A to Z of Psychiatric Drugs
Here is what you need to know about mental health medications.
Mental health concerns are very common, and they can impact your overall health and wellness. Roughly 1 in 5 adults in the U.S. reported dealing with mental illness in 2019, with 1 in 20 adults describing their mental health concerns as serious. Mental health medications have been used for years and have become an important tool in managing mental health conditions such as depression, anxiety disorders, bipolar disorder, attention deficit hyperactivity disorder (ADHD), and more.
Read on for a comprehensive look at psychiatric medications. Learn about the different medications that can help treat mental illness, what to expect when you start taking common mental health medications, and how to work with your provider to assess different medications.
The History of Mental Health Medications
In the 19th century, pharmacotherapy like morphine and potassium bromide was used to calm patients with mental illnesses. During the first half of the 20th century, medications like penicillin and thiamine helped treat mental health concerns caused by infections or vitamin deficiencies. By the second half of the 20th century, psychotropic drugs were starting to become more prevalent in treating illnesses like schizophrenia and depression.
Psychiatric Drugs Today
Today, millions of people in the U.S. take mental health medication. This is partly due to past and present research on how neurotransmitters (the chemical messengers that send messages across the body) regulate bodily functions, the nervous system, and mood. These findings provide important insights on how to develop psychotropic medications.
Why Mental Health Medication May Be Necessary
Each person with a mental health condition has different symptoms and experiences. Some individuals may benefit from psychotherapy alone, while others may respond to a combination of psychotherapy and pharmacological treatment. Mental health treatment is not a one-size-fits-all model, and each individual, along with their clinician, will need to find the most effective treatment options.
For many individuals, medication(s) can be an important piece of the puzzle when it comes to improving symptoms of their mental health condition. FDA-approved medications are proven to reduce symptoms and improve mental health.
Conquering the Stigma Around Mental Health Medication
If you or a loved one are dealing with mental health concerns, you may have felt a societal stigma when it comes to your condition. You might keep your thoughts and feelings to yourself and leave your mental health condition untreated. This may result in living life with an untreated mental illness, even though there are many options available to you.
Many individuals struggle with a mental health condition, and talking about it can help you find treatment options to reduce and ease symptoms.
Finding Your Mental Health Medication(s)
There are hundreds of available medications for mental health conditions. This gives you more options to find effective and tolerable medication(s) that work for you.
Mental health conditions may have some overlapping symptoms, but different mental health disorders have varying causes and underlying mechanisms involved. This is why different psychiatric meds may be used to treat each mental health condition.
An individual may also suffer from multiple mental health conditions at once, such as a depressive disorder and post-traumatic stress disorder (PTSD). Those with psychiatric comorbidity may require additional treatment considerations. It is also possible that your healthcare provider may prescribe more than one medication to treat your comorbid conditions, though this is not always the case.
Mental health medications affect each person differently. To personalize medication(s) choice and dosages, your healthcare provider may first evaluate your personal health and family history. They may also use pharmacogenetic testing, or genetic testing for mental health medications, to tailor your prescription to your genetic profile.
What It’s Like to Take a Mental Health Medication
Starting Small
Most healthcare providers will begin your treatment with a small dose of a front-line medication. Together with your clinician, you’ll monitor your symptoms and watch for any side effects. After several weeks, they may re-evaluate the dosage and slowly increase the dose you take each day, if necessary.
Keep in mind that you may not see a large improvement in symptoms for several weeks, as some mental health medications take time to show their intended effects.
Trial and Error
There may also be a period of trial and error when beginning a new prescription. The first mental health medication may lead to side effects or may not reduce symptoms as effectively as it should. Your healthcare provider may recommend trying a different medication, starting the process again.
By continually checking in with your healthcare provider and letting them know how you are reacting to your medication, they can determine whether or not they need to increase or decrease the dosage, or switch medications completely. This trial and error process can be an exhausting process. Though it may be discouraging, you may find an appropriate medication. Understanding genetic variations that can affect medication response, will give your healthcare provider even more insight into your treatment options.
Types of Mental Health Medications
There are several types of drugs used to treat mental health conditions, and numerous medications in each class. Each class of drugs is helpful in treating different mental illnesses. Psychiatric drug classes include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Selective norepinephrine reuptake inhibitors (SNRIs)
- Atypical antidepressants
- Monoamine oxidase inhibitors (MAOIs)
- Benzodiazepines
- Stimulants
- Antipsychotics
- Mood stabilizers
SSRIs
What do SSRIs Do?
SSRIs treat an individual by blocking the reabsorption of serotonin, increasing available serotonin in the brain. Serotonin is a neurotransmitter that carries signals to the brain. Low levels of serotonin can cause feelings of lethargy, sadness, and more.
