Mental health treatment makes strides

Dr. Oscar Urrea, medical director and CEO of Psychiatric Care Systems and medical director of Behavioral Health Services at Monongahela Valley and Washington hospitals, discusses treatment options in his Washington office.

Dr. Oscar Urrea recounted a conversation he had last week with a man who was distraught that he had been diagnosed with schizophrenia.

Urrea reassured him that he could lead a fulfilling and productive life, something that might not have been possible less than a generation ago.

“I told him that at least he has schizophrenia at the right time,” said Urrea, medical director and CEO of Psychiatric Care Systems and medical director of Behavioral Health Services at Monongahela Valley and Washington hospitals. “I was referring to the poor treatments we had years ago as compared with the treatments we have today.”

Indeed, early attempts to treat mental illness – long, sometimes permanent incarceration in psychiatric hospitals; lobotomies; bloodletting; dousing a patient in hot or cold water to “shock” the mind back into a normal state, or administering powerful drugs and tranquilizers – sound barbaric today.

As science continues to unravel mysteries of the brain, tremendous breakthroughs in medication have helped mental health patients better manage their medical conditions.

“There have been great advancements in medicine in general, and there have been crucial developments in psychiatric medications,” Urrea said. “In the middle to late 1980s, Prozac came along and literally revolutionized psychiatry. It changed the treatment of anxiety and depression. Literally, the treatment of depression is pre-Prozac and after-Prozac. That’s how dramatic the change was.”

Then, starting in 1993, a new generation of powerful antipsychotic drugs, including Seroquel, Abilify and Risperdal, came to the market to treat serious psychiatric disorders such as bipolar disorder and schizophrenia, with fewer side effects.

“Our psychotic and schizophrenic patients were improved in not having hallucinations, but they were very depressed. They had no drive, no energy, no willingness to do anything,” said Urrea. “With these new drugs, not only were we able to control hallucinations, but we gave these people life again. They could laugh, they could go to work.”

One of the effective therapies available today for severe depression and bipolar disorder is electroconvulsive therapy, or ECT, the application to the scalp of electric current strong enough to induce a brief seizure.

ECT had earned a bad reputation, Urrea said, partly because ECT used to be performed without anesthesia and muscle relaxants, resulting in seizures that horrified observers, and partly because of the movie “One Flew Over the Cuckoo’s Nest.”

But today’s ECT, done under anesthesia, has had remarkably positive results.

“The efficacy is wonderful. It raises serotonin levels faster than with medication,” Urrea said.

Patients can receive ECT on an inpatient or outpatient basis at Washington and Monongahela Valley hospitals.

More recently, long-lasting injectable medications given to patients once every week or few weeks have helped people with serious mental illnesses to stay on track and reduce stigma, said Karen Bennett, administrator of Greene County Human Services.

And because a doctor or hospital administers the shots, patients are more likely to remain in contact with a mental health professional.

Researchers are testing other treatment avenues, including ketamine, a street drug known as “Special K,” that also is used as a surgical anesthetic.

Ketamine is showing great promise in treating drug-resistant depression, Urrea said.

Currently, at least 17 ketamine clinics throughout the country are doing research and administering treatment through IV drip.

Research on LSD and other hallucinogens as a therapeutic tool is well underway, but the psychedelic drug likely is years away from FDA approval.

“To say LSD treatment is the ‘new thing’ in psychiatry isn’t even close at this time,” said Urrea.

Despite progress, people with mental illnesses face challenges with the psychiatric medications and treatments available today.

While today’s medications are safer, side effects can include diarrhea, drowsiness, weight gain and heart and neurological disorders. Side effects are one of the most common reasons patients abandon medications.

And treatment today still can be a long process of trial and error to find the right medication.

Ashley Bishop, 28, of Greene County, began taking psychiatric drugs at the age of 11, after her older took her own life.

She struggled to find a drug cocktail that provided her with relief from symptoms of bipolar disorder, post-traumatic stress disorder, anxiety and depression, finally settling on a combination of Invega, Clonipin and Neurontin.

Bishop, a youth support partner for Greene County Human Services’ High Fidelity Wraparound program, said she “was doing great. I felt the best I ever felt. Those medications were working great.”

Last year, though, she had to switch from Invega, an injectable, to Abilify, because of a thyroid issue.

The medication change, coupled with other issues, proved too much for Bishop, who ended up in the psychiatric ward of two area hospitals for the first time in eight years.

She currently is taking 14 pills per day, including lithium, and is dealing with side effects that include loss of appetite and lethargy.

“I’m struggling every day. I’m struggling at work, and it’s hard to get out of bed. It’s been just a really hard time for me,” Bishop said. “I know I need the medication, but I want to get back to what worked. I had been doing so well. I do worry about the future, if I’m going to have to take these the rest of my life. If I have to, I will. If I forget my medication or don’t take a dose, I feel mean, I’m not happy, and I’m in everyone’s face.”

Bishop has returned to work after taking a leave of absence, and is undergoing counseling while trying to find the right drugs.

Urrea acknowledges serious problems exist but remains optimistic about the future of psychiatric medicine.

“Clearly, we have to get better, and we are going to get better, but I am very happy with what we have available,” he said. “I am hopeful; I never give up. I always believe something good is going to come along. We can change treatment plans, and we have so many options today. Rarely now do we face a patient like we did in the ’50s and ’60s who don’t seem to be getting better at all. You might not be able to improve the patient 100 percent, but you can improve the person 25, 50 or 75 percent, and if you improve someone with psychosis 50 percent, that is important.”

Urrea pointed out that experts agree medications alone don’t work.

Greene County’s Bennett stressed the importance of combining medication with support services.

“Medication, when properly prescribed and taken, along with therapy and support services, are very important,” said Bennett. “The support services are out there.”

Environmental modifications – diet, exercise, sleep, social support – can also impact the quality of life of a person diagnosed with a mental illness.

“I don’t try to get through this all by myself,” said Bishop, whose support network includes friends and co-workers. “I believe 100 percent in seeking treatment and taking medications that will help you. If you need help with your mental illness, you need to get it. Don’t try to do it on your own.”

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