This Appendix is for your reference. You may wish to consult it as you and your physician discuss which medication is best for you.

Medication is an important ingredient in your overall treatment plan. Your job and your doctor’s job is to find the right one or the right combination for your needs.

Anti-depressants

Anti-depressants have been available for a number of decades and has evolved and improved over that time. The Canadian Network for Mood and Anxiety Treatments (CANMAT), a partnership among researchers, psychiatrists and other clinicians, has published detailed depression treatment guidelines for clinicians. The guidelines provide an extensive review of available research on depression and present recommendations for anti-depressants.⁵¹ The guidelines categorize them as first, second, and third line, according to the strength of the research showing effectiveness.

The following anti-depressants are from CANMAT’s first and second line listings.

There are more anti-depressants on the market than these and your physician may recommend something else for you. That’s OK – as long as it works for you.

First line (strongest evaluation research results)

Second line (strong evaluation research results)

Anti-convulsants⁵³

In the case of depression, anxiety disorder, or post-traumatic stress disorder,
anti-convulsants can be given, not for their anti-convulsant properties, but as mood stabilizers.

Second line (strong evaluation research results)

Research has shown that anti-convulsants used for people with PTSD show very few positive results, with one exception; Topamax. However, evaluative research is in early stages and no strong clinical recommendation has emerged.^{54, 55}

An anti-convulsant especially recommended for PTSD is:

Other useful medications

The treatment of depression, anxiety, and post-traumatic stress disorder can
involve medications other than (or as well as) anti-depressants. They are as
follows:

Atypical anti-psychotics

Atypical anti-psychotics are called second generation anti-psychotics. They have shown themselves to have fewer side effects – but some do remain so it is wise to talk with your psychiatrist before choosing this course of action. In the case of mental illness, they are most often used in combination with an anti-depressant to boost its effect.

Examples of atypical anti-psychotics are:⁵⁶

Medications for anxiety

Note that people often experience depression and anxiety together so it is common for anti-depressant and anti-anxiety medications to be taken together.

Benzodiazepines (tranquilizers)

This category of drugs is prescribed with caution. People who are taking them find that they do, indeed, provide calm and peaceful feelings. However, the danger is that our bodies can adjust to the initial dosage level to the point where it starts to be ineffective, meaning higher doses are needed to get the same effect. This is known as habituation. The very serious downside of habituation is addiction. Your physician or psychiatrist will monitor your usage closely.⁵⁷

Medication for substance use disorders

More to know about medication

Additional factors in making a prescribing decision

Whenever your physician or psychiatrist is prescribing medication for you, they will take the following into account (as well as your diagnosis):

• age
• weight
• whether you are pregnant or nursing
• if you have other illnesses
• other drugs you are taking

The role of your pharmacist

When you leave the office with your prescription, know that valuable information can also be obtained from your pharmacist. Pharmacies often have private rooms for confidential discussions and you can make an appointment. Sometimes you can just walk in and if the pharmacy is not busy, you can be seen. The pharmacist usually has information sheets (in plain language) or can recommended Internet sites for you to visit. They may also be able to take more time with you than your physician.

If this is your regular pharmacist, they will have all your medications on record. They can advise you about possible interactions which you can then discuss with your physician.

Other things to know

Some terms related to medications you should know about – for your own research – your family doctor or psychiatrist can explain them further to you.

Contra-indications: Given your health, other illnesses, allergies, or other medications you take, you should not be prescribed this specific drug.

Interactions: Happen when certain drugs, taken together, affect you in negative ways.

Side effects: Most medications have side effects – they may be common, experienced only by some people, or experienced rarely. Your physician will educate you about them. This information is also readily available online. Side effects are an important factor in your decision-making process. If you experience side effects, document them and report them to your doctor or psychiatrist. You may want to choose another medication.

Adverse reactions: An adverse reaction is a rare health event or even a life-threatening result for some people, discovered after a medication has come to market. Pharmaceutical companies are required by regulation to report adverse reactions to Health Canada and your doctor and psychiatrist should do the same. If you believe you are having an adverse reaction, contact your doctor immediately or go to the Emergency Department of your local hospital.

Some general pharmaceutical terms

Generics: When patent protection for a brand named drug expires, generic versions become available. Government and most employee drug benefits programs insist that pharmacists substitute available generic versions for their brand named counterparts when filling your prescription. Generics are less expensive than brand name medications. If you feel only the brand name drug is effective for you, your doctor or psychiatrist can direct the pharmacist not to substitute it for a generic. On the other hand, if you don’t mind a generic substitution (or even request a generic instead of a brand name because you are paying out-of-pocket and want to limit your expenses), your physician should make it clear to your pharmacist that they must fill your prescription with the same generic each and every time.

Formularies: Each province and territory in Canada has a formulary which lists approved medications for people entitled to government paid drug benefits (for example, seniors or people on social assistance). Each province or territory can have a somewhat different formulary, making coverage uneven across the country. New drugs and rare drugs usually can’t be found on formularies, meaning people have to pay out-of-pocket. The federal government has its own formulary.