What Conditions SSRIs Treat
SSRIs are a commonly prescribed medication for depression, and they currently have Food and Drug Administration (FDA) approval to treat the following conditions:
- Major depressive disorder
- Generalized anxiety disorder
- Social anxiety disorder
- Bulimia nervosa
- Obsessive-compulsive disorder
- Panic disorder
- Post-traumatic stress disorder (PTSD)
Common SSRI Drugs
SSRIs used in the U.S. include:
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
It may take anywhere from four to six weeks after beginning treatment before you notice an improvement in your symptoms.
There may be some side effects when taking an SSRI including sexual dysfunction, weight gain, and sleep disturbances. Depending on the person, these side effects and the severity may subside after a week or two or they may persist long-term.
SNRIs
How SNRIs Work
Similar to SSRIs, an SNRI medication works by blocking the reabsorption of both serotonin and norepinephrine, thereby increasing the balance of neurotransmitters in the brain. Having increased norepinephrine and serotonin in the brain increases communication between neurons, and can improve energy and mood.
What Conditions SNRIs Treat
Like SSRIs, SNRI medications may be prescribed to treat depression. In addition to major depressive disorder, the FDA has approved SNRIs to treat:
- Generalized anxiety disorder
- Panic disorder
- Chronic musculoskeletal pain
- Nerve pain
Common SNRI Drugs
SNRIs used in the U.S. include:
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor XR)
- Desvenlafaxine (Pristiq)
- Levomilnacipran (Fetzima)
Side effects while taking an SNRI may be similar to what you’d experience if prescribed an SSRI, such as sexual dysfunction and sleep disturbances. Other side effects may include an initial increase in anxiety and restlessness. Depending on the person, they may also experience nausea, dry mouth, and possibly high blood pressure.
Atypical Antidepressants
How Atypical Antidepressants Work
Atypical antidepressants are a group of medications that do not fit within other antidepressant classes. Depending on the drug, atypical antidepressants can increase the availability of neurotransmitters, including dopamine, serotonin, and/or norepinephrine in the brain. Since atypical antidepressants interact with neurotransmitters through separate mechanisms than other antidepressants, some may also be prescribed for treatment-resistant depression.
What Conditions Atypical Antidepressants Treat
Atypical antidepressants are prescribed for patients who are suffering from depression and they work a little differently from an SSRI or SNRI.
Your healthcare provider may also prescribe an atypical antidepressant in combination with an SSRI or SNRI. For example, esketamine (Spravato) is a nasal spray that can be used in conjunction with an oral antidepressant for treatment-resistant depression.
Common Atypical Antidepressant Drugs
Atypical antidepressants used in the U.S. include:
- Bupropion (Wellbutrin SR, Wellbutrin XL, Wellbutrin)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Trazodone (Desyrel, Oleptro)
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
- Esketamine (Spravato)
Side effects may include dizziness, feeling lightheaded, weight gain, a reduced appetite, nausea, gastrointestinal problems, and sleep issues like insomnia and/or drowsiness.
Benzodiazepines
How Benzodiazepines Work
Often used as a sedative, benzodiazepines work by increasing gamma-aminobutyric acid (GABA) in the body. GABA is a neurotransmitter found in the central nervous system. It is responsible for producing a calming effect in the brain and the surrounding pathways by blocking certain signals, and decreasing the amount of activity occurring in the nervous system. Benzodiazepines can cause a sense of relaxation.
What Conditions Benzodiazepines Treat
Benzodiazepines are often used to provide short-term relief for symptoms associated with certain conditions such as:
- Anxiety disorders
- Insomnia
- Panic disorders
- Alcohol withdrawal
- Seizures
Common Benzodiazepine Drugs
The benzodiazepines most frequently prescribed include:
- Lorazepam (Ativan)
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Chlordiazepoxide (Librium)
- Temazepam (Restoril)
- Diazepam (Valium)
Stimulants
How Stimulants Work
Stimulants work by increasing levels of dopamine in the brain. Dopamine is a neurotransmitter that can increase feelings of pleasure, happiness, and alertness. Stimulants can be prescribed as short-acting medication to be taken several times a day, or long-acting medication to be taken once per day.
What Conditions Stimulants Treat
Due to the nature of stimulants and their ability to increase energy and alertness, they are most often prescribed to treat:
- Attention-deficit hyperactivity disorder (ADHD)
- Narcolepsy
Common Stimulant Drugs
The stimulants most frequently prescribed include:
- Dextroamphetamine (Dexedrine)
- Dextroamphetamine/amphetamine combination product (Adderall)
- Methylphenidate (Ritalin)
Stimulants may cause side effects such as loss of appetite, headaches, and sleep problems.
Antipsychotics
How Antipsychotics Work
Most antipsychotic medications work by blocking the D2 dopamine receptor. This can reduce the effect that dopamine has on emotional and cognitive centers in the brain. It is thought that excessive dopamine stimulation can cause symptoms of psychosis such as visual or auditory hallucinations. Antipsychotic medications help balance the effects of this neurotransmitter.
