In-depth overview of psychiatric medications. Covers types of psychiatric medications, benefits and side-effects of psychiatric medications, taking psychiatric medications during pregnancy, and more.
- Special Message
- Relief from Symptoms
- Questions for Your Doctor
- Medications for Mental Illness
- Antipsychotic Medications
- Antimanic Medications
- Antidepressant Medications
- Antianxiety Medications
- Medications for Special Groups
- Index of Medications
- Addendum (Medication Warnings, Jan. 2007)
This booklet is designed to help mental health patients and their families understand how and why psychiatric medications can be used as part of the treatment of mental health problems.
It is important for you to be well informed about medications you may need. You should know what medications you take and the dosage, and learn everything you can about them. Many medications now come with patient package inserts, describing the medication, how it should be taken, and side effects to look for. When you go to a new doctor, always take with you a list of all of the prescribed medications (including dosage), over-the-counter medications, and vitamin, mineral, and herbal supplements you take. The list should include herbal teas and supplements such as St. John's wort, echinacea, ginkgo, ephedra, and ginseng. Almost any substance that can change behavior can cause harm if used in the wrong amount or frequency of dosing, or in a bad combination. Drugs differ in the speed, duration of action, and in their margin for error.
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If you are taking more than one medication, and at different times of the day, it is essential that you take the correct dosage of each medication. An easy way to make sure you do this is to use a 7-day pillbox, available in any pharmacy, and to fill the box with the proper medication at the beginning of each week. Many pharmacies also have pillboxes with sections for medications that must be taken more than once a day.
This booklet is intended to inform you, but it is not a "do-it-yourself" manual. Leave it to the doctor, working closely with you, to diagnose mental illness, interpret signs and symptoms of the illness, prescribe and manage medication, and explain any side effects. This will help you ensure that you use medication most effectively and with minimum risk of side effects or complications.
Anyone can develop a mental illness—you, a family member, a friend, or a neighbor. Some disorders are mild; others are serious and long-lasting. These conditions can be diagnosed and treated. Most people can live better lives after treatment. And psychotherapeutic medications are an increasingly important element in the successful treatment of mental illness.
Medications for mental illnesses were first introduced in the early 1950s with the antipsychotic chlorpromazine. Other medications have followed. These medications have changed the lives of people with these disorders for the better.
Psychotherapeutic medications also may make other kinds of treatment more effective. Someone who is too depressed to talk, for instance, may have difficulty communicating during psychotherapy or counseling, but the right medication may improve symptoms so the person can respond. For many patients, a combination of psychotherapy and medication can be an effective method of treatment.
Another benefit of these medications is an increased understanding of the causes of mental illness. Scientists have learned much more about the workings of the brain as a result of their investigations into how psychotherapeutic medications relieve the symptoms of disorders such as psychosis, depression, anxiety, obsessive-compulsive disorder, and panic disorder.
Just as aspirin can reduce a fever without curing the infection that causes it, psychotherapeutic medications act by controlling symptoms. Psychotherapeutic medications do not cure mental illness, but in many cases, they can help a person function despite some continuing mental pain and difficulty coping with problems. For example, drugs like chlorpromazine can turn off the "voices" heard by some people with psychosis and help them to see reality more clearly. And antidepressants can lift the dark, heavy moods of depression. The degree of response—ranging from a little relief of symptoms to complete relief—depends on a variety of factors related to the individual and the disorder being treated.
How long someone must take a psychotherapeutic medication depends on the individual and the disorder. Many depressed and anxious people may need medication for a single period—perhaps for several months—and then never need it again. People with conditions such as schizophrenia or bipolar disorder (also known as manic-depressive illness), or those whose depression or anxiety is chronic or recurrent, may have to take medication indefinitely.
Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some have side effects, and others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking are some of the factors that can influence a medication's effect.
You and your family can help your doctor find the right medications for you. The doctor needs to know your medical history, other medications being taken, and life plans such as hoping to have a baby. After taking the medication for a short time, you should tell the doctor about favorable results as well as side effects. The Food and Drug Administration (FDA) and professional organizations recommend that the patient or a family member ask the following questions when a medication is prescribed:
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- What is the name of the medication, and what is it supposed to do?
