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Mental Health

Medications

National Institute of Mental Health

U.S. Department of HealtH anD HUman ServiceS • national institutes of Health Contents

Mental Health Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What are psychiatric medications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

How are medications used to treat mental disorders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What medications are used to treat schizophrenia? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

What are the side effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

How are antipsychotics taken and how do people respond to them? . . . . . . . . . . . . . . . . . . . . . . . . . . 3

How do antipsychotics interact with other medications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

What medications are used to treat depression? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What are the side effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

How should antidepressants be taken? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Are herbal medicines used to treat depression? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

FDA warning on antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What medications are used to treat bipolar disorder? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Mood stabilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Atypical antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What are the side effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

How should medications for bipolar disorder be taken? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

What medications are used to treat anxiety disorders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Benzodiazepines (anti-anxiety medications) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Beta-blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

What are the side effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

How should medications for anxiety disorders be taken? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

What medications are used to treat ADHD? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

What are the side effects? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

How are ADHD medications taken? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Are ADHD medications safe? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

FDA warning on possible rare side effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Which groups have special needs when taking psychiatric medications? . . . . . . . . . . . . . . . . . . . . . . . . . 14

Children and adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Older adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Women who are pregnant or may become pregnant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

What should I ask my doctor if I am prescribed a psychiatric medication? . . . . . . . . . . . . . . . . . . . . . . . 16

Alphabetical List of Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Citations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

For More Information on Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

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Mental Health Medications

Medications are used to treat the people with mental disorders live fulfilling lives symptoms of mental disorders such

with the help of these medications . Without them,

as schizophrenia, depression, bipolar

people with mental disorders might suffer serious

disorder (sometimes called manic-depressive

and disabling symptoms .

illness), anxiety disorders, and attention deficit-

hyperactivity disorder (ADHD) . Sometimes

How are medications used to

medications are used with other treatments such as

treat mental disorders?

psychotherapy . This guide describes:

Medications treat the symptoms of mental

• Types of medications used to treat mental

disorders . They cannot cure the disorder, but they

disorders

make people feel better so they can function .

• Side effects of medications

• Directions for taking medications

Medications work differently for different people .

• Warnings about medications from the U .S .

Some people get great results from medications

Food and Drug Administration (FDA) .

and only need them for a short time . For example,

a person with depression may feel much better

This booklet does not provide information about

after taking a medication for a few months, and

diagnosing mental disorders . Choosing the right

may never need it again . People with disorders like

medication, medication dose, and treatment plan

schizophrenia or bipolar disorder, or people who

should be based on a person’s individual needs and

have long-term or severe depression or anxiety may

medical situation, and under a doctor’s care .

need to take medication for a much longer time .

Information about medications is frequently updated . Some people get side effects from medications Check the FDA website (http://www .fda .gov) and other people don’t . Doses can be small or

for the latest information on warnings, patient

large, depending on the medication and the person .

medication guides, or newly approved medications . Factors that can affect how medications work in Throughout this document you will see two

people include:

names for medications —the generic name and

• Type of mental disorder, such as depression,

in parenthesis, the trade name . An example is

anxiety, bipolar disorder, and schizophrenia

fluoxetine (Prozac) . See the end of this document

• Age, sex, and body size

for a complete alphabetical listing of medications .

• Physical illnesses

• Habits like smoking and drinking

What are psychiatric

• Liver and kidney function

medications?

• Genetics

Psychiatric medications treat mental disorders .

• Other medications and herbal/vitamin

Sometimes called psychotropic or psychothera-

supplements

peutic medications, they have changed the lives of

• Diet

people with mental disorders for the better . Many

• Whether medications are taken as prescribed .

Mental Health Medications

1

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What medications are used to treat schizophrenia?

