Anxiety and Depression  |  Treatments

Understanding Mental Health Treatments

BY HO KIM FUNG

1 September 2020  |   9 min read

Caring for a loved one with a mental health condition can be strenuous and lonely, especially during the current COVID-19 situation. Knowing more about your loved one’s mental health treatment options can prepare you for the upcoming journey.

What treatment options are available for my loved one?

Here are some of the common treatments which your loved one may be undergoing, and information that can help you to support them better.

Psychiatric Medications

Depending on your loved one mental health condition, the doctor may prescribe different medications to help your loved one manage their condition and symptoms. Some of the common types of psychiatric medications prescribed are listed below:

  • Antidepressants

    Antidepressants are medications commonly used to treat depression. They help to improve the symptoms of depression and prevent the depression symptoms from returning. Despite its name, antidepressants are also used to treat other health conditions such as anxiety, obsessive compulsive disorder (OCD), and pain too. There are a few types of antidepressants in the market today, and the most popular types of antidepressants are the selective serotonin reuptake inhibitors (SSRIs). Some common examples of SSRIs in Singapore are fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).

    Another type of antidepressants commonly used are the serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs work similarly as SSRIs, and some common examples include venlafaxine (Efexor) and duloxetine (Cymbalta).

    SSRIs and SNRIs are commonly used today as they are associated with fewer side effects than older types of antidepressants such as tricyclics and monoamine oxidase inhibitors (MAOIs). Antidepressants work about as well as one another in terms of effectiveness against depressive symptoms, however for reasons not well understood, some people respond better to some antidepressants than others.

  • Anxiolytics

    Anxiolytics or anti-anxiety medications are medications that help to reduce the symptoms of anxiety, such as panic attacks or worry. A commonly used type of anxiolytic is called benzodiazepines. Some common examples of benzodiazepines used in Singapore are lorazepam, diazepam, and alprazolam (Xanax). Benzodiazepines may also be used together with SSRIs or other antidepressants for treating certain types of anxiety disorders.

    Short-acting benzodiazepines (such as lorazepam) and medications called beta-blockers (such as propranolol) are also useful to manage the short-term physical symptoms of anxiety such as trembling, rapid heartbeat, and sweating. Taking these medications for a short duration and “as needed” can help the person keep these symptoms under control and reduce acute anxiety.

    Benzodiazepines take effect more quickly than the other antidepressants often prescribed for anxiety. However, people can become tolerant to benzodiazepines over time if taken for long durations, and some people may even become dependent on them. To avoid these issues, doctors usually prescribe benzodiazepines only for short durations.

  • Antipsychotics

    Antipsychotics are medications used to manage psychosis. “Psychosis” refers to conditions that affect the mind, where the person has some disconnection with reality, often having symptoms like hallucinations or delusions. Antipsychotics are often used together with other medications to treat conditions like OCD, schizophrenia, and post-traumatic stress disorder (PTSD). Some newer antipsychotics are also used to treat depression that has not responded to antidepressants alone.

    Antipsychotics are grouped into 2 classes: older, first-generation (or typical) and newer, second-generation (or atypical). Some common examples of first-generation antipsychotics are haloperidol, and chlorpromazine. Some common examples of second-generation antipsychotics are risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel).

    Certain symptoms like feelings of agitation and having hallucinations usually go away after a few days of starting an antipsychotic, but the full effects of the medications may not be seen for up to 6 weeks. Similar to antidepressants, each person responds differently to different antipsychotics and it may take a few trials to find one that works best for your loved one.

  • Mood Stabilisers

    Mood stabilisers are used primarily to treat bipolar disorder and mood swings associated with mental health conditions. They work by decreasing abnormal activity in the brain and helping to control unstable moods. Some common examples of mood stabilisers are lithium, valproic acid (Epilim), and carbamazepine (Tegretol).

Medications can help to manage mental health symptoms and make other concurrent therapies more effective.

Medications can help to manage mental health symptoms and make other concurrent therapies more effective. Certain symptoms may start to improve after a few days, and your loved one may feel he/she no longer needs the medications as he/she is feeling better. It is important to note that some psychiatric medications take a few weeks for the full effects to be felt, and it is essential that they are not stopped without the advice of your loved one’s doctor. Stopping the medications prematurely may cause your loved one to have a relapse

Medications can also cause some side effects but do inform your loved one’s doctor if they are facing severe side effects e.g.

