Mental Health Medications
Medications can play an important part of a treatment plan. Any information on this site should be discussed with a mental health care provider.
Medicines are usually more effective when combined with psychotherapy. In some cases, medication can reduce symptoms so that other methods of a treatment plan can be more effective. For example, a medication may alleviate some significant symptoms of major depression and then talk therapy can help you change negative patterns of thinking.
Medications may work better for one person than for another. It is difficult to predict exactly who will respond to what medication. Doctors usually review clinical records and see if there is an evidence base for recommending one type of medicine over another. Family history and side effects also come into play when prescribing medication.
Be persistent until you find the medication or combination of medications that works for you. A few psychiatric medications work quickly and you will see improvements within days, but many work more slowly. You may need to take a medication for several weeks before you see improvement.
If you feel a medication doesn't work, or you are having side effects, consult with a provider to adjust the treatment plan.
Some medications can be prescribed “off-label,” which means they haven’t been approved by the FDA for a given condition. A doctor should justify his thinking in recommending any treatment as well as be clear about the limits of the research around that medication and if there are any alternate options.
Medication may be a short-term aid that only needs to be taken for a few months. In other cases, medication may be a long-term, or even life-long, treatment approach. Some people are afraid that taking a medication will change their personality, but most people find that treatment allows them to take charge of their personality and make decisions about treatment and their quality of life.
Knowing the benefits and risks of all treatment decisions is crucial. NAMI has brief summaries of mental health medications provided by the College of Psychiatric and Neurologic Pharmacists.
Types of Medication
Psychiatric medications work by influencing the brain chemicals regulating emotions and thought patterns. Treatment typically consists of pills or capsules taken daily. A few medications are available as liquids, as injections or as tablets that dissolve in the mouth.
For most medications, your provider will start at a low dose and slowly increase dosages to therapeutic levels. Following these instructions will reduce side effects and discomfort.
Whenever stopping a medication, it's necessary to work with a doctor to taper off the dosage while brain chemicals get used to the change. Stopping medication abruptly can result in uncomfortable side effects.
Medications for mental illness fall into the following categories.
These medications reduce or eliminate the symptoms of psychosis (delusions and hallucinations) by impacting the brain chemical called dopamine. Antipsychotics play an important role in treating schizophrenia and schizoaffective disorder.
Newer, or second-generation or atypical, antipsychotics can also treat acute mania, bipolar disorder and treatment-resistant depression. The antipsychotics developed in the middle of the 20th century are often referred to as first-generation or typical antipsychotics. Second-generation antipsychotics are known as atypical antipsychotics.
Second-generation drugs aren’t necessarily better or worse than first-generation, but do have different side effects. First-generation antipsychotics are more likely to cause movement disorders. For example, tardive dyskinesia. This is an uncomfortable, potentially embarrassing condition in which the brain misfires and causes random, uncontrollable muscle movements or tics. These most typically affect the arms, fingers, legs, toes or facial muscles. Second-generation antipsychotics are more likely to result in weight gain. This increase in weight to other health complications such as metabolic syndrome. The important thing is to find the medication that works best for you.
People who have difficulty remembering to take daily pills, or people who have a history of discontinuing medication, may have better results by taking medication as a shot at the doctor’s office once or twice a month. This shot is called a long-acting injectable antipsychotic medication (LAI) and it has the same effects as medication taken in pill form.
These medications improve the symptoms of depression by impacting the brain chemicals associated with emotion, such as serotonin, norepinephrine and dopamine.
Newer medications, SSRIs and SNRIs (selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors), have fewer side effects than older drugs, but no medication is side-effect-free.
Side effects of SSRIs and SNRIs include:
- Nervousness, agitation or restlessness
- Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection
- Weight gain or loss
- Dry mouth
Many people won't experience these side effects, or will see them go away within a few weeks. But if they continue, changing medications or dosage will often resolve the problem.
One antidepressant (bupropion) affects mostly the brain chemical dopamine and thus forms a category of its own.
Older types of antidepressants, which include tricyclics and MAOIs (monoamine oxidase inhibitors), may be prescribed by a mental health professional if newer medications do not seem to be effective.