• Ziprasidone (Geodon)

Antipsychotic medications are used to treat

schizophrenia and schizophrenia-related

Aripiprazole (Abilify)

disorders . Some of these medications have

• Paliperidone (Invega) .

been available since the mid-1950’s . They are also

called conventional “typical” antipsychotics . Some

The antipsychotics listed here are some of the

of the more commonly used medications include:

medications used to treat symptoms of schizo-

• Chlorpromazine (Thorazine)

phrenia . Additional antipsychotics and other

• Haloperidol (Haldol)

medications used for schizophrenia are listed in

• Perphenazine (generic only)

the chart at the end .

• Fluphenazine (generic only) .

Note: The FDA issued a Public Health Advisory for atypical

In the 1990’s, new antipsychotic medications

antipsychotic medications . The FDA determined that death

were developed . These new medications are called

rates are higher for elderly people with dementia when

second generation, or “atypical” antipsychotics .

taking this medication . A review of data has found a risk with conventional antipsychotics as well . Antipsychotic medications One of these medications was clozapine (Clozaril) .

are not FDA-approved for the treatment of behavioral disorders It is a very effective medication that treats

in patients with dementia .

psychotic symptoms, hallucinations, and breaks

What are the side effects?

with reality, such as when a person believes he or

she is the president . But clozapine can sometimes

Some people have side effects when they start

cause a serious problem called agranulocytosis,

taking these medications . Most side effects go

which is a loss of the white blood cells that help a

away after a few days and often can be managed

person fight infection . Therefore, people who take

successfully . People who are taking antipsychotics

clozapine must get their white blood cell counts

should not drive until they adjust to their new

checked every week or two . This problem and the

medication . Side effects of many antipsychotics

cost of blood tests make treatment with clozapine

include:

difficult for many people . Still, clozapine is

• Drowsiness

potentially helpful for people who do not respond

• Dizziness when changing positions

to other antipsychotic medications .

• Blurred vision

• Rapid heartbeat

Other atypical antipsychotics were developed .

• Sensitivity to the sun

All of them are effective, and none cause

• Skin rashes

agranulocytosis . These include:

• Menstrual problems for women .

• Risperidone (Risperdal)

• Olanzapine (Zyprexa)

Atypical antipsychotic medications can cause

• Quetiapine (Seroquel)

major weight gain and changes in a person’s

metabolism . This may increase a person’s risk of

2

National Institute of Mental Health

getting diabetes and high cholesterol .1 A person’s

a person needs to try several medications before

weight, glucose levels, and lipid levels should be

finding the right one . Doctors and patients can

monitored regularly by a doctor while taking an

work together to find the best medication or

atypical antipsychotic medication .

medication combination, and dose .

Typical antipsychotic medications can cause side

Some people may have a relapse—their symptoms

effects related to physical movement, such as:

come back or get worse . Usually, relapses happen

• Rigidity

when people stop taking their medication, or when

• Persistent muscle spasms

they only take it sometimes . Some people stop

• Tremors

taking the medication because they feel better or

• Restlessness .

they may feel they don’t need it anymore . But

Long-term use of typical antipsychotic medications no one should stop taking an antipsychotic may lead to a condition called tardive dyskinesia

medication without talking to his or her doctor.

(TD) . TD causes muscle movements a person can’t

When a doctor says it is okay to stop taking a

control . The movements commonly happen around

medication, it should be gradually tapered off,

the mouth . TD can range from mild to severe,

never stopped suddenly .

and in some people the problem cannot be cured .

How do antipsychotics interact with

Sometimes people with TD recover partially or

other medications?

fully after they stop taking the medication .

Antipsychotics can produce unpleasant or dangerous

Every year, an estimated 5 percent of people taking side effects when taken with certain medications .

typical antipsychotics get TD . The condition

For this reason, all doctors treating a patient need

happens to fewer people who take the new, atypical to be aware of all the medications that person is antipsychotics, but some people may still get TD .

taking . Doctors need to know about prescription and

People who think that they might have TD should

over-the-counter medicine, vitamins, minerals, and

check with their doctor before stopping their

herbal supplements . People also need to discuss any

medication .

alcohol or other drug use with their doctor .

