From most recent estimates, one in two Americans used at least one prescription medication in the past month and one in five Americans used 3 or more prescriptions in the past month. While prescription use is increasing, so are adverse drug events (ADE). Approximately 4.5 million ambulatory visits related to ADEs occur each year. The Institute of Medicine (IOM) estimates that at least 1.5 million preventable adverse drug events occur within the healthcare system each year. All medications have inherent risks, but both healthcare providers and consumers can often manage or reduce many ADEs from occurring. So what can you do?

The following questions from the Federal Drug Administration (FDA) can help you talk with your healthcare team so that you can gain a better understanding of your medications and to safely use them. You may want to ask your healthcare professional…

> What are the brand and generic names of the medicine? Can I use a generic form?
> What is the medicine for and what effect should I expect? Does this drug replace any other medicine I have been using?
> How and when will I use it, what amount will I use, and for how long? What do I do if I miss a dose?
> Should I avoid any other medicines, (prescription or over-the-counter), dietary supplements, drinks, foods or activities while using this drug?
> When should I notice a difference or improvement? When should I report back to my healthcare team? Will I need to have any testing to monitor this drug’s effects?
> Can this medicine be used safely with all my other medications and therapies? Could there be interactions?
> What are the possible side effects? What do I do if a side effect occurs?
> What other medicines or therapies could be used to treat this condition? How do the risks and benefits compare?
> How and where do I store this medicine?
> Where and how can I get written information about this medicine? What other sources of information can I use to make my decision?

For other information and resources, check out the following:
www.consumermedsafety.org
www.fda.gov
www.mentalhealthmn.org/be-informed/steps-to-wellness (Downloadable Medication Form)

From the Substance Abuse and Mental Health Services Administration (SAMHSA)

Excessive Heat Exposure Can Pose Higher Risks for Those on Psychotropic Medication or Other Substances

During this period when parts of the Nation are experiencing record high temperatures, SAMHSA is reminding everyone that these conditions can pose certain health risks to everyone—including people with mental and substance use disorders.

Exposure to excessive heat is dangerous and can lead to heatstroke, which is considered a medical emergency. Heatstroke occurs when an abnormally elevated body temperature is unable to cool itself. Internal body temperatures can rise to levels that may cause irreversible brain damage and death.

Individuals with behavioral health conditions who are taking psychotropic medications, or using certain substances such as illicit drugs and alcohol, may be at a higher risk for heatstroke and heat-related illnesses. These medications and substances can interfere with the body’s ability to regulate heat and an individual’s awareness that his or her body temperature is rising.

Visit the CDC’s Extreme Heat: A Prevention Guide To Promote Your Personal Health and Safety for information on how to prevent, recognize, and treat heat-related illnesses.

Which of these treatments is most effective?  This is a question that doesn’t always have a clear answer.  Antidepressants have become the most frequently prescribed drug in doctor’s offices and outpatient clinics today.  In fact, between 1996 and 2005 the number of people in the United States taking antidepressants has doubled in size.

In a recent study, “Psychotherapy Versus Second-Generation Antidepressants in the Treatment of Depression”, researchers attempted to find a more clear answer to this frequently asked question.  This study when compared to past research focused more on comparing the “newest” drugs (i.e. Paxil, Zoloft, and Prozac) to psychotherapy administered by a “qualified” provider.  A majority of previous studies were comparing older drugs to psychotherapy which left an incomplete picture of the comparative effectiveness.

This study was a meta-analysis, meaning they looked at data from 15 studies of similar topics.  In the process of choosing these 15 they had to eliminate studies that were using inadequate treatment methods. This would include studies that included untrained psychotherapists or variables that affected treatment quality such as:  switching of treatments, changing of dosages of medication and/or changing frequency of psychotherapy.  Another factor taken into consideration was the level of depression of the participants.  Depending on severity of depression (mild, moderate, or severe) outcomes and effectiveness of medication and psychotherapy may vary and treatment recommendations may differ.  To improve accuracy this study focused only on participants that were diagnosed with major depressive disorder.

The result of this study found that psychotherapy can be just as effective in the treatment of depression when compared to the newest of antidepressant medications. It was also noted that in the long run psychotherapy showed slightly better results.

So the question is; did they come up with a clear answer?  When comparing risks, benefits, and cost the course of treatment is ultimately up to the individual and their providers.  Some questions to discuss with your doctor might include:

• How severe are my symptoms? How long have I experienced these symptoms?  In what ways do they impair my goals for my health?  Other research has indicated that anti-depressants are most effective for depression that is severe and/or chronic.
• Are their side effects that are more concerning to me?
• What are barriers to me following a treatment?  Can I remember to take medications as directed?  How will I get to appointments for therapy?  Do I have a plan for what to do if I relapse?

We still need more research to be completed that focuses on the effectiveness of these treatments.  Depression today is the fourth leading cause of disability in the United States and it is predicted to be the second by 2020.  It is essential for people with mental illnesses to understand the facts so they can make educated decisions with their doctors about which treatments are most suitable to their specific needs.

This post was written by MHAM Intern Jahna Sandkamp.

We’ve had a few hot days in Minnesota, and hope you all are beating the heat.

Individuals on certain medications may be more vulnerable to heat stress. Persons taking regular medication should consult with their physician.  Some medications cause an adverse reaction in hot weather, such as reducing a person’s ability to sweat. If you are on such a medication, or if you know someone who is, please take a look at these strategies for managing heat stress.

