Medications Used To Treat Mental Health, And Their Side Effects

While psychotherapy is an important aspect of treating mental health conditions, prescribed medication can often play a supportive and in some cases, vital role in the treatment process.

Medication can sometimes be used as a first-line treatment method, depending on the severity of symptoms, immediacy of risk, and the individual’s capacity to engage in therapy. This is because medication can be effective in immediately relieving symptoms and addressing underlying neurochemical imbalances, in order to regulate mood, reduce distress, and make therapy more effective.

It is important to remember that medication does not “cure” a condition or a disorder, but rather serves as a tool to restore balance in the brain chemistry and manage symptoms such as intrusive thoughts, delusions, psychosis, and mood swings.

Among the most frequently used pharmacological treatments are: antidepressant medications, antipsychotic medications, mood stabilizers and antimanic medications, and antianxiety medications.

Contents

• Antidepressant medications
• Antipsychotic medications
• Mood stabilizers and antimanic medications
• Antianxiety medications
• Further resources and reading

Antidepressant medications

Antidepressant medications work by affecting neurotransmitters such as serotonin, dopamine, and norepinephrine, all of which are chemicals essential for emotional and mood stability. As a result, they are most commonly used in treating mood-related disorders such as major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, and obsessive-compulsive disorder (OCD).

Commonly prescribed antidepressants can be categorized into five main classes, each one working differently in the brain:

SSRIs (Selective Serotonin Reuptake Inhibitors)

• Generally the first choice in treating depression, due to their effectiveness and lack of side effects compared to other categories.
• They work by increasing serotonin in the brain, a neurotransmitter responsible for mood regulation.
• Some examples of SSRIs include: fluoxetine (Prozac), citalopram, sertraline (Zoloft), paroxetine, and escitalopram.

SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors)

• Different from SSRIs in that they block the reuptake of both serotonin and norepinephrine (another neurotransmitter responsible for mood regulation).
• Usually used in cases of treatment-resistant depression, accompanied by chronic pain.
• Examples of SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta).

TCAs (Tricyclic antidepressants)

• An older class of antidepressants that also targets serotonin and norepinephrine.
• They can be effective, but have more side effects than SNRIs and SSRIs.
• Examples of TCAs include amitriptyline, imipramine, and nortriptyline.

Atypical Antidepressants

• Antidepressants that don’t fully fit into other categories.
• Used when other treatments are ineffective.
• Examples: bupropion (Wellbutrin) – targets dopamine and norepinephrine, less likely to cause sexual side effects, and mirtazapine (Remeron) – used as a sedative in cases of sleep or appetite disturbances.

Common side effects of the aforementioned categories of medication include:

• Sexual dysfunction (eg. decreased libido, delayed orgasm) – common with the use of SNRIs and SSRIs.
• Gastrointestinal issues (nausea, diarrhea, loss of appetite).
• Headache.
• Sleep disturbances (insomnia or intense drowsiness, depending on the agent used).
• Emotional blunting – feelings of “numbness”.
• Weight gain – common with paroxetine and mirtazapine.

Additional risks associated with the use of SNRIs include:

• Elevated blood pressure.
• Excessive sweating.
• Discontinuation syndrome – occurs when someone stops taking antidepressants abruptly, especially venlafaxine. It usually manifests as a withdrawal with flu-like symptoms such as nausea, insomnia, and dizziness.

Antipsychotic medications

Antipsychotic medications are used in treating psychosis, which occurs when the patient has difficulty discerning what is real and what is not.

They block several neurotransmitters, which, when out of balance, can lead to symptoms of psychosis such as hallucinations and/or delusions. Some examples of conditions where psychosis can be prevalent are schizophrenia, bipolar disorder, major depressive disorder with psychotic features, delusional disorder, and borderline personality disorder.

There are two main categories of antipsychotic medication.

First-generation antipsychotics (FGAs)

First-generation (typical) antipsychotics (FGAs) mostly target dopamine in the brain; however they can also block acetylcholine, norepinephrine, and histamine from attaching to other receptors.

Examples of FGAs include:

• Chlorpromazine (Thorazine).
• Fluphenazine (Prolixin, Permitil).
• Haloperidol (Haldol).
• Loxapine (Adusuve).
• Pimozide (Orap).

Side effects of FGAs include:

• Extrapyramidal symptoms (EPS) – movement disorders (tremors or rigidity), which are highly associated with the use of FGAs.
• Drowsiness.
• Hyperprolactinemia – elevated prolactin levels, which can lead to reproductive, metabolic, and endocrine issues.