How are antipsychotics taken and

To find out more about how antipsychotics work,

how do people respond to them?

the National Institute of Mental Health (NIMH)

Antipsychotics are usually pills that people swallow, funded a study called CATIE (Clinical Antipsychotic or liquid they can drink . Some antipsychotics are

Trials of Intervention Effectiveness) . This study

shots that are given once or twice a month .

compared the effectiveness and side effects of

five antipsychotics used to treat people with

Symptoms of schizophrenia, such as feeling

schizophrenia . In general, the study found that the

agitated and having hallucinations, usually go away older medication perphenazine worked as well as within days . Symptoms like delusions usually go

the newer, atypical medications . But because people

away within a few weeks . After about six weeks,

respond differently to different medications, it is

many people will see a lot of improvement .

important that treatments be designed carefully for

However, people respond in different ways to

each person . You can find more information at http://

antipsychotic medications, and no one can tell

www .nimh .nih .gov/trials/practical/catie/index .shtml .

beforehand how a person will respond . Sometimes

Mental Health Medications

3

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What medications are used to treat depression?

Depression is commonly treated What are the side effects?

with antidepressant medications .

Antidepressants may cause mild side effects that

Antidepressants work to balance some

usually do not last long . Any unusual reactions

of the natural chemicals in our brains . These

or side effects should be reported to a doctor

chemicals are called neurotransmitters, and

immediately.

they affect our mood and emotional responses .

Antidepressants work on neurotransmitters such as

The most common side effects associated with

serotonin, norepinephrine, and dopamine .

SSRIs and SNRIs include:

• Headache, which usually goes away within a

The most popular types of antidepressants are

few days .

called selective serotonin reuptake inhibitors

• Nausea (feeling sick to your stomach), which

(SSRIs) . These include:

usually goes away within a few days .

• Fluoxetine (Prozac)

• Sleeplessness or drowsiness, which may

• Citalopram (Celexa)

happen during the first few weeks but then

• Sertraline (Zoloft)

goes away . Sometimes the medication dose

• Paroxetine (Paxil)

needs to be reduced or the time of day it is

• Escitalopram (Lexapro) .

taken needs to be adjusted to help lessen

Other types of antidepressants are serotonin and

these side effects .

norepinephrine reuptake inhibitors (SNRIs) . SNRIs

• Agitation (feeling jittery) .

are similar to SSRIs and include venlafaxine

• Sexual problems, which can affect both men

(Effexor) and duloxetine (Cymbalta) . Another

and women and may include reduced sex

antidepressant that is commonly used is bupropion

drive, and problems having and enjoying sex .

(Wellbutrin) . Bupropion, which works on the

Tricyclic antidepressants can cause side effects,

neurotransmitter dopamine, is unique in that it does including: not fit into any specific drug type .

• Dry mouth .

SSRIs and SNRIs are popular because they do

• Constipation .

not cause as many side effects as older classes of

• Bladder problems . It may be hard to empty

antidepressants . Older antidepressant medications

the bladder, or the urine stream may not be

include tricyclics, tetracyclics, and monoamine

as strong as usual . Older men with enlarged

oxidase inhibitors (MAOIs) . For some people,

prostate conditions may be more affected .

tricyclics, tetracyclics, or MAOIs may be the best

• Sexual problems, which can affect both men

medications .

and women and may include reduced sex

drive, and problems having and enjoying sex .

4

National Institute of Mental Health

• Blurred vision, which usually goes away

time to adjust to the change . People don’t get

quickly .

addicted, or “hooked,” on the medications, but

• Drowsiness . Usually, antidepressants that

stopping them abruptly can cause withdrawal

make you drowsy are taken at bedtime .

symptoms .