- How and when do I take it, and when do I stop taking it?
- What foods, drinks, or other medications should I avoid while taking the prescribed medication?
- Should it be taken with food or on an empty stomach?
- Is it safe to drink alcohol while on this medication?
- What are the side effects, and what should I do if they occur?
- Is a Patient Package Insert for the medication available?
This booklet describes medications by their generic (chemical) names and in italics by their trade names (brand names used by pharmaceutical companies). They are divided into four large categories—antipsychotic, antimanic, antidepressant, and antianxiety medications. Medications that specifically affect children, the elderly, and women during the reproductive years are discussed in a separate section of the booklet.
Lists at the end of the booklet give the generic name and the trade name of the most commonly prescribed medications and note the section of the booklet that contains information about each type. A separate chart shows the trade and generic names of medications commonly prescribed for children and adolescents.
Treatment evaluation studies have established the effectiveness of the medications described here, but much remains to be learned about them. The National Institute of Mental Health, other Federal agencies, and private research groups are sponsoring studies of these medications. Scientists are hoping to improve their understanding of how and why these medications work, how to control or eliminate unwanted side effects, and how to make the medications more effective.
continue: Antipsychotic Medications
A person who is psychotic is out of touch with reality. People with psychosis may hear "voices" or have strange and illogical ideas (for example, thinking that others can hear their thoughts, or are trying to harm them, or that they are the President of the United States or some other famous person). They may get excited or angry for no apparent reason, or spend a lot of time by themselves, or in bed, sleeping during the day and staying awake at night. The person may neglect appearance, not bathing or changing clothes, and may be hard to talk to—barely talking or saying things that make no sense. They often are initially unaware that their condition is an illness.
These kinds of behaviors are symptoms of a psychotic illness such as schizophrenia. Antipsychotic medications act against these symptoms. These medications cannot "cure" the illness, but they can take away many of the symptoms or make them milder. In some cases, they can shorten the course of an episode of the illness as well.
There are a number of antipsychotic (neuroleptic) medications available. These medications affect neurotransmitters that allow communication between nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to schizophrenia symptoms. All these medications have been shown to be effective for schizophrenia. The main differences are in the potency—that is, the dosage (amount) prescribed to produce therapeutic effects—and the side effects. Some people might think that the higher the dose of medication prescribed, the more serious the illness; but this is not always true.
The first antipsychotic medications were introduced in the 1950s. Antipsychotic medications have helped many patients with psychosis lead a more normal and fulfilling life by alleviating such symptoms as hallucinations, both visual and auditory, and paranoid thoughts. However, the early antipsychotic medications often have unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements, leading researchers to continue their search for better drugs.
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The 1990s saw the development of several new drugs for schizophrenia, called "atypical antipsychotics." Because they have fewer side effects than the older drugs, today they are often used as a first-line treatment. The first atypical antipsychotic, clozapine (Clozaril), was introduced in the United States in 1990. In clinical trials, this medication was found to be more effective than conventional or "typical" antipsychotic medications in individuals with treatment-resistant schizophrenia (schizophrenia that has not responded to other drugs), and the risk of tardive dyskinesia (a movement disorder) was lower. However, because of the potential side effect of a serious blood disorder—agranulocytosis (loss of the white blood cells that fight infection)—patients who are on clozapine must have a blood test every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance on clozapine difficult for many people. Clozapine, however, continues to be the drug of choice for treatment-resistant schizophrenia patients.
Several other atypical antipsychotics have been developed since clozapine was introduced. The first was risperidone (Risperdal), followed by olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs.
All these medications have their place in the treatment of schizophrenia, and doctors will choose among them. They will consider the person's symptoms, age, weight, and personal and family medication history.
Dosages and Side Effects
Some drugs are very potent and the doctor may prescribe a low dose. Other drugs are not as potent and a higher dose may be prescribed.
Unlike some prescription drugs, which must be taken several times during the day, some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in "depot" forms that can be injected once or twice a month.
Most side effects of antipsychotic medications are mild. Many common ones lessen or disappear after the first few weeks of treatment. These include drowsiness, rapid heartbeat, and dizziness when changing position.