  • If you notice your loved one having sudden mental status changes such as disorientation, agitation, or restlessness, having a high temperature, and having tremors or muscle rigidity.
  • If your loved one develops a fever with rashes, or painful blisters on the skin and mucous membranes of the lips, eyes, and/or nose.

For information on common side effects of psychiatric medications, you can refer to www.imh.com.sg/clinical/page.aspx?id=242.

If your loved one is facing any issues with medication, consult your loved one’s doctor for help, and discuss alternative medications if necessary.

Psychotherapies

Psychotherapy can be conducted as the sole treatment for mental health conditions or can be accompanied by psychiatric medications. Common psychotherapies include:

  • Cognitive Behavioural Therapy

    Cognitive behavioural therapy (CBT) is a form of talk therapy that can help your loved one manage their problems by changing the way they think and behave. CBT is commonly used to treat anxiety and depression, but can also be useful for other mental health conditions.

    The principle behind CBT is the concept that a person’s thoughts, feelings, physical sensations and actions are all interconnected, such that negative thoughts and feelings can cause a person to become trapped in a vicious cycle. CBT aims to help the person look for practical ways to overcome his/her current issues, and to improve their state of mind by changing the negative cycles and patterns. The eventual aim of CBT is for your loved one to apply what was learnt from the sessions to manage problems in his/her daily life, so that they will not cause a negative impact on his/her life.

    For more information on CBT, you can refer to www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/.

  • Psychoanalytic Therapy

    Psychoanalytic therapy is a form of in-depth talk therapy that aims to help your loved one understand their past and how events in their early life could be affecting them now.

    The principle behind psychoanalytic therapy is the Freudian concept that the unconscious part of a person’s mind has powerful effects on his/her feelings, actions, and relationships. Many problems such as anxiety, depressive thoughts, troubling personality traits may have their roots in past experiences or events. A psychoanalytic therapist uses analytic techniques to help a person uncover such repressed thoughts, experiences, and emotions. With these insights, the person can then work on overcoming his/her current issues such as stopping self-defeating or self-destructive patterns.

    For more information on psychoanalytic therapy, you can refer to www.counselling -directory.org.uk/psychoanalytical.html

  • Client-centred Therapy

    Client-centred therapy (or person-centred therapy) is a form of talk therapy whereby your loved one (the client) does most of the talking. Your loved one is able to tell his/her stories at their own pace, and the therapist provides a model of reflective listening without trying to interpret or evaluate what is said, or provide solutions. This approach allows your loved one to undergo a journey of self-discovery and self-acceptance, leading him/her towards healing, growth, and self-actualisation.

    The principle behind client-centred therapy is the belief that the client knows more about themselves than the therapist can possibly know, and therefore does not need the guidance or wisdom of an expert. Instead, client-centred therapists believe that clients are able to find their own answers to their problems if provided with an appropriate therapeutic environment. Therefore, the therapist creates an atmosphere in which clients can express their thoughts and feelings while being assured that they are being understood and not judged.

    For more information on client-centred therapy, you can refer to www.health.harvard.edu/newsletter_article/Client-centered_therapy.

During therapy, a therapist talks to your loved one about their condition and related issues. Through these sessions, your loved one will learn about their condition, moods, feelings, thoughts and behaviour. Your loved one can also learn coping and stress management skills.

Occasionally, your loved one’s therapist may assign tasks for them to complete before the next session. You can support and encourage your loved one to complete these tasks, but also provide them with the privacy to do so independently . As therapy is a process, you and your loved one should set realistic expectations, understanding that there will not be any sudden changes, but rather a gradual growth.

How long does my loved one have to undergo treatment?

The length of treatment varies from one person to the next, and depends on:

  • What is their mental health condition?
  • How well are they responding to the treatment?
  • Are there any other factors that support or hinder their recovery?

Your support can play a key role in helping your loved one’s recovery. It is important that you also take care of your own emotional well-being, to ensure you can best support yourself and your loved one.

For more information on receiving and giving emotional support, you can refer to https://www.psychologytoday.com/sg/blog/emotional-fitness/201112/10-ways-get-and-give-emotional-support

If you or your loved one have any questions about their treatment, do not hesitate to contact their doctor. Alternatively for any immediate help, call:

  • Institute of Mental Health’s Mental Health Helpline – Tel: 6389-2222
  • Samaritans of Singapore – Tel: 1800-221-4444

You may also write in to the Agency for Integrated Care at ccmh@aic.sg for enquiries.

The contributor is a trained Pharmacist and Programme Manager at Agency for Integrated Care, Caregiving, Community Mental Health Division.

Top image by Unsplash