Second-generation (atypical) antipsychotics (SGAs)

Second-generation (atypical) antipsychotics (SGAs) act by blocking dopamine and serotonin. Some of these medications can also act as partial dopamine agonists (partially activating dopamine D2 receptors), depending on dopamine levels in the brain, offering a more balanced method of treatment.

Examples of SGAs include:

• Aripiprazole (Abilify).
• Clozapine (Clozaril).
• Iloperidone (Fanapt).
• Olanzapine (Zyprexa).
• Quetiapine (Seroquel).
• Risperidone (Perseris).

Side effects of SGAs are relatively lower when it comes to motor dysfunction in comparison with FGAs. SGAs are mostly linked with:

• Weight gain – most common with Olanzapine (Zyprexa) and Clozapine (Clozaril).
• Metabolic issues.
• Elevated blood sugar levels.

Mood stabilizers and antimanic medications

Mood stabilizers and antimanic medications are essential in treating bipolar disorder. By regulating the release and maintenance of neurotransmitters, they help reduce and prevent symptoms of mania from returning, therefore reducing the need for hospitalization.

Commonly prescribed mood stabilizers are lithium and anticonvulsants.

Lithium

Still considered the gold standard for the treatment of bipolar I disorder due to its natural origin and effectiveness. However, frequent blood monitoring with a healthcare provider is needed, because higher doses can be toxic and have effects on the thyroid and kidneys.

Brand names include Eskalith, Lithobid, and Lithonate.

Anticonvulsants

Originally developed to treat seizures, but these drugs have also proven to be effective in stabilizing mood:

Valproic acid (Depakote) is often used in the treatment of acute mania. It calms brain cells by blocking brain channels that allow sodium ions to enter, preventing abnormal electrical signals that can lead to mood episodes.

Possible dangerous side effects of valproic acid include:

• Hepatotoxicity – liver damage which can lead to liver failure in severe cases.
• Pancreatitis – inflammation of the pancreas.
• Teratogenic effects – fetal abnormalities caused by longer exposure to teratogens (agents that can cause developmental abnormalities).

Lamotrigine (Lamictal) is primarily used for the prevention of depressive episodes in bipolar disorder. It is not effective in the treatment of acute mania or hypomania.

Common side effects include:

• Rash.
• Dizziness.
• Headache.
• And in some rare cases, Stevens-Johnson syndrome – a serious skin reaction that leads to the formation of rashes and blisters, which later peel, creating painful raw areas.

Antianxiety medications

Anxiety disorders are among the most prevalent mental health conditions. Antianxiety medications are used when anxiety becomes chronic, in order to control panic symptoms and reduce physiological arousal.

These types of medications include antidepressants (SNRIs and SSRIs), benzodiazepines, buspirone, and beta-blockers.

Benzodiazepines

Benzodiazepines enhance the effects of GABA (a neurotransmitter that slows down brain activity), producing a calming effect and reducing anxiety.

Some examples include:

• Alprazolam (Xanax).
• Lorazepam (Ativan).
• Clonazepam (Klonopin).

Potential side effects range from cognitive impairment (memory, drowsiness, slowed thinking) to the risk of dependency and withdrawal symptoms, which is why they are used for short-term relief rather than long-term treatment.

You can use this equivalency chart to compare different benzodiazepines and their doses and half-lives.

Buspirone

Buspirone (Buspar) – a non-benzodiazepine anxiolytic used primarily for Generalized Anxiety Disorder (GAD). It acts as a partial agonist for serotonin, with some effects on dopamine. It has a slower onset of action and, unlike benzodiazepines, it doesn’t cause cognitive impairment, sedation, or dependence.

Potential side effects include:

• Dizziness.
• Headache.
• Nausea.
• Lightheadedness.

Beta-blockers

Beta-blockers are a type of cardiovascular medication used to treat high blood pressure and heart rhythm disorders. They are prescribed for anxiety disorders in order to treat physical symptoms, such as rapid heartbeat, trembling, and sweating, by blocking the effects of adrenaline.

Common side effects are:

• Dizziness.
• Headache.
• Fatigue.
• Slower heart rate.
• Cold hands or feet.

Further resources and reading

• National Institute of Mental Health – Mental Health Medications: https://www.nimh.nih.gov/health/topics/mental-health-medications
• Royal College of Psychiatrists – Guide to Psychiatric Medication: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing
• FDA – Drug Safety Communications: https://www.fda.gov/drugs/drug-safety-and-availability/drug-safety-communications 
• Harvard Health Publishing – Medication Topics: https://www.health.harvard.edu/topics/medications