Some people gain weight while taking medications and need to pay extra attention to diet and exercise to control their weight. Other side effects may include a decrease in sexual ability or interest, problems with menstrual periods, sunburn, or skin rashes. If a side effect occurs, the doctor should be told. He or she may prescribe a different medication, change the dosage or schedule, or prescribe an additional medication to control the side effects.
Just as people vary in their responses to antipsychotic medications, they also vary in how quickly they improve. Some symptoms may diminish in days; others take weeks or months. Many people see substantial improvement by the sixth week of treatment. If there is no improvement, the doctor may try a different type of medication. The doctor cannot tell beforehand which medication will work for a person. Sometimes a person must try several medications before finding one that works.
If a person is feeling better or even completely well, the medication should not be stopped without talking to the doctor. It may be necessary to stay on the medication to continue feeling well. If, after consultation with the doctor, the decision is made to discontinue the medication, it is important to continue to see the doctor while tapering off medication. Many people with bipolar disorder, for instance, require antipsychotic medication only for a limited time during a manic episode until mood-stabilizing medication takes effect. On the other hand, some people may need to take antipsychotic medication for an extended period of time. These people usually have chronic (long-term, continuous) schizophrenic disorders, or have a history of repeated schizophrenic episodes, and are likely to become ill again. Also, in some cases a person who has experienced one or two severe episodes may need medication indefinitely. In these cases, medication may be continued in as low a dosage as possible to maintain control of symptoms. This approach, called maintenance treatment, prevents relapse in many people and removes or reduces symptoms for others.
Antipsychotic medications can produce unwanted effects when taken with other medications. Therefore, the doctor should be told about all medicines being taken, including over-the-counter medications and vitamin, mineral, and herbal supplements, and the extent of alcohol use. Some antipsychotic medications interfere with antihypertensive medications (taken for high blood pressure), anticonvulsants (taken for epilepsy), and medications used for Parkinson's disease. Other antipsychotics add to the effect of alcohol and other central nervous system depressants such as antihistamines, antidepressants, barbiturates, some sleeping and pain medications, and narcotics.
Long-term treatment of schizophrenia with one of the older, or "conventional," antipsychotics may cause a person to develop tardive dyskinesia (TD). Tardive dyskinesia is a condition characterized by involuntary movements, most often around the mouth. It may range from mild to severe. In some people, it cannot be reversed, while others recover partially or completely. Tardive dyskinesia is sometimes seen in people with schizophrenia who have never been treated with an antipsychotic medication; this is called "spontaneous dyskinesia."1 However, it is most often seen after long-term treatment with older antipsychotic medications. The risk has been reduced with the newer "atypical" medications. There is a higher incidence in women, and the risk rises with age. The possible risks of long-term treatment with an antipsychotic medication must be weighed against the benefits in each case. The risk for TD is 5 percent per year with older medications; it is less with the newer medications.
continue: Antimanic Medications
Bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Episodes may be predominantly manic or depressive, with normal mood between episodes. Mood swings may follow each other very closely, within days (rapid cycling), or may be separated by months to years. The "highs" and "lows" may vary in intensity and severity and can co-exist in "mixed" episodes.
When people are in a manic "high," they may be overactive, overly talkative, have a great deal of energy, and have much less need for sleep than normal. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. Their attention span is often short, and they can be easily distracted. Sometimes people who are "high" are irritable or angry and have false or inflated ideas about their position or importance in the world. They may be very elated, and full of grand schemes that might range from business deals to romantic sprees. Often, they show poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state.
In a depressive cycle the person may have a "low" mood with difficulty concentrating; lack of energy, with slowed thinking and movements; changes in eating and sleeping patterns (usually increases of both in bipolar depression); feelings of hopelessness, helplessness, sadness, worthlessness, guilt; and, sometimes, thoughts of suicide.
The medication used most often to treat bipolar disorder is lithium. Lithium evens out mood swings in both directions—from mania to depression, and depression to mania—so it is used not just for manic attacks or flare-ups of the illness but also as an ongoing maintenance treatment for bipolar disorder.
Although lithium will reduce severe manic symptoms in about 5 to 14 days, it may be weeks to several months before the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder. If given in the absence of lithium or another mood stabilizer, antidepressants may provoke a switch into mania in people with bipolar disorder.
