REMEMBER JOSH from chapter 2? In the course of his illness, Josh was treated with several psychiatric medications, so we're going to revisit him while we talk about how medications are used in psychiatry. In this chapter, we talk about how psychiatrists choose medications, and what they do when patients don't get better right away. We talk about the patient's right to know about the risks of medications and procedures, a process called informed consent. With some medications, for example, there is a risk of addiction, and this presents a particular challenge to psychiatrists. Finally, we talk about treatment-resistant conditions and a little about what the future might hold as we strive for better ways to help patients. \n

Josh first saw Dr. Smith because he was depressed, and Dr. Smith clarified that Josh was suffering from a mental illness. His symptoms were not simply manifestations of adolescent angst, trouble adjusting to college, or stress. Dr. Smith recommended both medication and psychotherapy for Josh's depression. \n

You'll remember that Josh had a rather complicated story. He became depressed and was treated with an antidepressant. This medication quickly caused him to become hypomanic, that is, his mood and energy level were elevated too far above the normal, a process known as switching. Josh was then taken off the antidepressant and given a mood stabilizer, and for quite some time, he did well, but then an unfortunate series of events transpired. Josh played soccer in the cold, got the flu, and went into a smoke-filled room, and all these things triggered a terrible asthma attack. Josh needed to take steroids for his asthma, and this medication induced a full-blown episode of mania during which Josh became psychotic and dangerous and was admitted to a psychiatric hospital, where he was treated with even more medications. \n

In this chapter, we borrow Josh to explain the issues a psychiatrist thinks about when prescribing psychotropic medications.