People taking MAOIs need to be careful about

If a medication does not work, it is helpful to

the foods they eat and the medicines they take .

be open to trying another one . A study funded

Foods and medicines that contain high levels of a

by NIMH found that if a person with difficult-

chemical called tyramine are dangerous for people

to-treat depression did not get better with a first

taking MAOIs . Tyramine is found in some cheeses, medication, chances of getting better increased wines, and pickles . The chemical is also in some

when the person tried a new one or added a second

medications, including decongestants and over-the-

medication to his or her treatment . The study was

counter cold medicine .

called STAR*D (Sequenced Treatment Alternatives

Mixing MAOIs and tyramine can cause a sharp

to Relieve Depression) .2,3 For more information,

increase in blood pressure, which can lead to

visit http://www .nimh .nih .gov/trials/practical/stard/

stroke . People taking MAOIs should ask their

index .shtml .

doctors for a complete list of foods, medicines, and Are herbal medicines used to treat other substances to avoid . An MAOI skin patch has depression?

recently been developed and may help reduce some

of these risks . A doctor can help a person figure out The herbal medicine St . John’s wort has been used if a patch or a pill will work for him or her .

for centuries in many folk and herbal remedies .

Today in Europe, it is used widely to treat mild-to-

How should antidepressants be

moderate depression . In the United States, it is one

taken?

of the top-selling botanical products .

People taking antidepressants need to follow their

The National Institutes of Health conducted a

doctors’ directions . The medication should be taken

clinical trial to determine the effectiveness of

in the right dose for the right amount of time . It can

treating adults who have major depression with

take three or four weeks until the medicine takes

St . Johns wort . The study included 340 people

effect . Some people take the medications for a short diagnosed with major depression . One-third of time, and some people take them for much longer

the people took the herbal medicine, one-third

periods . People with long-term or severe depression took an SSRI, and one-third took a placebo, or may need to take medication for a long time .

“sugar pill .” The people did not know what they

Once a person is taking antidepressants, it is

were taking . The study found that St . John’s wort

important not to stop taking them without the

was no more effective than the placebo in treating

help of a doctor . Sometimes people taking

major depression .4 A study currently in progress is

antidepressants feel better and stop taking the

looking at the effectiveness of St . John’s wort for

medication too soon, and the depression may

treating mild or minor depression .

return . When it is time to stop the medication,

Other research has shown that St . John’s wort

the doctor will help the person slowly and safely

can dangerously interact with other medications,

decrease the dose . It’s important to give the body

including those used to control HIV . On February

Mental Health Medications

5

10, 2000, the FDA issued a Public Health Advisory The warning also says that patients of all ages letter stating that the herb appears to interfere with

taking antidepressants should be watched closely,

certain medications used to treat heart disease,

especially during the first few weeks of treatment .

depression, seizures, certain cancers, and organ

Possible side effects to look for are depression

transplant rejection . Also, St . Johns wort may

that gets worse, suicidal thinking or behavior,

interfere with oral contraceptives .

or any unusual changes in behavior such as

Because St . John’s wort may not mix well with

trouble sleeping, agitation, or withdrawal from

other medications, people should always talk

normal social situations . Families and caregivers

with their doctors before taking it or any herbal

should report any changes to the doctor . The

supplement .

latest information from the FDA can be found

at http://www .fda .gov .

FDA warning on antidepressants

Results of a comprehensive review of pediatric

Antidepressants are safe and popular, but some

trials conducted between 1988 and 2006 suggested

studies have suggested that they may have

that the benefits of antidepressant medications

unintentional effects, especially in young people .

likely outweigh their risks to children and

In 2004, the FDA looked at published and

adolescents with major depression and anxiety

unpublished data on trials of antidepressants that

disorders .5 The study was funded in part by NIMH .

involved nearly 4,400 children and adolescents .

Finally, the FDA has warned that combining the

They found that 4 percent of those taking

newer SSRI or SNRI antidepressants with one of

antidepressants thought about or tried suicide

the commonly-used “triptan” medications used

(although no suicides occurred), compared to

to treat migraine headaches could cause a life-

2 percent of those receiving placebos (sugar pill) .

threatening illness called “serotonin syndrome .”