The most common side effects of tricyclics (and tetracyclics) include:
- Dry mouth
- Blurred vision
- Urinary retention
- Increased appetite leading to weight gain
- Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
- Increased sweating
Monoamine oxidase inhibitors (MAOIs) are the least prescribed antidepressants because they can cause dangerously high blood pressure if combined with certain foods or medications. People taking MAOIs must watch their diets carefully to avoid potentially life-threatening complications. The foods that are off-limits include aged cheese, sauerkraut, cured meats, draft beer and fermented soy products such as miso, tofu or soy sauce. For some individuals, wine and all forms of beer may be contraindicated.
Many antidepressants may also be useful for treating depression that is mixed with anxiety. Some antidepressants may be useful for PTSD, generalized anxiety disorder and OCD, but may require higher doses.
Depression that is part of bipolar disorder requires more careful assessment, as antidepressants may worsen the risk of mania and provide little help for depression associated with bipolar disorder.
Certain medications work solely to reduce the emotional and physical symptoms of anxiety. Benzodiazepines such as alprazolam (Xanax) can treat social phobia, generalized anxiety disorder and panic disorder. Heart medications known as beta-blockers are also effective at treating the physical trembling and sweating that people with phobias experience in difficult situations.
Benzodiazepines work quickly and are very effective in the short-term. People prone to substance abuse may become dependent on them, however. It also may be necessary to increase the dosage over time. The body becomes accustomed to these medications over time and may require larger doses for the same therapeutic effect. People who stop taking benzodiazepines abruptly may experience unpleasant withdrawal symptoms.
Other side effects can include:
- Low blood pressure
- Decreased sex drive
- Lack of coordination
- Unusual emotional dysfunction, including anger and violence
- Memory loss
- Difficulty thinking
Mood stabilizers are the most common medications for treating the mood swings of bipolar disorder. The oldest of them, Lithium, has been in use for over 50 years and has proven very effective, particularly for bipolar I disorder. However, regular blood tests are a requirement if you’re taking Lithium, which has potential serious side effects to the kidneys and thyroid.
There are also newer mood stabilizers originally created as anticonvulsants that may work better than Lithium for some people. Mood stabilizers can prevent highs (manic or hypomanic episodes) and lows (depressive episodes). All have important side effects to know about and monitor.
Certain medications are safe and effective for children, while others haven’t been formally researched yet. Doctors may treat children by prescribing these medications “off-label.” Questions remain about how these medications affect a child’s growing body and brain. Children may also experience different side effects than adults. Antidepressants, for instance, carry a warning that they may increase suicidal tendencies in young people. Because of these uncertainties, it’s important to monitor children and teens closely when they're taking a medication.
As we age, our bodies process medicines more slowly, so older adults may need lower dosages. We’re also more likely to take multiple medications, increasing the risk of unexpected and dangerous drug interactions. Memory problems may cause older adults to miss doses or overdose. And certain side effects may be more common in older adults, such as tardive dyskinesia, a side effect of antipsychotics. For all these reasons, older people should pay careful attention when monitoring treatment and symptoms.
A pregnant woman with mental illness (or who may be pregnant or may want to become pregnant) faces additional risks with medication. However, for some medicines there is not enough research to make the decision clear.
Women who stop taking medication because of pregnancy may relapse, which poses its own dangers for the mother and child. Some medications can be transmitted to the infant through the placenta or breastfeeding. Women should discuss the pros and cons with their doctor. After giving birth, women should also consult their doctor about how to prevent postpartum depression and whether it’s safe to take medication while breastfeeding.
Members of Specific Cultural Groups
Certain ethnic groups respond differently to medication, though more research is needed. African Americans and some Asian Americans, for instance, metabolize some medications more slowly than Caucasians. They are thus at increased risk of certain side effects and may benefit from lower dosages.
For many ethnic groups treatment is also complicated by language barriers, socio-economic stresses, lack of minority health care professionals and stigma. To improve the odds of a strong recovery, reach out to culturally-specific mental health providers. They can help locate support groups and doctors who take culture and ethnic background into consideration.