Mental Health
Medications
National Institute of Mental Health
U.S. Department of HealtH anD HUman ServiceS • national institutes of Health Contents
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
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
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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
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 .
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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
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 f