In 2005, the FDA decided to adopt a “black box”

A person with serotonin syndrome may be agitated,

warning label—the most serious type of warning—

have hallucinations (see or hear things that are not

on all antidepressant medications . The warning

real), have a high temperature, or have unusual

says there is an increased risk of suicidal thinking

blood pressure changes . Serotonin syndrome is

or attempts in children and adolescents taking

usually associated with the older antidepressants

antidepressants . In 2007, the FDA proposed that

called MAOIs, but it can happen with the newer

makers of all antidepressant medications extend the antidepressants as well, if they are mixed with the warning to include young adults up through age 24 .

wrong medications .

6

National Institute of Mental Health

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What medications are used to treat bipolar disorder?

Bipolar disorder, also called manic- Antipsychotics used to treat people with bipolar depressive illness, is commonly treated

disorder include:

with mood stabilizers . Sometimes,

• Olanzapine (Zyprexa), which helps people

antipsychotics and antidepressants are used along

with severe or psychotic depression, which

with a mood stabilizer .

often is accompanied by a break with reality,

hallucinations, or delusions7

Mood stabilizers

• Aripiprazole (Abilify), which can be taken as

People with bipolar disorder usually try mood

a pill or as a shot

stabilizers first . In general, people continue

Risperidone (Risperdal)

treatment with mood stabilizers for years . Lithium

Ziprasidone (Geodon)

is a very effective mood stabilizer . It was the first

Clozapine (Clorazil), which is often used

mood stabilizer approved by the FDA in the 1970’s

for people who do not respond to lithium or

for treating both manic and depressive episodes .

anticonvulsants .8

Anticonvulsant medications also are used as mood

Antidepressants

stabilizers . They were originally developed to

treat seizures, but they were found to help control

Antidepressants are sometimes used to treat

moods as well . One anticonvulsant commonly

symptoms of depression in bipolar disorder .

used as a mood stabilizer is valproic acid, also

Fluoxetine (Prozac), paroxetine (Paxil), or

called divalproex sodium (Depakote) . For some

sertraline (Zoloft) are a few that are used . However,

people, it may work better than lithium .6 Other

people with bipolar disorder should not take an

anticonvulsants used as mood stabilizers are

antidepressant on its own . Doing so can cause the

carbamazepine (Tegretol), lamotrigine (Lamictal)

person to rapidly switch from depression to mania,

and oxcarbazepine (Trileptal) .

which can be dangerous .9 To prevent this problem,

doctors give patients a mood stabilizer or an

Atypical antipsychotics

antipsychotic along with an antidepressant .

Atypical antipsychotic medications are sometimes

Research on whether antidepressants help people

used to treat symptoms of bipolar disorder .

with bipolar depression is mixed . An NIMH-

Often, antipsychotics are used along with other

funded study found that antidepressants were

medications .

no more effective than a placebo to help treat

depression in people with bipolar disorder . The

people were taking mood stabilizers along with

Mental Health Medications

7

the antidepressants . You can find out more about

Some possible side effects linked with valproic

this study, called STEP-BD (Systematic Treatment

acid/divalproex sodium include:

Enhancement Program for Bipolar Disorder),10 at

• Changes in weight

http://www .nimh .nih .gov/trials/practical/step-bd/

• Nausea

index .shtml .

• Stomach pain

• Vomiting

What are the side effects?

• Anorexia

Treatments for bipolar disorder have improved over

Loss of appetite .

the last 10 years . But everyone responds differently Valproic acid may cause damage to the liver or to medications . If you have any side effects, tell

pancreas, so people taking it should see their

your doctor right away . He or she may change the

doctors regularly .

dose or prescribe a different medication .

Valproic acid may affect young girls and women

Different medications for treating bipolar disorder

in unique ways . Sometimes, valproic acid may

may cause different side effects . Some medications increase testosterone (a male hormone) levels used for treating bipolar disorder have been

in teenage girls and lead to a condition called

linked to unique and serious symptoms, which are

polycystic ovarian syndrome (PCOS) .11,12 PCOS

described below .

is a disease that can affect fertility and make the

Lithium can cause several side effects, and some of menstrual cycle become irregular, but symptoms them may become serious . They include:

tend to go away after valproic acid is stopped .13

• Loss of coordination

It also may cause birth defects in women who are

• Excessive thirst

pregnant .

