2012 Annual Meeting in Tampa, FL, April 29-May 2
Mental Illness in the Criminal Justice System: Constructing a Comprehensive and Competent Criminal Justice/Mental Health Treatment System
The deinstitutionalization of psychiatric facilities has been a major factor that has led to the current crisis of the criminalization of the mentally ill. Judge Steven Leifman, a Miami-Dade County Judge who has also served as Special Advisor on Criminal Justice and Mental Health for the Supreme Court of Florida, is responsible for chairing the Court’s Mental Health Subcommittee. He and his group authored a ground-breaking report entitled, Transforming Florida’s Mental Health System.
During his presentation, Judge Leifman will discuss new and effective strategies that are being developed and employed to transform the mental health system. He will address ways that providers can assist those with mental health disorders to maneuver the criminal justice system to minimize burden. Additionally, he will discuss how pharmacists and other health care professionals can get involved in a legislative manner to help transform the mental health system.
Ask the Psychiatric Pharmacist Columns
Latest Columns
Question:
I have heard that there may be negative effects associated with stopping antidepressants. Is this true?
Answer:
Yes, this is true. The effects you may experience if you abruptly stop an antidepressant medication are known as discontinuation or withdrawal symptoms. Up to eighty percent of patients who abruptly stop taking antidepressants develop discontinuation symptoms. These symptoms generally appear within days of stopping an antidepressant and can last up to two weeks. If the antidepressant is restarted, the discontinuation symptoms are quickly eliminated.
Common antidepressant discontinuation symptoms can be divided into four groups.
- Gastrointestinal symptoms: nausea, vomiting, diarrhea and abdominal cramps
- Somatic symptoms: headaches, lethargy and sweating
- Sleep-related symptoms: insomnia, excessive dreaming and nightmares
- Affective symptoms: anxiety, agitation and low mood
In order to avoid withdrawal symptoms associated with stopping these drugs, the dosages are often reduced gradually by your health care provider. Therefore, you should never abruptly stop taking your antidepressant medication. You should always consult your doctor or pharmacist before discontinuing any medication. Finally, be sure to maintain a sufficient amount of antidepressant medications at all times by refilling your prescriptions regularly.
Thompson C. Discontinuation of antidepressant therapy: Emerging complications and their relevance. J Clin Psychiatry 1998 Oct;59:541-548.
Written by:
Meredith Shawn Riser, Pharm.D.
Eugene H. Maklela, Pharm.D., BCPP
Question:
I was recently prescribed an antidepressant. The information sheet from the pharmacy said the medication may increase suicidal thoughts. Is this true?
Answer:
It is true that antidepressants may increase the risk of suicidal thoughts and behavior in children and young adults up to age 24. However, studies did not show an increased risk beyond age 24. Also, studies show that older adults (ages 65 and older) taking antidepressants actually have a decreased risk of suicidal thoughts and behavior. The information sheet that came with the medication may be intimidating but if you know what signs to look for, depression can be safely treated.
Depression is a disease that affects over 14 million Americans a year. In 2006, about 33,000 people in the United States committed suicide. Typically 90% of those people have some type of mood disorder (i.e. - major depression, bipolar disorder). However, long term treatment of depression with antidepressants can decrease suicidal thoughts and behavior.
All patients, but especially children, should be monitored for any signs of worsening depression or suicidal thoughts or actions, especially during the first several weeks of treatment. Things to look for include irritability, sleeplessness or withdrawal from normal social situations or activities. Contact your healthcare provider if you experience any new or unusual changes in behavior, feelings or mood. Also, it is important that you do not stop taking the antidepressant without first consulting a healthcare provider, so make sure you keep any follow-up appointments.
References:
"Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers." National Institute of Mental Health. Web. 11 Nov. 2010. <http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml>.
“Antidepressant Use in Children, Adolescents, and Adults.” US Food and Drug Administration. Web. 11 Nov. 2010. <http://www.fda.gov/Drugs/DrugSafety/>
Kratochvil C, Vitiello B, et al. "Selective Serotonin Reuptake Inhibitors in Pediatric Depression: Is the Balance Between Benefits and Risks Favorable?" Journal of Child and Adolescent Psychopharmacology 16.1/2 (2006): 11-24. Print.
Written by:
Karen Moeller, Pharm.D., BCPP
Recent Columns
- Part of my mental illness makes me hear voices. I started to take an antipsychoticto help with my symptoms. The medication helps, but sometimes I still hear the voices. Does this mean the medication is not working anymore?
- What does it take to get a medication to the American public?
- Someone I really care about has mental illness but repeatedly stops taking his medication and his symptoms come back. Sometimes my friend has to be hospitalized. How can I help him?
- I have schizophrenia and was recently started on a new drug. I have been having trouble sitting still and must constantly be moving. Could this be a side effect of my new medication?
View more Ask The Psychiatric Pharmacists Columns on the NAMI Website.