Some people are afraid that taking a medication will change their personality, but most find that medication allows them to take charge of their lives.
Medications for mental health conditions fall into the following major categories:
Antipsychotics developed in the mid-20th century are often referred to as first-generation or typical antipsychotics, while antipsychotics developed more recently are referred to as second-generation or atypical antipsychotics. These medications reduce or eliminate symptoms of psychosis (delusions and hallucinations) by affecting the brain chemical called dopamine.
All antipsychotics play a vital role in treating schizophrenia and schizoaffective disorder. Second-generation antipsychotics can also be used to treat acute mania, bipolar disorder and treatment-resistant depression.
Second-generation antipsychotics aren’t necessarily better than first-generation, but they do have different side effects. First-generation antipsychotics are more likely to cause movement disorders like tardive dyskinesia—an uncomfortable condition in which the brain misfires and causes random, uncontrollable muscle movements or tics. Second-generation antipsychotics are more likely to result in weight gain, which can lead to health complications such as metabolic syndrome. Work with your provider to find the best medication for you.
These medications improve symptoms of depression by affecting the brain chemicals associated with emotion, such as serotonin, norepinephrine and dopamine.
Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) are newer antidepressants that have fewer side effects than older drugs, but no medication is entirely free of side effects. Potential side effects of SSRIs and SNRIs include:
- Nervousness, agitation or restlessness
- Reduced sexual desire/difficulty reaching orgasm/inability to maintain an erection
- Insomnia, drowsiness
- Weight gain or loss
- Dry mouth
One antidepressant (Bupropion) affects mostly the brain chemical dopamine and thus forms a category of its own. Meanwhile, older types of antidepressants, including tricyclics and monoamine oxidase inhibitors (MAOIs), may be prescribed by a mental health professional if newer medications do not seem to be effective. Common side effects of tricyclics include:
- Dry mouth
- Blurred vision
- Urine retention
- Increased appetite, leading to weight gain
- Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
- Increased sweating
MAOIs are the least-prescribed of all antidepressants because they can cause dangerously high blood pressure when combined with certain foods or medications. People taking MAOIs must watch their diets carefully to avoid potentially life-threatening complications. Off-limits foods typically include aged cheese, sauerkraut, cured meats, draft beer and fermented soy products such as miso, tofu or soy sauce. Some people may have to avoid wine and all forms of beer.
Some antidepressants may be useful for post-traumatic stress disorder (PTSD), generalized anxiety disorder and obsessive-compulsive disorder (OCD) but may require higher doses. Symptoms of depression that are part of a bipolar disorder need more careful assessment because antidepressants may worsen the risk of mania and provide little relief from depressive symptoms. As always, ask your doctor about what treatment options are right for you.
Certain medications work solely to reduce the emotional and physical symptoms of anxiety. Benzodiazepines such as alprazolam (Xanax) can treat social phobia, generalized anxiety disorder and panic disorder. These medicines work quickly and are very effective in the short-term. However, people prone to substance abuse may become dependent on them.
Increasing the dosage over time might be necessary because the body can become used to these medications and require larger doses for the same therapeutic effect. People who stop taking benzodiazepines suddenly may experience unpleasant withdrawal symptoms. Other potential side effects include:
- Low blood pressure
- Decreased sex drive
- Lack of coordination
- Unusual emotional dysfunction, including anger and violence
- Memory loss
- Difficulty thinking
Mood stabilizers commonly treat the mood swings associated with bipolar disorder. The oldest of them, lithium, has been in use for over 50 years and has proven very effective, particularly for bipolar disorder, type I. However, regular blood tests are required when taking lithium because of potential serious side effects to the kidneys and thyroid.
Newer mood stabilizers, many of which were originally used to treat seizure disorders, may work better than lithium for some people. Mood stabilizers can prevent manic or hypomanic episodes and depressive episodes. but also have side effects to know about and monitor.
Off-Label & Generic Medications
Some medications can be prescribed “off-label,” which means they haven’t been approved by the FDA for a given condition. A doctor should be clear about the limits of the research around off-label medication and always check for alternate options.
Be aware that generic medications and brand name medications are not exactly the same. The FDA requires only that generic medications contain the same activechemicals to those in brand name medications and that the route of administration—whether the medication is available as tablets, capsules, patches or injections—be identical.
Other characteristics may differ, like the inactive ingredients, color, flavor, fillers and binders. These inactive ingredients usually vary between drug companies and can influence the way a medication works for an individual. If you notice the look of the generic medication you are taking has changed, talk with your prescriber or pharmacist.