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Mental Health Medications

The following article on Anxiety Disorders is from the National Institute of Mental Health (NIMH). While this material has been expert-reviewed, it is not NIMH or MHANYS intention to provide specific medical advice. Both MHANYS and NIMH advise readers to consult with a qualified health care provider for diagnosis, treatment, and answers to personal questions.

Overview

Medications can play a role in treating mental disorders and conditions and are often used in combination with other treatment approaches such as psychotherapies and brain stimulation therapies. Medications can affect people in different ways, and it may take several tries to find the medication that is most effective with the fewest side effects. It’s important for people to work with a health care provider or mental health professional to develop a treatment plan that meets their needs and medical situation.

Information about medications is updated frequently. Check the U.S. Food and Drug Administration (FDA) Medication Guides webpage  for the latest warnings, patient medication guides, and newly approved medications. The MedlinePlus Drugs, Herbs and Supplements  website also provides information on medications, including side effects and FDA warnings.

This page provides basic information about mental health medications, but it is not a complete source for all medications available and should not be used as a guide for making medical decisions.

Antidepressants

Antidepressants are medications used to treat depression. In some cases, health care providers may prescribe antidepressants to treat other health conditions such as anxiety, pain, and insomnia.

Commonly prescribed types of antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and norepinephrine-dopamine reuptake inhibitors (NDRIs).

These medications are commonly prescribed because they improve symptoms related to a broad group of depressive and anxiety disorders and are associated with fewer side effects than older types of antidepressants. Although older antidepressant medications, such as tricyclics and monoamine oxidase inhibitors (MAOIs), are associated with more side effects, they may be the best option for some people.

Antidepressant medications take time to work—usually 4 to 8 weeks—and symptoms such as problems with sleep, appetite, energy, or concentration sometimes improve before mood lifts. It is important for people to follow their health care provider’s directions and take the medication for the recommended amount of time before deciding whether it works.

Common side effects of SSRIs and other antidepressants may include upset stomach, headache, or sexual dysfunction. The side effects are generally mild and tend to improve over time. People who are sensitive to the side effects of these medications sometimes benefit from starting with a low dose, increasing the daily dose very slowly, and adjusting when they take the medication (for example, at bedtime or with food).

Esketamine  is a newer FDA-approved medication for treatment-resistant depression, which may be diagnosed when a person’s symptoms have not improved after trying at least two antidepressant therapies. Esketamine is delivered as a nasal spray in a health care provider’s office, a clinic, or a hospital. It often acts rapidly—typically within a couple of hours—to relieve depression symptoms. People usually continue to take an oral antidepressant to maintain the improvement in symptoms.

Combining antidepressants with medications or supplements that also act on the serotonin system, such as “triptan” medications (often used to treat migraine headaches) and St. John’s Wort (a dietary supplement), can cause a rare but life-threatening illness called serotonin syndrome . Symptoms of serotonin syndrome include agitation, muscle twitches, hallucinations (seeing or hearing things others do not see or hear), high temperature, and unusual blood pressure changes. For most people, the risk of such extreme reactions is low. It is important for health care providers to consider all possible interactions and use extra care in prescribing and monitoring medication combinations that carry above-average risk.

Please note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the medication or when the dose is changed. People of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline  at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

Anti-Anxiety Medications

Anti-anxiety medications help reduce symptoms of anxiety, such as panic attacks and extreme fear and worry.

Many medications commonly used to treat depression—including SSRIs and SNRIs—may also be used to treat anxiety. In the case of panic disorder or social anxiety disorder, health care providers typically start with SSRIs or other antidepressants as the first treatment because they have fewer side effects than other medications.

Another common type of anti-anxiety medication is benzodiazepines. These medications are sometimes used to treat generalized anxiety disorder.

Short half-life (or short-acting) benzodiazepines are used to treat the short-term symptoms of anxiety. Health care providers may also prescribe beta-blockers off-label to treat short-term symptoms. People with phobias—an overwhelming and unreasonable fear of an object or situation, such as public speaking—often experience intense physical symptoms. Beta-blockers can help manage these symptoms, such as rapid heart rate, sweating, and tremors.

As short-term treatments, benzodiazepines and beta-blockers can be used as needed to reduce severe anxiety. Taking benzodiazepines over long periods may lead to drug tolerance or even dependence. To avoid these problems, health care providers usually prescribe benzodiazepines for short periods and taper them slowly to reduce the likelihood that a person will experience withdrawal symptoms or renewed anxiety symptoms. Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both conditions.

Buspirone  is a different type of medication that is sometimes used to treat anxiety over longer periods. In contrast to benzodiazepines, buspirone must be taken every day for 3 to 4 weeks to reach its full effect and is not effective for treating anxiety on an “as-needed” basis.

Stimulants

Health care providers may prescribe stimulant medications when treating attention-deficit/hyperactivity disorder (ADHD) and narcolepsy . Stimulants increase alertness, attention, and energy. They can also elevate blood pressure, heart rate, and breathing.