Conditions Antipsychotics Treat
Antipsychotic medications are sometimes prescribed along with another mental health medication. Taken alone or with another medication, antipsychotics typically treat:
- Schizophrenia
- Schizoaffective disorder
- Depression
- Bipolar disorder
Common Antipsychotic Drugs
First-generation antipsychotics were the first class of antipsychotics. Some more commonly used first-generation antipsychotics include:
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
- Perphenazine (Trilafon)
- Fluphenazine (Prolixin)
Second-generation antipsychotics are more widely prescribed due to being approved for multiple mental health conditions. Second generation antipsychotic drugs include:
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Asenapine (Saphris)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Paliperidone (Invega)
- Clozapine (Clozaril)
Side effects of antipsychotic medications depend on the class of antipsychotics. First-generation antipsychotics may cause movement symptoms and drowsiness. Side effects of second-generation antipsychotics may include drowsiness, restlessness, low blood pressure, and weight gain.
Mood Stabilizers
How Do Mood Stabilizers Work?
Many mood stabilizers work by regulating the neurotransmitters glutamate or GABA or by regulating sodium or calcium channels on the surface of brain cells.
Conditions Mood Stabilizers Treat
While mood-stabilizing medications mainly treat bipolar disorder, some may also be prescribed to treat other mental health conditions such as depression (usually along with an antidepressant).
Common Mood Stabilizing Drugs
Most mood stabilizing medications are also anticonvulsant medications, which were originally prescribed to help treat seizures. The most frequently prescribed mood-stabilizing medications include:
- Lithium (Eskalith, Lithobid)
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal XR)
- Valproate (Depakote, Depakene)
Mood stabilizing medications may have some side effects that may become serious, including nausea and vomiting, rash or swelling, and fast, slow, or irregular heartbeat. It is especially important to regularly monitor your symptoms and speak with your healthcare provider about any side effects you may experience.
The Role of Pharmacogenetic Testing (PGx)
Pharmacogenetic testing is a genetic test that determines your genotype to provide information about how your body may process medications. It analyzes specific genes that have been shown to influence medication efficacy and/or response. Using genetic testing, your healthcare provider will gain important knowledge about your unique medication absorption, metabolism or sensitivity. This will give your healthcare provider insight into your personal treatment plan. With this more-informed approach, designed to minimize trial and error, your healthcare provider can prescribe medication(s) and dosages personalized for you.
Assessing Medication Selection & Dosages
Healthcare providers frequently refer to guidelines and FDA drug labeling when it comes to drug selection and dosages for patients, and there more than 270 medications that have available pharmacogenomic information in their drug labeling.
Genomind Pharmacogenetic Testing looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and over 700 medications to help clinicians determine:
- Which medications may be more or less likely to be effective
- Which medications may be more or less likely to have side effects
- How you metabolize medications for personalized dosing guidance
Genomind PGx can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind provider near you. Get started today.
Comorbid Conditions and Polypharmacy
Polypharmacy, or taking multiple medications at the same time, can add another layer of complexity to prescribing. Whether you are taking multiple medications for the same condition, or treating several conditions simultaneously, polypharmacy increases the risk of drug-drug interactions. If you need to take more than one medication, this can make it more difficult to develop an appropriate treatment plan.
For example, research published in the Journal of Affective Disorders found that 23% of patients taking multiple medications experienced side effects or reduced effectiveness from their antidepressant medication.
By assessing potential drug-drug interactions in addition to your genetic profile with PGx testing, healthcare providers can tailor prescription recommendations.
Genomind’s Precision Medicine Software is specifically designed to support these higher risk polypharmacy patient populations often seen in high-volume psychiatry, primary care, and Medicare offices. The software covers 99% of the most commonly prescribed medications for the top health care conditions, giving healthcare providers the ability to quickly analyze complex genetic and medication interactions. With Genomind’s software and testing together, healthcare providers will be able to evaluate safer prescribing options with speed and precision.
Is Your Mental Health Medication Working for You?
When it comes to mental health treatment, medication can provide an effective solution in addition to therapy. However, you may not always find the appropriate psychiatric meds the first time. If your symptoms are not decreasing, or they have returned, this does not mean that your mental health condition is untreatable. It simply means that you may need another medication or dosage, one that may be better suited to your genotype.
With PGx testing, your clinician can learn more about your genes and personal metabolic profile as they relate to mental health treatment. Subsequently, they can create a personalized treatment plan, one that may be less likely to include trial and error. By being aware of PGx testing, you can now be empowered to speak to your healthcare provider about creating personalized mental health treatment plans.
This page is for information purposes only. Genomind does not make any medication recommendations. If you are seeking mental health medication, always consult with your healthcare physician for prescription options.
