Coping with Mental Health: Medications
Treating mental health conditions with medication is common. Approximately one in six U.S. adults takes a psychiatric medication. Antidepressants are the most frequently filled prescriptions for mental health, followed by anti-anxiety drugs, sedatives, and hypnotics, then antipsychotics.1
Only a few professionals can prescribe psychiatric medication: psychiatrists (medical doctors with specific training in mental health), and psychiatric or mental health nurse practitioners. Additionally, general practitioners, physician assistants, and nurse practitioners may prescribe, though they tend to refer more complex mental health conditions to specialists.
In a similar way to treating physical health conditions, finding an effective medication for the management of mental health conditions can require some trial and error. There is no laboratory or physical test for a mental health diagnosis. Likewise, there are no physiological indicators that can direct you to an effective medication. “It is important to know that some people may not feel better with the first medicine they try,” states the National Institute of Health, “and may need to try several medicines to find the one that works for them. Others may find that a medicine helped for a while, but their symptoms came back. It is important to carefully follow your doctor’s directions for taking your medicine at an adequate dose and over an extended period of time (often 4 to 6 weeks) for it to work.”2 Additionally, you may require more than one psychiatric drug to manage your symptoms, as well as adjustment of your dose during treatment.
Certain groups of people have special needs for psychiatric medication, including children and adolescents, older adults, and women who are pregnant or may become pregnant. The risks for these groups are higher than the general population. If you are one of these individuals, carefully discuss the pros and cons of medication with your doctor as well as other possible options for effective management of your mental health condition like psychotherapy.
If you have a physical health condition you should discuss your treatment regimen with your psychiatric prescribing physician to minimize or avoid drug interactions and to monitor side-effects.
Classes of drugs
The first generation of antidepressants included tricyclics (TCAs) and Monoamine Oxidase Inhibitors (MAOIs). Though widely used, these drugs were generally less tolerable and had more side-effects than many of the antidepressants available today. The newest, second generation of antidepressants available today are the most commonly used, and include Selective Serotonin Reuptake Inhibitors (SSRI’s) and Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s). Common brand names for SSRI’s include Celexa (Citalopram), Luvox (Fluvoxamine), Paxil (Paroxetine), Prozac (Fluoxetine), and Zoloft (Sertraline). For SNRI’s there are Effexor (venlafaxine) and Cymbalta (Duloxetine). Additionally, Wellbutrin (Bupropion) is a common treatment for depression that is also used in the cessation of smoking.
Research shows that most antidepressants are near equally effective in treating the symptoms of depression, though for reasons not well understood not all medications work the same for all individuals with some people responding more favorably than others.3, 4 Research also shows that antidepressants are most effective for chronic, moderate, and severe depression, and less effective for the treatment of mild depression. People vary in how well they tolerate antidepressants, as well as the severity and range of side-effects experienced. The FDA lists the most common side effects as:
- Nausea and vomiting
- Weight Gain
- Sexual Problems5
A class of drugs used commonly for the treatment of panic, social, and generalized anxiety disorder. Two of the most commonly prescribed classes of drugs for anxiety based disorders are benzodiazepines and antidepressants. Benzodiazepines are commonly used for generalized anxiety disorder, whereas antidepressants are commonly used in panic and social anxiety disorder. Both, however, can and are used in combination for the treatment of any of the anxiety-based disorders. Common brand names of benzodiazepines are Klonopin (Clonazepam), Xanax (Alprazolam), Valium (Diazepam), and Ativan (Lorazepam). It is important to note that there is potential for dependence or abuse of these drugs. The FDA reports the most common side effects for benzodiazepines as:
- Blurred Vision
For the treatment of bipolar disorder, and often as adjunct therapy for other mood disorders. The oldest, most well studied, most affordable mood stabilizer is lithium, which has been shown to decrease suicidality and the intensity and frequency of mood swings. Other mood stabilizers come from the anticonvulsant class of drugs. Common brand names are Depakote (Divalproex Sodium), Tegretol (Carbamazepine), Lamictal (lamotrigine), and Trileptal (Oxcarbazepine). Due to the complexity of symptoms in bipolar disorder, more than one medication may be required to manage the condition. The most common side effects include:
- Itching, Rash
- Excessive thirst
- Frequent Urination
- Tremor (shakiness) of the hands
- Nausea and Vomiting
- Slurred Speech
- Fast, slow, irregular, or pounding heartbeat
- Changes in vision
- Loss of Coordination
- Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs6
These medications are used to manage psychotic episodes, or psychosis. Antipsychotics are a first line of treatment for many of the Schizophrenia Spectrum and Other Psychotic Disorders. However, in combination with other medications and often in lower doses, they can be used to manage attention-deficit hyperactivity disorder (ADHD), severe depression, eating disorders, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), the manic phase of bipolar disorder, and generalized anxiety disorder.7
The first generation of antipsychotics were in general difficult to tolerate and had severe side effects. These include Haldol (Haloperidol), perphenazine, and fluphenazine. The newest, second generation of antipsychotics commonly prescribed today are in general better tolerated with less severe side effects. The newer antipsychotics are called “atypical” and include the common brand names Risperdal (Risperidone), Zyprexa (Olanzapine), Seroquel (Quetiapine), Geodon (Ziprasidone), Abilify (Aripiprazole), Invega (Paliperidone), and Latuda (Lurasidone).8 Common side effects of antipsychotics are:
- Weight gain
- Dry mouth
- Blurred vision
- Low Blood Pressure
- Uncontrollable movements, tics, and tremors
- Low white blood cell count9
Used for the treatment of attention deficit hyperactivity disorder in children, adolescents, and adults, stimulants for these individuals can have a calming and focusing effect. Common drugs of this class include Concerta or Ritalin (Methylphenidate), Dexedrine (Dextroamphetamine), Adderall (combined levoamphetamine and dextroamphetamine), and Vyvanse (Lisdexamfetamine). Other non-stimulant drugs used for the treatment of ADHD include atomoxetine, clonidine, and guanfacine.10
Though stimulants are used primarily for the management of ADHD, they are occasionally used as adjunct treatment in other disorders like narcolepsy and treatment resistant depression.
Common side effects include:
- Difficult falling or staying asleep
- Loss of appetite
- Stomach pain
The use of medication for the management of mental health conditions carries both pros and cons that you should discuss with your prescribing physician. Like all medication, they carry inherent risks, side-effects, and for some classes of drugs like benzodiazepines, the potential for dependence or abuse. At the same time, with medical supervision and the strict following of a treatment plan, psychoactive drugs can be effective for the management of mental health conditions. These are not a complete list of adverse effects and it’s important to always speak to your doctor about adverse events and side effects. Only you and your doctor can determine the best treatment plan for your specific needs and conditions.