About psychiatric medications
Psychiatric medications are often used to treat patients who have a mental illness. Although these medications do not actually cure a patient’s condition, they can help control or minimize the impact of symptoms, allowing patients to live fuller and more productive lives. In many cases, a combination of medications and psychotherapy can result in dramatic improvements to a patient’s condition.
Medications were first used to treat mental illness in the 1950s. Since that time, a wide variety of drugs have been developed to treat many different types of mental health disorders. These medications have become increasingly effective while causing fewer or minor side effects.
Treatment with medications may be either short-term or long-term. Some people with depression may need a medication for just a brief period to help them work through a particularly difficult time in their lives. Others – such as those with ongoing disorders like schizophrenia, bipolar disorder or clinical depression – may need to take medications indefinitely.
It is common for certain types of drugs to work for some patients and not for others. Factors that can influence how a patient reacts to a drug include age, gender, body size, genetics, physical illnesses, diet and other lifestyle factors (e.g., smoking).
Patients taking psychiatric medications should inform all treating physicians about prescribed medications. Dentists should also be informed of all prescribed medications. This information can help physicians avoid interactions between medications.
People with mental illnesses should not be discouraged if a medication does not help control their symptoms, as there is likely an alternative medication or a combination of medications that will be helpful. Patience and regular consultation with a physician are essential to finding a safe and effective medication regimen.
Types and differences of psychotropics
There are several different types of psychiatric medications. They include:
Anti-anxiety medicationsUsed to relieve symptoms of fear and anxiety. In some cases, they may also be used to treat insomnia, as anesthetics or as aids in helping patients withdraw from other medications. Anti-anxiety medications are highly effective and some begin to work in just 30 to 90 minutes. The most commonly used anti-anxiety medications include benzodiazepines, buspirone and beta blockers.
AntidepressantsUsed to treat major depression and other mental health conditions such as anxiety disorders, post-traumatic stress disorder (PTSD) and eating disorders. They work by increasing the levels of the neurotransmitters (chemicals that convey nerve messages) serotonin, norepinephrine and dopamine in the brain. Response to medication typically takes several weeks. There are many different classes of antidepressants, including monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and other serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs).
Antidepressants are generally taken for at least four to nine months, or even indefinitely, to prevent recurrence and/or worsening of symptoms. Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.
AntipsychoticsMedications used mainly to treat psychosis, a severe mental condition in which the patient loses contact with reality, especially in those patients who suffer from schizophrenia. These medications control symptoms such as hallucinations (sensory perceptions of phenomena that are not actually present) and delusions (false beliefs held despite evidence to the contrary). These medicines may take anywhere from days to weeks to begin working. Examples of antipsychotics include haloperidol, chlorpromazine, clozapine, risperidone, olanzapine, quetiapine and ziprasidone.
Mood stabilizersDrugs used mainly to treat bipolar disorder, which is characterized by extreme mood swings between depression and mania. These drugs balance the fluctuations in mood. Examples of mood stabilizers include anticonvulsants and lithium.
Central nervous system (CNS) stimulant medicationsThese drugs may be especially helpful in treating children with attention deficit hyperactivity disorder (ADHD). Examples of CNS stimulants include dextroamphetamine and methylphenidate.
Conditions treated with psychiatric medications
Psychiatric medications are prescribed to treat a variety of mental health conditions. Though they may not be able to cure the condition itself, they can create significant relief from symptoms that allows patients to effectively manage their condition. Some mental health disorders that are treated with psychiatric medications include:
- Mood disorders. Mental health disorders that affect a person’s mood and interfere with the ability to function. Mood disorders include dysthymia, major depression, bipolar disorder and seasonal affective disorder (SAD).
- Anxiety disorders. Conditions in which patients feel anxious or distressed for no logical reason. People with these disorders may feel chronic, intense and irrational anxiety on a regular or even daily basis. Examples include panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and phobias.
- Personality disorders. Conditions in which a person struggles to deal with other people and acts in a manner that is inflexible and not well-suited to coping with the demands and changes of life. Examples include paranoid personality disorder, schizoid personality disorder, antisocial personality disorder, borderline personality disorder (BPD) and obsessive-compulsive personality disorder.
- Eating disorders. Conditions that involve serious disturbances in eating behavior, including unhealthy reduction of food intake, severe overeating and/or dangerous methods to prevent weight gain, such as self-induced vomiting. The most common types of eating disorders are anorexia nervosa, bulimia nervosa and binge eating disorder. Other, less common types of eating disorders include pica and rumination disorder.
- Sleep disorders. Disturbances of usual sleep patterns or behaviors that may include difficulty falling or staying asleep, falling asleep at inappropriate times, sleeping excessively or abnormal behaviors during sleep. More than 100 sleep disorders have been identified. They may be divided into dyssomnias (e.g., insomnia, sleep apnea, narcolepsy), parasomnias (e.g., night terrors, sleepwalking) and sleep disorders that are associated with other medical or psychiatric conditions.