Prescription stimulants typically improve alertness and focus for most people, regardless of diagnosis. These medications can markedly improve daily functioning for people with significant focus problems, such as people with ADHD. Although motor hyperactivity associated with ADHD in children usually goes away by the time they reach adolescence, people with ADHD may continue to experience inattention and difficulty with focus into adulthood. As such, stimulant medications can be helpful for adults with ADHD, as well as for children and adolescents with ADHD.

Stimulant medications are safe when taken under a health care provider’s supervision and used as directed. Some children taking them may report feeling slightly different or “funny.” Most side effects of stimulant medications are minor and disappear at lower doses.

Some parents worry that stimulant medications may lead to misuse or dependence, but evidence shows this is unlikely when the medications are used as prescribed. Other challenges with stimulant treatment, such as sleep disturbance and slowed growth, can generally be safely managed in collaboration with the prescribing health care provider while continuing treatment.

Antipsychotics

Antipsychotic medications are typically used to treat psychosis, a condition that involves some loss of contact with reality. People experiencing a psychotic episode often experience delusions (false beliefs) or hallucinations (hearing or seeing things others do not see or hear). Psychosis can be related to drug use or a mental disorder such as schizophrenia, bipolar disorder, or severe depression (also known as “psychotic depression”).

Health care providers may also prescribe antipsychotic medications in combination with other medications to relieve symptoms associated with delirium, dementia, or other mental health conditions. Antipsychotic treatment for older adults necessitates additional care and consideration. The FDA requires that all antipsychotic medication labels include a black-box warning stating that antipsychotics are associated with increased rates of stroke and death in older adults with dementia.

Older, first-generation antipsychotic medications are sometimes called “typical” antipsychotics or “neuroleptics.” Long-term use of typical antipsychotic medications may lead to a condition involving uncontrollable muscle movements called tardive dyskinesia (TD). TD can range from mild to severe. People who think they might have TD should check with their health care provider before stopping their medication.

Newer, second-generation medications are sometimes called “atypical” antipsychotics. Several atypical antipsychotics may be used to treat a broader range of symptoms compared with older medications. For example, these medications are sometimes used to treat bipolar depression or depression that has not responded to antidepressant medication alone. Health care providers may ask people taking atypical antipsychotic medications to participate in regular monitoring to check weight, glucose levels, and lipid levels.

Some symptoms, such as feeling agitated and having hallucinations, typically go away within days of starting antipsychotic medication. Other symptoms, such as delusions, usually go away within a few weeks of starting antipsychotic medication. However, people may not experience the full effects of antipsychotic medication for up to 6 weeks.

If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed an atypical antipsychotic called clozapine . People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1% to 2% of people.

Mood Stabilizers

Mood stabilizers are typically used to treat bipolar disorder and mood changes associated with other mental disorders. In some cases, health care providers may prescribe mood stabilizers to augment the effect of other medications used to treat depression. Lithium , an effective mood stabilizer, is approved for the treatment of mania and maintenance treatment of bipolar disorder. Some studies indicate that lithium may reduce the risk of suicide among people taking it for long-term maintenance. Health care providers generally ask people who are taking lithium to participate in regular monitoring to check lithium levels and kidney and thyroid function.

Mood stabilizers are sometimes used to treat depression (usually with an antidepressant), schizoaffective disorder, disorders of impulse control, and certain mental illnesses in children. For people with bipolar depression, health care providers typically prescribe a mood stabilizer and an antidepressant to reduce the risk of switching into mania or rapid cycling.

Some anticonvulsant medications may also be used as mood stabilizers, as they may work better than lithium for some people, such as people with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder. Health care providers generally ask people taking anticonvulsants to participate in regular monitoring to check medication levels and assess side effects and potential interactions with other common medications.

Special Groups: Children, Older Adults, Pregnant People

All types of people take mental health medications, but some groups have special needs and considerations.

Children and Adolescents

Many medications used to treat mental disorders are safe and effective for children and adolescents. However, it is important to know that children may experience different reactions and side effects than adults, and some medications have FDA warnings about potential side effects for younger people.

In some cases, a health care provider may prescribe an FDA-approved medication on an “off-label” basis to treat a child’s symptoms even though the medication is not approved for the child’s specific mental disorder or for use by people under a certain age. Although there has been less research on mental disorders in children than in adults, there is some evidence that medications can be helpful for children. It is important to monitor children and adolescents who take medications on an “off-label” basis.

A child’s health care provider may suggest trying non-medication treatments, such as psychotherapies, first and may add medication later, if necessary. In other cases, the health care provider may suggest non-medication treatment in combination with medication.

Older Adults

People over 65 should take extra care with medications, especially if they are taking many different medications. Older adults have a higher risk of experiencing drug interactions and are often more sensitive to medications. Even healthy older adults react to medications differently than younger people do because older adults’ bodies often process and eliminate medications more slowly.

Before starting a medication, older adults and their family members should talk with a health care provider about any effects the medication may have on physical and mental functioning. The health care provider can also discuss strategies to make it easier to follow the treatment plan, helping to ensure that older adults take the correct medication dose at the correct time.

