Can medications help me zoom in and zoom out from my thoughts and feelings

When thinking about pharmacological solutions for folks with mood disorders, I tend to think in terms of “zooming in” and “zooming out” problems rather the the usual “chemical imbalance” theory.

For folks with excessive zooming in to thoughts and feelings, I tend to think about SSRI’s, SNRIs, Antidepressants in general, Quetiapine, Anitipsychotics etc as “numbing agents” or “detaching agents”. Interestingly, a few years ago at Griffith Uni, they trialed oral Ketamine for severe depression, which is very “detaching” in action.

For folks with “primary” excessive zooming out from thoughts and feelings, some of the above may have more “dissociative/detaching” side effects, so I would use it with a degree of caution.

I do wonder if we can view ADHD as a lack of zooming in OR “loose anchoring” to various thoughts and feelings, and hence, fleeting from one thing to another perhaps. Hence a “zooming in” agent like Dexamphetamine seems to make sense.

The challenge is, most mood disorders are not simply a zooming in problem, or a zooming out problem. Often there is a mix.

Some people have both extreme zooming in, and extreme zooming out problems, and a single drug is not going to be the whole answer unfortunately.

There’s no such thing as a “zooming in and zooming out drug according to context” is there?

Hence, many will have to do the hard work of learning how to zoom out on the things that don’t matter, or matter but can’t control, and zoom into the things that truly matter, or things that they can control.

"Excuse me....Where is the information for my prescription medicine?"

Have you ever been surprised, or even frustrated with the lack of written information that comes with something as important as your prescription medications such as Antidepressants?

Perhaps when you are prescribed something for the first time? Or perhaps it's a medicine you've been taking for a while but you needed to check if it's ok to have a few drinks at the party tonight? Or maybe you've just had one of those days and you need something to alleviate that headache?

Why is it that your basic over-the-counter mouth ulcer gel is hidden in a roll of detailed information, but your important 'Prescription Only' medication comes with next to nothing??

Gone are the days where the pharmacist would hide behind a wall and make up a special 'secret concoction' ordered by the doctor, which the pharmacy assistant would then hand to you labelled 'The Mixture' or 'The Tablets'. We now live in the in age of information and we now not only demand information, we are also entitled to it, and medicines are certainly no exception.

So, how much information should be provided? Is more always better? Should you jump on the computer and start 'googling' away and take advantage of all the information available on the Internet?

My response would be, information is power. BUT, only if the information is accurate, reliable and correctly interpreted and appropriately personalised to the circumstances at hand. The problem is where the source of information is coming from and whether the person receiving the information fully understands the context in which it's conveyed.

The Internet has a seemingly limitless amount of information of just about everything. And as it's unregulated it's a huge task to separate accurately published information from an abundance of mis-information. Specifically, truly accurate and legitimate drug,medical and health information can be particularly difficult to find. Many medical academics make a career of interpreting countless studies to ensure the studies, data and information are legitimate and accurate to current standards. Therefore, it would be fair to say that interpreting drug and medical information requires a certain level of training, skill and experience.

So, where can you find reliable information?

All Australian drug manufacturer's are required by law to have a CMI (Consumer Medicine Information which are dose and brand specific) available for their medicines, but not all will provide it with the packaging. A copy can be obtained at the pharmacy.

The other thing to note is that CMI's are designed to convey common and important information to the general public in a general and simplied manner, designed to be accompanied by personalised advice from your doctor or pharmacist.

Your doctor or pharmacist will be able to tell you, given your medication history and lifestyle, which side-effects you are most likely to experience and how you can alleviate it, which side-effects are serious requiring attention, and which aren't. They will also be able to tell you which side-effects are unlikely to affect you based on your history. They will even be able to give you some helpful tips and caution based on their professional experience, which can not be found on the CMI.

For those who crave information and think that 'more is better', think again....

Technical drug information is also far from personalised, and although it is in-depth, it requires careful interpretation by qualified healthcare professionals to determine which components are relevant, and is therefore unsuitable for distribution to the general public.
Any information without adequate interpretation by a qualified healthcare professional can result in anxiety, non-compliance and mis-management. Just Imagine reading through a long list of reported side-effect ranging from seemingly mild and funny, to seemingly serious and often foreign-sounding side-effects, which, in itself can sound scary. This alone would likely deter most of us from initiating or continuing medication therapy, unless this information is accurately interpreted to determine it's relevance with a great deal of professional perspective.