• Frequent urination

Lamotrigine can cause a rare but serious skin rash

• Blackouts

that needs to be treated in a hospital . In some cases,

• Seizures

this rash can cause permanent disability or be life-

• Slurred speech

threatening .

• Fast, slow, irregular, or pounding heartbeat

In addition, valproic acid, lamotrigine,

• Hallucinations (seeing things or hearing

carbamazepine, oxcarbazepine and other

voices that do not exist)

anticonvulsant medications (listed in the chart at

• Changes in vision

the end of this document) have an FDA warning .

• Itching, rash

The warning states that their use may increase the

• Swelling of the eyes, face, lips, tongue,

risk of suicidal thoughts and behaviors . People

throat, hands, feet, ankles, or lower legs .

taking anticonvulsant medications for bipolar or

If a person with bipolar disorder is being treated

other illnesses should be closely monitored for new

with lithium, he or she should visit the doctor

or worsening symptoms of depression, suicidal

regularly to check the levels of lithium in the blood, thoughts or behavior, or any unusual changes in and make sure the kidneys and the thyroid are

mood or behavior . People taking these medications

working normally .

should not make any changes without talking to

their health care professional .

8

National Institute of Mental Health

Other medications for bipolar disorder may also

There is no cure for bipolar disorder, but treatment

be linked with rare but serious side effects . Always

works for many people . Treatment works best when

talk with the doctor or pharmacist about any

it is continuous, rather than on and off . However,

potential side effects before taking the medication .

mood changes can happen even when there are no

For information on side effects of antipsychotics,

breaks in treatment . Patients should be open with

see the section on medications for treating

their doctors about treatment . Talking about how

schizophrenia .

treatment is working can help it be more effective .

For information on side effects and FDA warnings

It may be helpful for people or their family

of antidepressants, see the section on medications

members to keep a daily chart of mood symptoms,

for treating depression .

treatments, sleep patterns, and life events . This

chart can help patients and doctors track the illness .

How should medications for bipolar

Doctors can use the chart to treat the illness most

disorder be taken?

effectively .

Medications should be taken as directed by a

Because medications for bipolar disorder can have

doctor . Sometimes a person’s treatment plan needs

serious side effects, it is important for anyone

to be changed . When changes in medicine are

taking them to see the doctor regularly to check for

needed, the doctor will guide the change . A person possibly dangerous changes in the body .

should never stop taking a medication without

asking a doctor for help.

Mental Health Medications

9

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What medications are used to treat anxiety disorders?

Antidepressants, anti-anxiety medications, MAOIs are also used for anxiety disorders .

and beta-blockers are the most common

Doctors sometimes prescribe phenelzine (Nardil),

medications used for anxiety disorders .

tranylcypromine (Parnate), and isocarboxazid

Anxiety disorders include:

(Marplan) . People who take MAOIs must avoid

• Obsessive compulsive disorder (OCD)

certain food and medicines that can interact with

• Post-traumatic stress disorder (PTSD)

their medicine and cause dangerous increases in

• Generalized anxiety disorder (GAD)

blood pressure . For more information, see the

• Panic disorder

section on medications used to treat depression .

• Social phobia .

Benzodiazepines (anti-anxiety

medications)

Antidepressants

The anti-anxiety medications called

Antidepressants were developed to treat depression, benzodiazepines can start working more quickly but they also help people with anxiety disorders .

than antidepressants . The ones used to treat anxiety

SSRIs such as fluoxetine (Prozac), sertraline

disorders include:

(Zoloft), escitalopram (Lexapro), paroxetine

• Clonazepam (Klonopin), which is used for

(Paxil), and citalopram (Celexa) are commonly

social phobia and GAD

prescribed for panic disorder, OCD, PTSD, and

• Lorazepam (Ativan), which is used for panic

social phobia . The SNRI venlafaxine (Effexor) is

disorder

commonly used to treat GAD . The antidepressant

• Alprazolam (Xanax), which is used for panic

bupropion (Wellbutrin) is also sometimes used .

disorder and GAD .