To avoid heat-related illness:

• Avoid, as much as possible, working or playing in the hot sun or other hot areas.  If you must be out in the sun, wear a head covering and sunscreen.  A wide brimmed hat or visor will not only protect your head from intense rays of the sun; it will also provide a shield for your eyes.
• Shut blinds and open windows slightly during the day to release trapped hot air.  Use air conditioners if you have them.
• Wear lightweight clothing.
• Drink plenty of water and fruit juices; avoid alcohol, carbonated or caffeinated drinks.  Because the body loses fluids in the heat, drinking lots of liquids helps to avoid dehydration.
• Eat frequent, small meals; avoid high-protein foods
• Take cool baths or showers—cold water can lower body temperatures 25 times faster than sitting in an air-conditioned room
• Spend time (even 2 hours will reduce the risk of heat-related illness) in an air-conditioned environment or basement; cover windows to block direct sunlight; turn lights on low or off; use fans to blow hot air outside.  Public libraries, community centers or other similar locations may be a good option for spending some time away from the heat.
• Do NOT direct fans to blow in at you.  Fans can actually increase heat stress.
• Do not leave older people, children, or pets, alone in cars.

Non-emergency questions about how to stay cool—call 2-1-1 or for emergency heat-related health problems—call 9-1-1

A study published online in the Proceedings of the National Academy of Sciences, suggests that anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants. Researchers at the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University found that mice that were treated concurrently with SSRI antidepressants and anti-inflammatory drugs had diminished behavioral responses compared to mice treated with SSRI antidepressants alone.  To see if this finding had the same effect on humans, the researchers examined data extracted from the completed National Institute of Mental Health funded STAR*D study. The findings from the STAR*D data showed that individuals that were depressed and taking an SSRI antidepressant and an anti-inflammatory drug were less likely to have their symptoms relieved (40%), compared with individuals that were depressed and taking an SSRI depressant, but not taking an anti-inflammatory (54%).

Experts caution that this is a preliminary study and further studies need to be done. Individuals should not change their medication regimen based upon these recent findings, but should follow the advice of their prescribing physician.

Just a reminder that in recognition of Mental Illness Awareness Week, MHAM is hosting the Celebrating Recovery education event on Tuesday, October 5 at the Ramada Plaza in Minneapolis. The event will begin at 9:30 a.m. and conclude at 3 p.m. We would love to see you there! If you register before October 5, admission is $15. At the door admission is $20. Your admission includes presentations, a Wellness Fair, a Steps To Wellness self-care kit, and lunch.

This will be a great event for individuals living with mental illnesses, their family members and friends, and mental health providers. Michael Trangle, MD will speak about holistic care and staying healthy and Minnesota 10 x 10 and the DIAMOND program. Kim Lutes will share her experiences with the mental health system and the importance of self-advocacy. Brain Doran will discuss ways in which family members and friends can support a loved one who is living with a mental illness. Brett Dumke will provide an overview of the brand new Steps to Wellness self-care kits. Ed Eide will give examples of how individuals can share their stories to influence public policy.

The Steps to Wellness kits have been developed with support from an educational grant from Lilly USA, LLC, a charitable contribution from Janssen, Division of Ortho-McNeil-Janssen Pharmaceutical, Inc., a grant from Park Nicollet Foundation Healthy Community, and a grant from Pfizer Healthcare. The kits contain tools to help individuals manage their health and learn skills to advocate for themselves when working with medical professionals and social service providers. After the event, the kits will be available for order from the MHAM website.

Tickets to this event are still available. Please see the Celebrating Recovery page on our website to register online. Scholarships are available. To arrange for a scholarship, please contact Ed Eide at 612-843-4868, ext. 1 or edeide at mentalhealthmn.org.

CVS CarePlus conducted many of the blood draws required when a person is taking clozapine.  On June 1, 2010 the company ended this service and those individuals using CVS CarePlus must find an alternative for the required blood draw.

There are several options available that can result in connecting with a provider that can conduct the necessary blood draws:

• Speak with your psychiatrist or prescriber and make sure that they are aware that the blood draw is no longer available through CVS CarePlus.  Your prescriber should be able to direct you to an alternative provider.
• Contact your primary care clinic and set up appointments for the necessary blood draws.
• An appointment could be made with an independent lab in your area.
• Contact a home care agency that has the capacity to do in-home blood draws.
• Contact a pharmacy that has the capacity to do the blood draws.

Without the blood draws, people will not be able to obtain refills on clozapine, so the blood draws are critical.  If a person is not able to find an alternative provider for the blood draws, the advocacy program at the Mental Health Association of MN would assist the person in finding a workable solution.

By Brett Dumke, MHAM Education Coordinator

Who will develop the next generation of medications for mental illness? That was the question posed by the Director of the National Institute of Mental Health (NIMH), Dr. Thomas Insel, on a recent NIMH blog posting. Dr. Insel commented on the recent decision of two major pharmaceutical companies to terminate their psychiatric medication development programs and the likelihood of others to do so as well. If new drug innovation comes to a screeching halt, it will have a profound impact for individuals who have not responded well to medications that are currently available. In order to fill this void, the National Institutes of Health (NIH) and NIMH may have to play a key part in all phases of drug development in the coming years.  MHAM will continue to monitor this alarming trend and will provide updates when they develop.