My Tips for Obtaining Reliable Drug or Medication Information:

1. Always raise concerns and questions with your Dr before leaving the consult. This is the time to decide if you wish to initiate drug therapy of any sort, or not. This is the point where your Dr will be able to give you your options, and be able to take you through the risk vs benefits of your options. It's vital that you make this decision together, and fully disclose your compliance with any treatment plans with your doctor upon subsequent visits so that your progress can be accurately monitored and reassessed to maintain optimal therapy, medication or otherwise.
2. When handing your script into the pharmacy, tell pharmacy staff when you commence a new drug medication or when your medication dosage changes. This should prompt them to ensure that the pharmacist gives you appropriate medication counselling & CMI & other written material. This also gives the pharmacist time to prepare both personalised verbal & written material for you upon collecting your script.
3. If this is not your first time taking your medications & you require information ask to speak to the pharmacist as well as requesting a CMI or other written material.
4. Always provide the doctor and pharmacist with your current & complete medication, medical & lifestyle history, as this is the only way they can truly personalise the information, determine which information is relevant for your situation & provide you with the best health outcome.
5. Always ask if there is something you do not fully understand or require more information about.
6. Feel free to do your own research but always validate and discuss your information with your doctor and / or pharmacist. Good communication, honesty and rapport with your doctor, pharmacist or healthcare professional is essential for an optimal therapeutic relationship.
7. Ask for more resources. Rather than trawling through the internet for hours on end searching for shreds of valuable factual information, your doctor or pharmacist can often provide you with additional resources such as books, other reading material, legitimate websites, hotlines, other healthcare providers etc This ensures you always deal with legitimate and accurate information providers.
8. Allow your doctor, pharmacist & healthcare professionals time to provide you with additional information as it may require more time and resources to give you more personalised or detailed information. This generally requires follow up consultation/s to your doctor, & follow up visits or phone calls to the pharmacy.


Your doctor, pharmacist and healthcare providers are your most legitimate and accurate sources of drug, medical & health information. By keeping clear, open & honest communication with them, you will become better informed and equipped to manage your medications and medical conditions in the best possible way.


UDinh Pharmacist
B.Pharmacy Australia

Antidepressants....When to go off it and How?

My analogy for taking antidepressants is like flying a plane.  Taking off is difficult, as is landing the plane.  It may take 2-4 weeks to have an effect, and during these two weeks, you may experience some annoying side effects like haziness or "fogginess".  Sometimes, the depressive or anxiety symptoms may worsen with suicidal thoughts during this initial period, so close monitoring is required by your Doctor and the treating team.

When you have been titrated to an effective dose, then you will be on "autopilot mode".  It will be relatively easy and stable, and will require less monitoring than initially.

Now, when you "land the plane" or get off the antidepressants, then it will be difficult again.  When you land the plane, you would not land it during a middle of a storm would you?  So similarly, when it's time to take you off the antidepressant, it will be wise to choose a time of stability.

My rule of thumb for the duration of use of antidepressants is:

• For first episode, aim for 6-12months depending on the case.  Your Doctor together with your psychologists or counsellor will guide you here.
• For the second episode or "relapse", we may aim for 2 years.  Again your Doctor will guide you here.
• For subsequent major episodes, some authority will suggest long term use.  However, every case is different again, so your Doctor will help to guide you here. 

Few important last reminders about going off antidepressants. 

• Do it under the guidance of your Doctor and try not to "just go off it".
• Have an assessment by your Doctor or treating team prior to going off it.
• If you were to land a plane, you would come down slowly and similarly, go off your antidepressants slowly over a period of 4 weeks is a general guide.  Again, this will be different for different people.  If someone is more unstable as evident from their past history, I will go even slower.
• Once you are off your antidepressants, be on the lookout for early signs of relapse.  Remember that the earlier you can address it, the better the outcome.

Depression, Anxiety, and Over The Counter Medications

If you have depression or anxiety, and uses over the counter medications, there are a few things you need to be mindful of the next time you visit your local chemist.

1 Sedating antihistamines may cause drowsiness and hence, may exacerbate your low mood.
2 Decongestants like pseudoephedrine may exacerbate your anxiety and insomnia due to its stimulant effects.
3 Antiinflamatories like ibuprofen may interacts with some antidepressants to cause stomach irritation and ulcers.
4 Mild narcotics like codeine may cause sedation and drowsiness and hence, may exacerbate low mood.

The above is not an exhausted list, so always speak with a Pharmacist regarding your condition and any other medications that you are taking currently.  They can then advise you accordingly.

Generic versions of Antidepressants...Is it actually worthwhile?

Generics (non branded) are common these days and can be a safe and cheaper alternative to the "original medication" (branded).  However, there are some pitfalls which one needs to be aware.

