Page 78 - 1

78
themselves, are loud with pressured speech. They can be angry,
irritable and even grandiose and psychotic. They may think they are
God, a president or other important figures. Unfortunately such a
presentation can be caused by stimulant drugs and even steroids, hence
the difficulty in initial diagnosis.

Treatment

Antidepressants, known as SSRI’s for the their action on Serotonin,
are widely prescribed in this population. Common ones are Prozac,
Zoloft, Paxil, Celexa and Lexapro. Not only they improve symptoms
of depression, but anxiety, a very common associate of depression,
also improves. Typically addicts complain of anxiety and restlessness.
Given the SSRI’s safety records as compared to tricyclic (traditional
antidepressants), they are by far the most common prescribed
psychotropic medicine.

The most common side effects from SSRI’s come from their effect on
increase Serotonin in the nervous system in general. Weight gain,
gastro-intestinal pain, tops the list of common side effects. They may
also affect sleep, appetite and weight. Sexual side effects are as high
as 20-25%, but patients usually do not complain about them. Decrease
libido, and delayed or no ejaculation are typical in men, and to a lesser
degree in women.

Suicidal behavior and completed suicide have been the focus of media
and political groups. Recent data give conflicting reports as to the
prevalence of this problem, but it has been adopted by the psychiatric
community as a required element of the psychiatric evaluation.
Children, adolescents and adults are all at risk.

Other antidepressants are gaining market share due to effectiveness,
different side effect profile, and some without the sexual side effects
and weight gain. Wellbutrin, also sold as Zyban for smoke cessation,
is unique because of its action on norepinephrine and to less extent on
dopamine. It causes no sexual, weight gain side effects, but is a
powerful activating agent that can cause insomnia and agitation.