The National Institute on Aging’s Safe Use of Medicines for Older Adults  booklet offers information and practical tips to help older people take their medications safely.

People Who Are Pregnant or Who May Become Pregnant

Researchers are continuing to investigate the use of mental health medications during pregnancy. The risks associated with taking medication during pregnancy depend on the type of medication and the stage of pregnancy. While no medication is considered universally safe during pregnancy, untreated mental disorders can also pose risks to the pregnant person and the developing fetus.

Pregnant people and health care providers can work together to develop a personalized treatment plan that considers individual needs and circumstances. It is important to weigh the benefits and risks associated with all available treatment options, including psychotherapies, medications, brain stimulation therapies, or a combination of these options. Health care providers may closely monitor a person’s physical and mental health throughout pregnancy and, after delivery, pay particular attention to signs of perinatal or postpartum depression.

Certain medications taken during pregnancy—including some benzodiazepines, mood stabilizers, and antipsychotic medications—have been linked with birth defects, but the risks vary widely and depend on the specific medication.

Antidepressants, especially SSRIs, are generally considered safe for use during pregnancy. Antidepressant medications can cross into the placenta and may reach the fetus, but the risk of birth defects and other problems is very low. Some studies have found an association between third-trimester SSRI exposure and certain symptoms, including breathing problems, in newborns. However, the FDA does not find sufficient evidence for a causal link  and recommends that health care providers treat depression during pregnancy according to the person’s specific needs.

Visit the FDA website for more information about medications and pregnancy .

Understanding Your Medications

People respond to medications in different ways, and it may take several tries to find the medication that is most effective with the fewest side effects. In some cases, people find that a medication helps for a while, and then their symptoms come back. It often takes some time for a medication to be effective, so it is important to stick with the treatment plan and take medication as prescribed.

People should not stop taking a prescribed medication, even if they are feeling better, without the help of a health care provider. A health care provider can adjust the treatment plan and slowly and safely decrease the medication dose. It’s important to give the body time to adjust to the change. Stopping a medication too soon may cause unpleasant or harmful side effects.

If you are prescribed a medication:

  • Tell the health care provider about all other medications, vitamins, and supplements you are already taking.
  • Remind the health care provider about any allergies and any problems you have had with medications in the past.
  • Make sure you understand how to take the medication before you start using it and take your medication as instructed.
  • Talk to the health care provider about possible side effects and what to expect when taking a medication.
  • Don’t take medications prescribed for another person or give your medication to someone else.
  • Call a health care provider right away if you have any problems with your medication or are worried that it might be doing more harm than good. The health care provider will work with you to address any problems and determine next steps.
  • Report serious side effects to the FDA MedWatch Adverse Event Reporting Program.

Contact FDA MedWatch

The FDA is responsible for protecting public health by ensuring the safety, efficacy, and security of drugs (medications), biological products, and medical devices.

Visit FDA MedWatch  to voluntarily report a serious adverse effect, product quality problem, product use error, or product failure that you suspect is associated with the use of an FDA-regulated drug, biologic, medical device, dietary supplement, or cosmetic. You or your health care provider can make a report online  or by calling 1-800-332-1088. You can also report suspected counterfeit medical products to the FDA through MedWatch .

Subscribe to MedWatch Safety Alerts

FDA MedWatch also offers several ways to help you stay informed about medical products that are prescribed, administered, or dispensed every day. You can sign up to receive the MedWatch E-list , which delivers safety information to your email inbox. You can also follow MedWatch on Twitter @FDAMedWatch .

Reports from the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency charged with improving the safety and quality of America’s health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help the public, health care professionals, and policymakers make informed health decisions. Recent AHRQ reports include:

Resources from the U.S. National Library of Medicine

The National Library of Medicine (NLM) , part of the National Institutes of Health , is the world’s largest medical library and produces electronic information resources on a range of topics. NLM resources include:

  • DailyMed:  DailyMed contains labeling for prescription and nonprescription drugs for human and animal use. It also contains labeling for additional products such as medical gases, devices, cosmetics, dietary supplements, and medical foods.
  • MedlinePlus: Drugs, Herbs and Supplements:  MedlinePlus is an online resource that provides information and resources about drugs, herbs, and supplements.
  • MedlinePlus: Antidepressants : MedlinePlus is an online resource that provides information and resources about antidepressants.

Mental Health Association in New York State (MHANYS) has additional resources that can be accessed through its main website. These resources include links to advocacy and policy work, school-based programs, mental health wellness training programs and more.

MHANYS
mhanys.org

Advocacy and Policy
mhanys.org/advocacy-policy

Mental Health Community Partners
mhcommunitypartners.org

CarePath™
mhanys.org/carepath

SMHRT: Family Education
https://www.mentalhealthednys.org/family-education-webinar-series/

Data Source
National Institute of Mental Health: Mental Health Information Health Topics www.nimh.nih.gov/health/topics