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A person may have one episode of bipolar disorder and never have another, or be free of illness for several years. But for those who have more than one manic episode, doctors usually give serious consideration to maintenance (continuing) treatment with lithium.
Some people respond well to maintenance treatment and have no further episodes. Others may have moderate mood swings that lessen as treatment continues, or have less frequent or less severe episodes. Unfortunately, some people with bipolar disorder may not be helped at all by lithium. Response to treatment with lithium varies, and it cannot be determined beforehand who will or will not respond to treatment.
Regular blood tests are an important part of treatment with lithium. If too little is taken, lithium will not be effective. If too much is taken, a variety of side effects may occur. The range between an effective dose and a toxic one is small. Blood lithium levels are checked at the beginning of treatment to determine the best lithium dosage. Once a person is stable and on a maintenance dosage, the lithium level should be checked every few months. How much lithium people need to take may vary over time, depending on how ill they are, their body chemistry, and their physical condition.
Side Effects of Lithium
When people first take lithium, they may experience side effects such as drowsiness, weakness, nausea, fatigue, hand tremor, or increased thirst and urination. Some may disappear or decrease quickly, although hand tremor may persist. Weight gain may also occur. Dieting will help, but crash diets should be avoided because they may raise or lower the lithium level. Drinking low-calorie or no-calorie beverages, especially water, will help keep weight down. Kidney changes—increased urination and, in children, enuresis (bed wetting)—may develop during treatment. These changes are generally manageable and are reduced by lowering the dosage. Because lithium may cause the thyroid gland to become underactive (hypothyroidism) or sometimes enlarged (goiter), thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone may be given along with lithium.
Because of possible complications, doctors either may not recommend lithium or may prescribe it with caution when a person has thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies. Special caution should be taken during the first 3 months of pregnancy.
Anything that lowers the level of sodium in the body—reduced intake of table salt, a switch to a low-salt diet, heavy sweating from an unusual amount of exercise or a very hot climate, fever, vomiting, or diarrhea—may cause a lithium buildup and lead to toxicity. It is important to be aware of conditions that lower sodium or cause dehydration and to tell the doctor if any of these conditions are present so the dose can be changed.
Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics—substances that remove water from the body—increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, blurred vision, confusion, dizziness, muscle twitching, irregular heartbeat, and, ultimately, seizures. A lithium overdose can be life-threatening. People who are taking lithium should tell every doctor who is treating them, including dentists, about all medications they are taking.
With regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives.
continue: Anticonvulsant Medications
Some people with symptoms of mania who do not benefit from or would prefer to avoid lithium have been found to respond to anticonvulsant medications commonly prescribed to treat seizures.
The anticonvulsant valproic acid (Depakote, divalproex sodium) is the main alternative therapy for bipolar disorder. It is as effective in non-rapid-cycling bipolar disorder as lithium and appears to be superior to lithium in rapid-cycling bipolar disorder.2 Although valproic acid can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases valproic acid has caused liver dysfunction, liver function tests should be performed before therapy and at frequent intervals thereafter, particularly during the first 6 months of therapy.
Other anticonvulsants used for bipolar disorder include carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin), and topiramate (Topamax). The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder. Some studies suggest particular efficacy of lamotrigine in bipolar depression. At present, the lack of formal FDA approval of anticonvulsants other than valproic acid for bipolar disorder may limit insurance coverage for these medications.
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Most people who have bipolar disorder take more than one medication. Along with the mood stabilizer—lithium and/or an anticonvulsant—they may take a medication for accompanying agitation, anxiety, insomnia, or depression. It is important to continue taking the mood stabilizer when taking an antidepressant because research has shown that treatment with an antidepressant alone increases the risk that the patient will switch to mania or hypomania, or develop rapid cycling.5 Sometimes, when a bipolar patient is not responsive to other medications, an atypical antipsychotic medication is prescribed. Finding the best possible medication, or combination of medications, is of utmost importance to the patient and requires close monitoring by a doctor and strict adherence to the recommended treatment regimen.
continue: Antidepressant Medications
Major depression, the kind of depression that will most likely benefit from treatment with medications, is more than just "the blues." It is a condition that lasts 2 weeks or more, and interferes with a person's ability to carry on daily tasks and enjoy activities that previously brought pleasure. Depression is associated with abnormal functioning of the brain. An interaction between genetic tendency and life history appears to determine a person's chance of becoming depressed. Episodes of depression may be triggered by stress, difficult life events, side effects of medications, or medication/substance withdrawal, or even viral infections that can affect the brain.
