipsychotics that can mess with that, Dr. Shaban says. And doctors will need to monitor your white blood cell count super closely if you’re taking the atypical antipsychotic clozapine, since it can lower a specific type of infection-fighting white blood cell, says Dr. Keisari.  

You’ll also want to talk to your doctor about the risks versus benefits of being on antipsychotics if you’re planning on getting pregnant, says Dr. Shaban. Using antipsychotic meds while pregnant may increase the baby’s risk for birth defects, research suggests. That said, “untreated mental health in a mother can have really lasting effects,” Dr. Shaban says, so only you and your doctor can decide what’s best for you. (Just so you know, she’s personally had pregnant patients who stayed on antipsychotics, so it’s not unheard of.)

How long can you take antipsychotics?

It really depends on what you’re being treated for. Someone with schizophrenia or schizoaffective disorder, for example, will probably need to stay on antipsychotic meds to manage their psychosis, says Dr. Shaban. But someone who’s using an antipsychotic in addition to other medication for depression or manic episodes might wean off that antipsychotic when they’re feeling stable, she adds. 

Remember that everyone’s different, so it might take some trial and error to find an antipsychotic that manages your symptoms and doesn’t give you bad side effects, Dr. Shaban says. Once you do, your symptoms may start to get better in a few days, though it could take a number of weeks to get the full effects, Dr. Keisari says.

Bottom line: Antipsychotic medications are usually prescribed for treating psychosis in disorders like schizophrenia, but they’re also used for other mental health conditions. Regardless of what you’re taking antipsychotics for, be open with your doctor about side effects and any questions you have, says Dr. Shaban. They can help you find what works for you.

The post A Nice Lil Intro to Antipsychotics appeared first on Wondermind.

Explainer Link Copied 12.04.23

What Experts Want You to Know About MAOI Drugs

MAO who? Let’s talk. ByAmy Marturana Winderl

If you heard about MAOI drugs from a friend or a pharma commercial, you might know the bare minimum: It’s an antidepressant. But if you’re not sure what it does or who it can help, you’re certainly not alone. 

There are a ton of antidepressants out there—a great thing, because it means we’ve got options if you, your doctor, or therapist think you’d benefit from treatment. But with so many types of mental health medications (many of which come with their own fancy acronym) and individual drugs within those categories… every commercial might leave you wondering, Wait, do I need this? 

So, here’s everything you need to know about MAOI drugs, including how they work, who they’re meant for, and the side effects to keep in mind.

What is an MAOI drug?

MAOI stands for monoamine oxidase inhibitor, and they’re a type of antidepressant used to treat major depressive disorder (MDD) and other mood disorders by inhibiting (hence the I) an enzyme in the body called monoamine oxidase (that would be the MAO), according to the National Institutes of Health (NIH). 

This enzyme’s job is to break down certain neurotransmitters, or chemical messengers in the brain that regulate our brain chemistry and moods. There’s a long-standing theory in depression research that one specific category of neurotransmitter called monoamine neurotransmitters plays a role in MDD. You’ve probably heard of them: norepinephrine, serotonin, and dopamine. So, when MAOIs block the enzyme that normally breaks down these neurotransmitters, it enables more of them to float around your body—and that could improve your depression symptoms.

Fun fact: MAOI drugs were the first antidepressants on the market back when they debuted in the 1950s, according to the NIH. They were actually discovered as a treatment for mood disorders by accident, says psychiatrist Alexander Herman, MD, PhD, an assistant professor of psychiatry at the University of Minnesota Medical School. “The original MAOI was being developed as a tuberculosis treatment and they noticed it had mood-boosting effects on people using it,” Dr. Herman explains. After delving deeper, researchers figured out why the drug had this effect and worked to create other medications that did the same thing. The more you know…

What are the side effects of MAOI drugs?

While they may be the OGs, MAOIs have been overshadowed by other kinds of antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, which are considered generally safer. That’s because, when you take an MAOI, you also have to limit certain foods and drinks or face really dangerous health risks. “Oral MAOIs inhibit the MAOs in the gut that are responsible for metabolizing tyramine, which is in foods like aged cheese and soy,” Dr. Herman explains. 

Sounds weird, but tyramine has a similar chemical makeup to neurotransmitters like serotonin and dopamine. So, “taking a monoamine blocker can cause tyramine to build up in the body.” That excess can trigger an increased release of adrenaline, which spikes blood sugar and blood pressure in a life-threatening way, Dr. Herman says. Plus, other medications, when mixed with an MAOI, can have the same effect, according to the Mayo Clinic. Yeah, not ideal. 

Because of all that, anyone who’s prescribed an MAOI has to follow a low-tyramine diet. That means avoiding things like aged cheeses, cured and smoked meats, pickled and fermented foods, and anything that contains soy. Oh, and alcohol, sourdough bread, and dried or overripe fruits. (So, like, almost everything you’d find on a good charcuterie board.) Eating within those very strict restrictions is hard for a lot of people to follow, Dr. Herman says.

While that’s the biggest bummer, MAOI drugs can also come with the same side effects as other antidepressant meds, like dizziness, dry mouth, nausea, and lightheadedness. Maybe it’s not surprising then that docs prefer prescribing other antidepressants first. “It’s pretty far down on the list for me,” says Philip Lam, DO, assistant clinical professor of psychiatry at the University of Arizona College of Medicine. And Dr. Herman notes that he’s never seen a primary care doctor prescribe these medications for depression and “even psychiatrists are hesitant to do so.”

One thing to note: While MAOI drugs are typically oral medications, some do come in patch form. “Because it’s absorbed through the skin, dietary restrictions may not be as necessary,” says Dr. Lam. The patch MAOIs are usually a lower dose and associated with fewer side effects, per the NIH. But, Dr. Lam adds, it’s harder to get insurance approval for the patch, for whatever reason.

Who are MAOI drugs good for?

Despite being a huge pain, people who’ve tried basically every antidepressant medication there is may find that MAOIs work for them. 

Same goes for those with atypical depression, Dr. Herman says. This type of depression, which goes by major depressive disorder with atypical features in the DSM-5-TR, is a subtype of MDD (though some say it’s debatable) that’s associated with symptoms like increased appetite, sleepiness, a feeling of heaviness in your limbs, and an all-consuming sensitivity to feeling rejected by other people. Some research suggests that people who have it respond particularly well to MAOIs.

Still, even if you have atypical symptoms right off the bat, chances are your doctor will have you try other treatments before putting you on an MAOI because of all that food drama. 

The bottom line: It’s reasonable to expect a little trial and error to figure out whether any mental health treatment works well for you—most mental health meds take a few months to even start working as they should. But if you’ve been trying to find a solution and feel better for a long time and nothing seems to be working, an MAOI drug may end up being the hidden solution you didn’t know to ask about. “These medications can be prescribed safely, though it does require a little more effort,” Dr. Hermann says.

The post What Experts Want You to Know About MAOI Drugs appeared first on Wondermind.