Psychiatric medications are used to treat mental health and substance use disorders. They are often used in combination with other treatments, such as psychotherapy. Psychiatric medications can affect various aspects of a person’s physical, mental, and emotional functioning, such as alertness, mood, attention, coordination, energy, judgment, and sleep.
These medications may affect people in different ways. Each person’s circumstances are unique. Doctors consider many factors in considering medication choices, including a person’s needs and symptoms, age, sex, allergies, other medications, medical problems, medication expense, and preferences; the specific effects and potential side effects of a medication; and more. (See sidebar.)
Psychiatric medications work by helping a person’s body make more or less of substances in the brain called neurotransmitters. Serotonin and dopamine are examples of neurotransmitters, which are stored in the nerves and released throughout the day.
Some of these medications take effect right away, while others take time. Some may take several weeks or longer for the full benefits to take hold.
Psychiatric medications do not rid a person of a mental illness or cure it, but they can greatly decrease the person’s symptoms and improve their ability to live their life.
People who take a psychiatric medication should have follow-up visits with their doctor to see whether it is having the desired effect, and to discuss any side effects. The medication or dosage may need to be adjusted to help with symptoms. It may take time to discover what works best. Medications may be changed, or the dose adjusted to achieve the best response for the person and minimize side effects.
For some mental health disorders, medication may need to be used continually to control symptoms. This is referred to as maintenance treatment. Like a person taking insulin or high blood pressure medicines every day, maintenance treatment is necessary to keep symptoms from recurring. The person typically has regularly scheduled visits with their doctor to make sure the medicine is still working, that no side effects are causing problems, and that the person is doing well. This helps to prevent relapse of the symptoms.
There are several general categories of common psychiatric medications, including antidepressants, anti-anxiety and sleep medications, antipsychotics, mood stabilizers, and stimulants.
Antidepressants
Several different types of antidepressants are available to help relieve symptoms of depression. But antidepressants are also used to treat many other conditions. For example, they can help to treat panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, social phobia, obsessive-compulsive disorder (OCD), borderline personality disorder, bulimia nervosa, irritable bowel syndrome, chronic pain, insomnia, and migraine headaches.
The major types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).
SSRIs are the first-line treatment for youth* and adults with depression. Other medications are used in certain circumstances.
Doctors weigh many factors in choosing an antidepressant, such as the person’s medical status, prior bouts of depression, prior responses to an antidepressant, and the presence of symptoms such as increased sleep, weight gain, or anxiety.
Antidepressants take time to begin working. Most people do not see major benefits for three to six weeks. Because doses are often increased slowly, it may take eight weeks or longer until the medication has its full impact. About 50% of people who are prescribed antidepressant medication will respond (feel better, defined as a 50% reduction in symptoms). (Taliaz et al., 2021; Steinert, 2018)
Response can vary depending on the severity of symptoms, type of medication, length of time taking medication, and other factors. For many people, combined treatment, involving both medication and psychotherapy, has proven most effective in treating depression and in lowering relapse rates.
Various types of antidepressants produce different side effects. Some common side effects, such as dry mouth or nausea, may subside after a few weeks.
The U.S. Food and Drug Administration (FDA) requires a black box warning on antidepressants. A black box warning is a mandatory FDA-issued warning on a medication label about serious risks or restrictions on its use.
Determining whether antidepressant medications increase the risk for suicide is difficult because children and adolescents with depression are more likely to think about suicide and attempt it than other children. With this concern, the FDA reviewed all published and unpublished clinical trials of antidepressants in children and adolescents. In 2004, it issued a black box warning about an increased risk of suicidal thoughts and/or behaviors in youth under age 18 who take antidepressants. A black box warning is a mandatory FDA-issued warning on a medication label about serious risks or restrictions on its use.
There was no record of completed suicides in their review of over 2,000 youth who were treated with antidepressant medications. However, the rate of suicidal thinking/behavior (including actual suicide attempts) was twice as high in youth taking medications (4%) as those taking a placebo or sugar pills (2%). In 2007, the FDA expanded the warning to include young adults through age 24. This warning remains in effect. Treating underlying depression in youth who are thinking about suicide is an important strategy because antidepressant medications improve depressive symptoms, which is a very effective way to treat suicidal thoughts and behavior. Antidepressant medication may increase the risk for suicidal thoughts and/or behaviors in a small percentage of youth. If a doctor determines that medication is appropriate for your child, it is important to weigh the pros and cons of antidepressants. If your child has moderate to severe depression, the benefit of reducing depressive symptoms may outweigh the risks of medication side effects. It is important that your child be monitored closely for all side effects, including suicidal thinking and behavior, particularly in the first few weeks after beginning treatment with an antidepressant and after adjusting the antidepressant dose. (Adapted from AACAP and APA, Depression: Parents' Medication Guide.)*Read more about medication for children and youth in Depression: Parents’ Medication Guide from AACAP and APA.
Anti-Anxiety and Sleep Medications
Several types of medications are used to treat anxiety disorders, including antidepressants, buspirone, benzodiazepines and beta-blockers.
Antidepressants, including SSRIs and SNRIs, are often first-line treatment for anxiety disorders such as social anxiety disorder, generalized anxiety disorder, PTSD and OCD.
Buspirone is used to treat generalized anxiety disorder. It is not addictive, so it can be used for longer periods of time.