Depressed people will seem sad, or "down," or may be unable to enjoy their normal activities. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening.
Not everyone who is depressed has all these symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person's quality of life can be greatly improved.
Antidepressants are used most often for serious depressions, but they can also be helpful for some milder depressions. Antidepressants are not "uppers" or stimulants, but rather take away or reduce the symptoms of depression and help depressed people feel the way they did before they became depressed.
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The doctor chooses an antidepressant based on the individual's symptoms. Some people notice improvement in the first couple of weeks; but usually the medication must be taken regularly for at least 6 weeks and, in some cases, as many as 8 weeks before the full therapeutic effect occurs. If there is little or no change in symptoms after 6 or 8 weeks, the doctor may prescribe a different medication or add a second medication such as lithium, to augment the action of the original antidepressant. Because there is no way of knowing beforehand which medication will be effective, the doctor may have to prescribe first one and then another. To give a medication time to be effective and to prevent a relapse of the depression once the patient is responding to an antidepressant, the medication should be continued for 6 to 12 months, or in some cases longer, carefully following the doctor's instructions. When a patient and the doctor feel that medication can be discontinued, withdrawal should be discussed as to how best to taper off the medication gradually. Never discontinue medication without talking to the doctor about it. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing more episodes.
Dosage of antidepressants varies, depending on the type of drug and the person's body chemistry, age, and, sometimes, body weight. Traditionally, antidepressant dosages are started low and raised gradually over time until the desired effect is reached without the appearance of troublesome side effects. Newer antidepressants may be started at or near therapeutic doses.
Early Antidepressants. From the 1960s through the 1980s, tricyclic antidepressants (named for their chemical structure) were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin. Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment. Other antidepressants introduced during this period were monoamine oxidase inhibitors (MAOIs). MAOIs are effective for some people with major depression who do not respond to other antidepressants. They are also effective for the treatment of panic disorder and bipolar depression. MAOIs approved for the treatment of depression are phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). Because substances in certain foods, beverages, and medications can cause dangerous interactions when combined with MAOIs, people on these agents must adhere to dietary restrictions. This has deterred many clinicians and patients from using these effective medications, which are in fact quite safe when used as directed.
The past decade has seen the introduction of many new antidepressants that work as well as the older ones but have fewer side effects. Some of these medications primarily affect one neurotransmitter, serotonin, and are called >selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa).
The late 1990s ushered in new medications that, like the tricyclics, affect both norepinephrine and serotonin but have fewer side effects. These new medications include venlafaxine (Effexor) and nefazadone (Serzone).
Other newer medications chemically unrelated to the other antidepressants are the sedating mirtazepine (Remeron) and the more activating bupropion (Wellbutrin). Wellbutrin has not been associated with weight gain or sexual dysfunction but is not used for people with, or at risk for, a seizure disorder.
Each antidepressant differs in its side effects and in its effectiveness in treating an individual person, but the majority of people with depression can be treated effectively by one of these antidepressants.
Side Effects of Antidepressant Medications
Antidepressants may cause mild, and often temporary, side effects (sometimes referred to as adverse effects) in some people. Typically, these are not serious. However, any reactions or side effects that are unusual, annoying, or that interfere with functioning should be reported to the doctor immediately. The most common side effects of tricyclic antidepressants, and ways to deal with them, are as follows:
- Dry mouth—it is helpful to drink sips of water; chew sugarless gum; brush teeth daily.
- Constipation—bran cereals, prunes, fruit, and vegetables should be in the diet.
- Bladder problems—emptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain.
- Sexual problems—sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor.
- Blurred vision—this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor.
- Dizziness—rising from the bed or chair slowly is helpful.
- Drowsiness as a daytime problem—this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness.