When treating anxiety disorders, antidepressants

generally are started at low doses and increased

Buspirone (Buspar) is an anti-anxiety medication

over time .

used to treat GAD . Unlike benzodiazepines,

however, it takes at least two weeks for buspirone

Some tricyclic antidepressants work well for

to begin working .

anxiety . For example, imipramine (Tofranil)

is prescribed for panic disorder and GAD .

Clonazepam, listed above, is an anticonvulsant

Clomipramine (Anafranil) is used to treat OCD .

medication . See FDA warning on anticonvulsants

Tricyclics are also started at low doses and

under the bipolar disorder section .

increased over time .

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National Institute of Mental Health

Beta-blockers

Common side effects from beta-blockers include:

Beta-blockers control some of the physical

Fatigue

symptoms of anxiety, such as trembling and

Cold hands

sweating . Propranolol (Inderal) is a beta-blocker

Dizziness

usually used to treat heart conditions and high

Weakness .

blood pressure . The medicine also helps people

In addition, beta-blockers generally are not

who have physical problems related to anxiety . For

recommended for people with asthma or diabetes

example, when a person with social phobia must

because they may worsen symptoms .

face a stressful situation, such as giving a speech,

or attending an important meeting, a doctor may

How should medications for anxiety

prescribe a beta-blocker . Taking the medicine for

disorders be taken?

a short period of time can help the person keep

physical symptoms under control .

People can build a tolerance to benzodiazepines if

they are taken over a long period of time and may

What are the side effects?

need higher and higher doses to get the same effect .

See the section on antidepressants for a discussion

Some people may become dependent on them . To

on side effects .

avoid these problems, doctors usually prescribe

the medication for short periods, a practice that is

The most common side effects for benzodiazepines especially helpful for people who have substance are drowsiness and dizziness . Other possible side

abuse problems or who become dependent on

effects include:

medication easily . If people suddenly stop taking

• Upset stomach

benzodiazepines, they may get withdrawal

• Blurred vision

• Headache

symptoms, or their anxiety may return . Therefore,

• Confusion

they should be tapered off slowly .

• Grogginess

Buspirone and beta-blockers are similar . They

• Nightmares .

are usually taken on a short-term basis for

Possible side effects from buspirone (BuSpar)

anxiety . Both should be tapered off slowly . Talk

include:

to the doctor before stopping any anti-anxiety

• Dizziness

medication .

• Headaches

• Nausea

• Nervousness

• Lightheadedness

• Excitement

• Trouble sleeping .

Mental Health Medications

11

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What medications are used to treat ADHD?

• Stomachaches and headaches .

Attention deficit/hyperactivity disorder

(ADHD) occurs in both children and

Less common side effects. A few children

adults . ADHD is commonly treated with

develop sudden, repetitive movements

stimulants, such as:

or sounds called tics . These tics may or

• Methylphenidate (Ritalin, Metadate,

may not be noticeable . Changing the

Concerta, Daytrana)

medication dosage may make tics go away .

• Amphetamine (Adderall)

Some children also may appear to have a

• Dextroamphetamine (Dexedrine, Dextrostat) .

personality change, such as appearing “flat”

In 2002, the FDA approved the nonstimulant

or without emotion . Talk with your child’s

medication atomoxetine (Strattera) for use as a

doctor if you see any of these side effects .

treatment for ADHD . In February 2007, the FDA

How are ADHD medications taken?

approved the use of the stimulant lisdexamfetamine

dimesylate (Vyvanse) for the treatment of ADHD

Stimulant medications can be short-acting or long-

in children ages 6 to 12 years .

acting, and can be taken in different forms such

as a pill, patch, or powder . Long-acting, sustained

What are the side effects?

and extended release forms allow children to take

Most side effects are minor and disappear when

the medication just once a day before school .

dosage levels are lowered . The most common side

Parents and doctors should decide together which

effects include:

medication is best for the child and whether the

• Decreased appetite . Children seem to be less

child needs medication only for school hours or for

hungry during the middle of the day, but

evenings and weekends too .

they are often hungry by dinnertime as the

ADHD medications help many children and

medication wears off .

adults who are hyperactive and impulsive .