Benzodiazepines are also used to treat anxiety, but they need to be used with care because they can be addictive. Side effects of benzodiazepines include sedation, falls, dizziness, and impairment in the use of machinery, such as driving a car. They should not be taken with alcoholic beverages.
Beta-blockers, which are typically used to treat heart conditions, are also prescribed to treat anxiety disorders in the short term.
Sleep medications, also called hypnotics, are typically prescribed for a brief time to help with sleep problems — getting to sleep or staying asleep. Because many of them can lead to dependence, they should be used only for short periods of time. Benzodiazepines are also used to treat insomnia.
Melatonin supplements, available without a prescription, are also used to help with sleep. Melatonin is a natural hormone involved in the sleep cycle. Melatonin supplements are not regulated by the FDA, and the amount of melatonin in supplements can vary widely. They are generally safe for short-term use. However, as with any supplements, it’s important to talk with your health care professional, especially if you are taking medications or have other health conditions.
Antipsychotic Medications
Antipsychotics are used to treat psychotic symptoms, such as delusions and hallucinations, in people with schizophrenia and other psychoses. They are also used to treat manic and depressive symptoms in people with bipolar disorder.
Antipsychotic medications can cause a range of potential side effects, including a drop in blood pressure, dizziness, increased blood glucose (sugar levels), high blood pressure, and weight gain. Older, first-generation antipsychotic medications (such as haloperidol) can also cause tardive dyskinesia, which involves movements of the mouth and tongue not done on purpose and usually occurs after long-term treatment. Other movement-related side effects, such as restlessness and muscle contractions, may occur in young adults but can be quickly treated. In part because they generally have fewer side effects, newer, second-generation antipsychotics (such as quetiapine, aripiprazole, risperidone) are more commonly prescribed for psychotic symptoms.
Antipsychotic medications are sometimes used to help with behavior problems that may occur in autism spectrum disorder.
The FDA requires that all antipsychotics include a black box warning.
Based on reviews of the human trials, the FDA requires manufacturers of antipsychotic medications to add a black-box warning noting that the drugs are associated with an increased risk of death in elderly patients with dementia. A black box warning is a mandatory FDA-issued warning on a medication label about serious risks or restrictions on its use. The initial warning requirement, issued in 2005, applied to second-generation antipsychotic medications. In 2008, FDA expanded that requirement to also cover first-generation antipsychotics.
Mood Stabilizers
Mood stabilizers are typically prescribed to reduce mood swings in people with bipolar disorders. Different mood stabilizers vary in their side effects, potential for drug interactions, and the way the body processes them. Doctors may start at a low dose and slowly increase it to minimize the side effects.
Lithium is commonly used for acute and preventive treatment of both manic and depressive episodes in people with bipolar disorder. People taking lithium will have their blood levels checked to make sure the medication is at an effective, but not concerning, level. Potential side effects of lithium include frequent urination, hypothyroidism, a change in the heartbeat, weight gain, tremor, and stomach symptoms.
Anticonvulsant medications (such as lamotrigine and valproate) are also used to treat bipolar disorder. Other medications are sometimes used to treat symptoms of bipolar disorder, including antipsychotics and antidepressants.
Stimulants
Stimulants are often prescribed for attention-deficit/hyperactivity disorder (ADHD) in children and adults. For most children with ADHD, stimulants will help improve their ability to focus and learn. The most commonly used stimulants include amphetamines and methylphenidates. Common side effects of stimulants include insomnia, loss of appetite, irritable mood, and elevated blood pressure.
Nonstimulant medications, such as atomoxetine, viloxazine and guanfacine, are also used to treat ADHD.
ADHD medications are often prescribed by pediatricians and other primary care doctors. ADHD medications are the most successful intervention for ADHD. Approximately three-quarters of children and adolescents will respond well to one or more of the medications used for ADHD. While this does not mean that every symptom will go away, improvement should be noticeable.
Read more in the “ADHD: Parents’ Guide to Medication” from AACAP and APA.
Medications for substance use disorders
For most people with substance use disorders, a combination of medication and individual or group therapy is most effective. Treatment approaches that address an individual’s specific situation and any co-occurring medical, psychiatric, and social problems support lasting recovery.
Medications are used to control cravings, relieve symptoms of withdrawal, and prevent relapses. Psychotherapy can help individuals with substance use disorder better understand their behavior and motivations, develop higher self-esteem, cope with stress, and address other psychiatric problems. Read more on substance use disorders.
Alcohol use disorder. Medications are often used along with behavioral treatment and mutual support programs to treat alcohol use disorder. Three medications are approved by the FDA for treating alcohol use disorder: naltrexone, acamprosate, and disulfiram. These medications are not addictive and can be used alone or in combination with therapy. Read more on alcohol use disorder treatment and recovery.
Opioid use disorder. Treatments for opioid use disorder are highly effective; however, most people with opioid use disorder do not receive treatment. Counseling and behavioral therapies are often important parts of treatment alongside medications. Three medications approved by the FDA are commonly used to treat opioid use disorder, including methadone, buprenorphine, and naltrexone. Medications for opioid use disorder do not substitute one addiction for another. They can prevent withdrawal and cravings, relieve withdrawal symptoms, or block the euphoric effects of opioids, enabling people to return to their lives. Intranasal Narcan can be used to reverse an opioid overdose and is available over the counter and by prescription. Narcan can be lifesaving for a person who has overdosed. Read more on opioid use disorder treatment and recovery.
Physician Considerations
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