1. Generic medications are not always identical to their branded versions.  Yes, they contain the same amount of the active drug, however, they may vary markedly in the other components which make up the medication (what we call excipients).  These other components are fillers and binders etc which make up the medication, hence, generic medications will vary in shape, colour and tablet/capsule size.  This variation may give rise to allergies to adverse reactions to individuals who may not tolerate certain ingredients. 
2. Accidental over-medicating is a very common and serious side-effect of generic medication.  All generic medications differ in packaging and labelling from their branded versions, and most generic medications differ in tablet / capsule shape and size (the only exceptions are those generics produced by the same manufacturer as their branded versions, in which they usually only repackage the box and labelling).  This causes a lot of confusion with those patients who take several different types of medications, as well as the elderly.  It is not uncommon for patients to be taking 2 or 3 generic brands of the SAME medication at the SAME time, and only discovering this to be the case when they are queried by their pharmacist or doctor, or when they develop symptoms of overdosing, or worse.  This issue used to predominantly affect the elderly and those on multiple medications, but now with the market being flooded with generics, these alternative brands can affect everyone.  Even those who only take the occasional course of antibiotic - the medication looks different, but is it the actually a different type of drug to the medication taken previously which caused a severe allergy?
3. Generic medications contain the same active drug and dosage as their branded version, but they may not produce an identical clinical / therapeutic effect.  The FDA and TGA and other government bodies regulating medicines allow for a certain "window" of clinical equivalence (what we term bio-equivalence).  If the drug company can show that their generic version falls in this "bio-equivalent window" then they are approved to be a generic version.  As this "window" indicates a range rather than a single figure, this means that the generic may not produce the exact same therapeutic effects.  This is a problem with patients who take long term medications where their doctor has made dosage adjustments (termed "dosage titration") over the period of time to give the patient the most beneficial and appropriate therapeutic effect from their medications.  An example is an individual with Bipolar who has been titrated on "Epilim" for mood control, who may destabilise when changed to a generic version.

But generic brands have their place, and can save you a lot of money over time.  However, before you say "yes" to generics, it's important to understand what you are saying "yes" to.

My advice when considering a generic brand is:

1. If it's your first time taking the medication, this is an ideal situation to start on a generic brand.
2. Ask your doctor which of your medications your doctor would be comfortable for you to switch to generic brands and discuss these with your pharmacist.  Your pharmacist is a valuable source of information and can give you much detail about generics.
3. Ask for a generic brand that is made by the same manufacturer, whenever possible.  The packaging is different but the tablet / capsule is likely to be identical in colour & shape because it is actually the same medication repackaged, sometimes with the exception of the imprint on the tablet / capsule.
4. Ask to see the generic brand.  Have a look at the packaging and the contents.  Will you confuse them with other different medications that you currently take because they are similar in appearance?
5. Ensure that the pharmacist clearly labels your new generic medication both on the outside packaging and on the internal packaging (because if you throw the outside packaging out, you still need a clear reminder of what the medication is).  This label should clearly show you which medication it is a substitute for.
6. Always finish your previous medication pack before starting a new generic to avoid confusion.  Don't stock up on your medications as this causes much confusion when you switch generics and have several different types of packaging floating around.  This also imposes a danger when the doctor changes your drug strength.
7. Insist on the same generic brand.  Avoid switching to different generic brands of the same medication as this will simply add to the confusion.  When you make a switch, stick to it and avoid changing unless therapeutically necessary.  Sometimes it's not possible for every pharmacy to stock every generic version of a particular medication, so often they will offer you a generic that they stock so that you don't have to search for it elsewhere or go without.  This problem can be minimised if you are a regular pharmacy customer of one or two pharmacies only, as they will always keep your medication on hand ready for your next refill.  Also, be organised and don't refill your script upon taking your last dose of medication, to enable you time to find the same generic brand.
8. Try to stay with the same pharmacy and doctor.  This will give you a double checking safety measure, because if they are familiar with what you normally take, and have a reliable computer history of your medications, then they will be able to pick up any discrepancies including medication brands.

I hope this has been helpful.

UDinh Pharmacist
B.Pharmacy Qld

Can Medications like Antidepressants Help Everyone with Depression?

The current medical approach to solve medical problems is to find the cause of something, and then fix it.  Like most things in life, this approach has its good and bad.  The great thing about this approach is that, if we know what the cause of the problem is, then we can fix the problem accurately and effectively.  The main flaw with this approach is when we don't have a full understanding about the problem, for example depression, then we are not going to be able to provide a complete solution.  In current medical thinking, we believe that depression and anxiety maybe due to chemical imbalance like Serotonin, Adrenalin and Dopamine in the brain.  However, this is not the complete picture as medications that "recalibrate" these brain chemicals, do not provide a complete cure for everyone with depression.  Having said that, there is still some evidence that it is effective in treating depression and anxiety for a proportion of patients.  However, there are controversies around this area, so we will see how the evidence evolves over time.

In Eastern philosophy to health, it focuses more on going back to the basics and look after one's body, and then, allowing the body to heal itself.

This requires that we aim for good nutrition, avoid toxins like smoking, alcohol and drugs, engage in regular exercise, adequate and good quality sleep, good fluid intake, and very importantly, a healthy positive mindset, good self understanding, and developing a high Emotional Intelligence (EQ).  One can achieve more resilience, and a higher EQ through counselling, including CBT(Cognitive Behavioural Therapy), ACT(Acceptance and Committed Therapy), interpersonal skills, and then most importantly, apply it in our every day life.

I encourage all sufferers to talk to your Doctor about counselling, CBT or ACT in addition to your medication needs.  There is good evidence that doing both i.e. taking medication as well as engaging in counselling, have the best outcome.