• Sleep problems . If a child cannot fall asleep,

They help people focus, work, and learn .

the doctor may prescribe a lower dose . The

Stimulant medication also may improve physical

doctor might also suggest that parents give

coordination . However, different people respond

the medication to their child earlier in the

differently to medications, so children taking

day, or stop the afternoon or evening dose .

ADHD medications should be watched closely .

To help ease sleeping problems, a doctor

may add a prescription for a low dose of

Are ADHD medications safe?

an antidepressant or a medication called

Stimulant medications are safe when given under

clonidine .

a doctor’s supervision . Some children taking them

may feel slightly different or “funny .”

12

National Institute of Mental Health

Some parents worry that stimulant medications

ADHD who take atomoxetine are more likely to

may lead to drug abuse or dependence, but there is

have suicidal thoughts than children and teenagers

little evidence of this . Research shows that teens

with ADHD who do not take atomoxetine . If

with ADHD who took stimulant medications were

your child is taking atomoxetine, watch his or her

less likely to abuse drugs than those who did not

behavior carefully . A child may develop serious

take stimulant medications .14

symptoms suddenly, so it is important to pay

attention to your child’s behavior every day . Ask

FDA warning on possible rare side

other people who spend a lot of time with your

effects

child, such as brothers, sisters, and teachers, to tell

In 2007, the FDA required that all makers of

you if they notice changes in your child’s behavior .

ADHD medications develop Patient Medication

Call a doctor right away if your child shows any of

Guides . The guides must alert patients to

the following symptoms:

possible heart and psychiatric problems related to

Acting more subdued or withdrawn than usual

ADHD medicine . The FDA required the Patient

Feeling helpless, hopeless, or worthless

Medication Guides because a review of data found

New or worsening depression

that ADHD patients with heart conditions had a

Thinking or talking about hurting himself or

slightly higher risk of strokes, heart attacks, and

herself

sudden death when taking the medications . The

Extreme worry

review also found a slightly higher risk (about 1 in

Agitation

1,000) for medication-related psychiatric problems,

Panic attacks

such as hearing voices, having hallucinations,

Trouble sleeping

becoming suspicious for no reason, or becoming

Irritability

manic . This happened to patients who had no

Aggressive or violent behavior

history of psychiatric problems .

Acting without thinking

• Extreme increase in activity or talking

The FDA recommends that any treatment plan for

• Frenzied, abnormal excitement

ADHD include an initial health and family history

• Any sudden or unusual changes in behavior .

examination . This exam should look for existing

heart and psychiatric problems .

While taking atomoxetine, your child should

see a doctor often, especially at the beginning

The non-stimulant ADHD medication called

of treatment . Be sure that your child keeps all

atomoxetine (Strattera) carries another warning .

appointments with his or her doctor .

Studies show that children and teenagers with

Mental Health Medications

13

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Which groups have special needs when taking

psychiatric medications?

Psychiatric medications are taken by all types study found that low doses of the stimulant of people, but some groups have special

methylphenidate are safe and effective for

needs, including:

preschoolers . However, children of this age are

• Children and adolescents

more sensitive to the side effects of the medication,

• Older adults

including slower growth rates . Children taking

• Women who are pregnant or may become

methylphenidate should be watched closely .15,16,17

pregnant .

In addition to medications, other treatments

for young people with mental disorders should

Children and adolescents

be considered . Psychotherapy, family therapy,

Most medications used to treat young people with

educational courses, and behavior management

mental illness are safe and effective . However,

techniques can help everyone involved cope with

many medications have not been studied or

the disorder . For more information on child and

approved for use with children . Researchers are

adolescent mental health research, visit http://www .