Medication Management Psychiatrists
Encino Psychiatrists Karen L. Vause and Ramzi Kiriakos
Encino Psychiatrists
16550 Ventura Blvd.
Suite 212
Encino, CA 91436
Direct Contact Information
Karen Vause, MD (818) 995-0640
Ramzi Kiriakos, MD (818) 881-8208
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Medication Management

In many cases, psychotherapy alone can control most of the symptoms that disturb the patient. The use of medications may, in many cases, offer a quicker recovery and comprehensive recovery.

Accurate diagnosis is the essence for accurate treatment and precise resolution of the issues that bring the patient to treatment. When treating people, it is never purely mental or physical.  It is always an interplay of the two elements. If a patient is treated for a cardiac condition, some medication can affect their mood and make them depressed.  In those cases, it makes more sense to switch to another drug that can treat the heart without causing depression, rather than adding an antidepressant medication. The same is true for medications used for the heart that can cause delirium and hallucinations. Some people may have a cardiac condition such a mitral valve prolapse that can appear as an anxiety with panic attacks.  Some anti-anxiety medications will reduce the anxiety rather quickly, but the patient may develop tolerance to the medication. This would mean that the patient may need to take a higher dose to get the same relief.  It is possible to become addicted to certain antianxiety medications and experience an increase in anxiety or panic attacks when the medications are reduced or stopped.

Treatment of Depression

We have a large number of medications used for the treatment of depression. There are multiple types of symptoms that can occur when a person is depressed.  Some people experience restlessness and fidgety behavior. They may be unable to sit quietly. Their sleep is disturbed and they are agitated. Certain antidepressants will make those symptoms worse.  Some persons may have a depression that makes them feel exhausted with no energy and no appetite. They tend to sleep longer than what is normal for them. For these patients, some antidepressant medications will help them and some may make them feel worse.

Furthermore, we cannot predict before a medication trial how a particular patient with certain symptoms will react to what we believe is the right medication for them, even when the diagnosis is accurate. There is range of individual responses to medication. This requires starting with the best estimate of the right medication and a slow increase to a level that provides relief from symptoms.

Bipolar Disorder

In bipolar disorder, the patient may have mood cycles from feeling “too good” to “very low”. When the patient is feeling “too good”, he may be too self- confident, loud, spend too much money, have grandiose unrealistic ideas, become hypersexual and reckless. People may take risks with serious consequences that never occur to them when they are “feeling too good”. During other times, they may be depressed and feeling low and unhappy. They are slowed down and do not function well. They may be sad and tearful, even suicidal. In the treatment of bipolar disorder, we need to treat the mania or feeling “too good” as well as the depression which is more frequent. In bipolar disorder it is important to use mood stabilizers. The purpose of mood stabilizers is to reduce the frequency of the mood swings between mania and depression. If mood swings still occur, they may be decreased in intensity and do not cause as much dysfunction. There are many mood stabilizers available and the choice of the best one for an individual will depend on their physical condition, temperament and ability to cooperate with treatment. Some mood stabilizers require blood testing.

Psychoses

Psychoses, in many cases, respond well to medications. These illnesses as a group may distort the person’s perception of reality. They may hear voices, have frightening internal experiences and beliefs. These symptoms make them feel disconnected from those around them including family members. They may need help from others in order to be able to function in the world around them. It is important that these individuals receive early treatment, as early treatment may put the illness in remission and may eliminate the illness in some individuals.

Obsessive Compulsive Disorders

In obsessive compulsive disorders, the best responses are obtained with a combination of medications and therapy.  With the proper treatment the individual will feel less overwhelmed with the intrusive nature of the obsessions and have fewer disturbances in their daily living. Their compulsions also become less frequent, less disruptive and do not affect  the  productivity of the individual.

Medications used for the treatment of OCD are generally a combination of drugs used to treat depression and also used to stabilize mood. The third group of medications are used to treat anxiety. The choice of medication is determine by the mix of other symptoms present with the OCD symptoms. A combination of medications with different forms of therapy may be the ideal treatment for a given individual.

Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD)

For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) as well as Attention Deficit Disorder (ADD), there is a wide variety of medications that are effective in adults and children. The stimulant medications will activate the part of the brain that controls distractibility, inattention, impulsivity and hyperactivity. Treatment of ADD and ADHD requires continuous reassessment through the life cycle. The ideal treatment outcome would be improved social behavior, increased concentration on a task whether it is academic, social or athletic. The overall functional level of the person is increased.

We have a large number of medications because one size does not fit all. Each drug has a different therapeutic focus as well as different side effect profile. More than one medication may be needed. There is also a lot of individual variation in response. Initially, there may be side effects that disappear with time. In some cases, the good effect of the medication may become muted with time. Some individuals require adjustments or modifications in medication. Treatment of ADD and ADHD requires continuous reassessment through the life cycle as maturation, expectations for performance and responsibilities increase.

Substance Use Disorders and Addictions

In the treatment of substance use disorders and addictions, the primary goal is to bring order to the patient’s life and to contain the disruptive effects of addiction. No addictive substance can solve life problems. Initially, the individual may start abusing substances as a form of self- medication. Before they realize it they become addicted. Therapy should treat the addiction as well as the underlying conditions. Common use of addictive substances for self-medication occurs in: anxiety disorders, depression, OCD, ADHD and psychosis. When people have a history of addiction, medications should be selected with care to avoid any substance with addictive potential.

Medical Treatment for Sleep Disorders

The best approach to sleep disorder is to treat associated disorders that can cause insomnia such as: depression, anxiety, addiction, psychosis, PTSD and OCD. In many cases especially in people past age 40, they may have a primary sleep disorder, insomnia without an underlying disorder. It is important to teach the patient about “sleep hygiene”— how to have daily  practices conducive  to encouraging healthy sleep.

When prescribing hypnotic medications, preference should be given to non-habit forming medications. If habit-forming mediations are necessary, then switching them regularly to prevent addiction is essential. Some individuals may have long term primary insomnia that should be treated with non-addicting medication.

Eating Disorders and Post Traumatic Stress Disorders (PTSD)

Medication therapy can be a very helpful adjunct for the treatment of Eating Disorders and Post Traumatic Stress Disorders (PTSD) complementing other approaches to these conditions.

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