Conditions of concern
Patients should exercise extra caution or avoid psychiatric medications altogether if they have been diagnosed with particular health conditions. These conditions differ from medication to medication.
For example, some psychiatric medications, most notably the benzodiazepines, may cause dependence in some patients, particularly those with a history of substance abuse.
Patients who are candidates for using psychiatric medications should inform their physician of their medical history including all medical conditions that they have and list current prescription and non-prescription drugs or supplements being taken.
- Side effects
Potential side effects of psychiatric medications
Symptoms associated with psychiatric medications differ depending on the type of drug taken. However, some symptoms that are commonly associated with many types of psychiatric medications include:
- Balance problems and dizziness
- Dry mucous membranes (especially those inside the mouth)
Most side effects are transient (they improve or go away after a week or two) and dose-related (they improve with a reduced dose and worsen when the dosage is increased).
In some cases, discontinuing use of a psychiatric medication can cause withdrawal symptoms. These symptoms typically subside after a while, usually after the drug is out of the patient’s system or the patient’s body has had a chance to adjust to the change. These symptoms may be similar to the side effects that some patients experience when they first start using a psychiatric medication, and they include:
- Irritability or restlessness
Drug or other interactions
Patients who may be candidates for using psychiatric medications should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Each type of psychiatric medication has its own list of medications that may interact poorly with the drug.
Central nervous system (CNS) depressants interact poorly with many psychiatric medications and may cause increased sedation. Some CNS depressants – such as benzodiazepines – are used as psychiatric medications. Other examples of CNS depressants include:
- Barbiturates. Drugs that produce relaxation and sleep.
- Narcotic pain relievers. Drugs that relieve severe pain.
- How to use
Pregnancy use issues
Some types of psychiatric medications, especially when taking during the first trimester (first three months of pregnancy), have been shown to potentially affect the fetus (unborn child), causing birth defects. Following birth these infants may have other difficulties such as withdrawal symptoms, infant sedation, feeding difficulties and low birth weight.
In addition, psychiatric medications often pass into breast milk and can be transmitted to a newborn child during breastfeeding. For these reasons, women who are pregnant or planning to become pregnant as well as those who are breastfeeding should consult their mental health physician in addition to their obstetrician (pregnancy specialist) before using psychiatric medications.
In December 2005, the U.S. Food and Drug Administration (FDA) issued a warning to healthcare professionals and patients about the use of the antidepressant drug paroxetine (Paxil) during pregnancy. Various studies suggest an increased risk of birth defects (e.g., heart defects) in women who use Paxil during pregnancy. Nearly a year after the FDA warning, the American College of Obstetricians and Gynecologists (ACOG) issued a similar warning in November 2006. However, because reproductive-age women have the highest incidence of mental health conditions, both the FDA and ACOG indicate that the benefit to the mother of treatment with the drug may outweigh the risk to the fetus, and advise that prescription of the antidepressant should be considered on an individual basis.
Child use issues
Some psychiatric medications have been approved for use in children. Use of these drugs in children should be closely monitored, as in many cases children may be more susceptible to experiencing side effects. In addition, children may be less likely than adults to volunteer information about side effects they may be experiencing.
The U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in children and adolescents. Therefore, children and teens being treated with antidepressants should be monitored closely for unusual changes in behavior.
Elderly use issues
Psychiatric medications generally work just as well for older adults as they do for other adults. However, elderly patients may be more susceptible to experiencing side effects, chiefly because drugs are eliminated from the body more slowly than in younger adults. As a result, dosage levels of psychiatric medications may need to be reduced for older patients.
Symptoms of medication overdose
Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Such symptoms vary depending upon the medication, but they should be taken seriously, as overdosing on some forms of psychiatric medication can be fatal.
Symptoms of overdose associated with several types of psychiatric medications include:
- Loss of consciousness
- Extreme agitation or confusion
- Increased blood pressure or heart rate
Questions for your doctorPatients may wish to ask their doctor the following questions related to psychiatric medications:
- Which psychiatric medication is most appropriate for me?
- What are the potential dangers and side effects associated with these psychiatric medications?
- Which side effects, if any, should I immediately report to you?
- Is there anything in my medical history that may prohibit the use of psychiatric medications?
- Which foods, drinks or other drugs interact poorly with the psychiatric medications you are prescribing for my condition?
- Are there any lifestyle modifications I need to make while taking the medication?
- What happens if the psychiatric medication you recommend for me isn’t effective?
- Should children or elderly adults use special precautions when taking these medications?
- I’ve heard that pregnant or breastfeeding women should avoid using some psychiatric medications. Is this true?
- For how long will I require medication treatment?
- How soon after taking the medication will I notice improvement in my symptoms?
- Might I also benefit from psychotherapy?