- Increased heart rate—pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.
The newer antidepressants, including SSRIs, have different types of side effects, as follows:
- Sexual problems—fairly common, but reversible, in both men and women. The doctor should be consulted if the problem is persistent or worrisome.
- Headache—this will usually go away after a short time.
- Nausea—may occur after a dose, but it will disappear quickly.
- Nervousness and insomnia (trouble falling asleep or waking often during the night)—these may occur during the first few weeks; dosage reductions or time will usually resolve them.
- Agitation (feeling jittery)—if this happens for the first time after the drug is taken and is more than temporary, the doctor should be notified.
- Any of these side effects may be amplified when an SSRI is combined with other medications that affect serotonin. In the most extreme cases, such a combination of medications (e.g., an SSRI and an MAOI) may result in a potentially serious or even fatal "serotonin syndrome," characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.
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The small number of people for whom MAOIs are the best treatment need to avoid taking decongestants and consuming certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles. The interaction of tyramine with MAOIs can bring on a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the individual should carry at all times. Other forms of antidepressants require no food restrictions. MAOIs also should not be combined with other antidepressants, especially SSRIs, due to the risk of serotonin syndrome.
Medications of any kind—prescribed, over-the-counter, or herbal supplements—should never be mixed without consulting the doctor; nor should medications ever be borrowed from another person. Other health professionals who may prescribe a drug—such as a dentist or other medical specialist—should be told that the person is taking a specific antidepressant and the dosage. Some drugs, although safe when taken alone, can cause severe and dangerous side effects if taken with other drugs. Alcohol (wine, beer, and hard liquor) or street drugs, may reduce the effectiveness of antidepressants and their use should be minimized or, preferably, avoided by anyone taking antidepressants. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants. The potency of alcohol may be increased by medications since both are metabolized by the liver; one drink may feel like two.
Although not common, some people have experienced withdrawal symptoms when stopping an antidepressant too abruptly. Therefore, when discontinuing an antidepressant, gradual withdrawal is generally advisable.
Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor and/or the pharmacist.
continue: Antianxiety Medications
Everyone experiences anxiety at one time or another — "butterflies in the stomach" before giving a speech or sweaty palms during a job interview are common symptoms. Other symptoms include irritability, uneasiness, jumpiness, feelings of apprehension, rapid or irregular heartbeat, stomachache, nausea, faintness, and breathing problems.
Anxiety is often manageable and mild, but sometimes it can present serious problems. A high level or prolonged state of anxiety can make the activities of daily life difficult or impossible. People may have generalized anxiety disorder (GAD) or more specific anxiety disorders such as panic, phobias, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD).
Both antidepressants and antianxiety medications are used to treat anxiety disorders. The broad-spectrum activity of most antidepressants provides effectiveness in anxiety disorders as well as depression. The first medication specifically approved for use in the treatment of OCD was the tricyclic antidepressant clomipramine (Anafranil). The SSRIs, fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft) have now been approved for use with OCD. Paroxetine has also been approved for social anxiety disorder (social phobia), GAD, and panic disorder; and sertraline is approved for panic disorder and PTSD. Venlafaxine (Effexor) has been approved for GAD.
Antianxiety medications include the benzodiazepines, which can relieve symptoms within a short time. They have relatively few side effects: drowsiness and loss of coordination are most common; fatigue and mental slowing or confusion can also occur. These effects make it dangerous for people taking benzodiazepines to drive or operate some machinery. Other side effects are rare.
Benzodiazepines vary in duration of action in different people; they may be taken two or three times a day, sometimes only once a day, or just on an "as-needed" basis. Dosage is generally started at a low level and gradually raised until symptoms are diminished or removed. The dosage will vary a great deal depending on the symptoms and the individual's body chemistry.
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It is wise to abstain from alcohol when taking benzodiazepines, because the interaction between benzodiazepines and alcohol can lead to serious and possibly life-threatening complications. It is also important to tell the doctor about other medications being taken.
People taking benzodiazepines for weeks or months may develop tolerance for and dependence on these drugs. Abuse and withdrawal reactions are also possible. For these reasons, the medications are generally prescribed for brief periods of time—days or weeks—and sometimes just for stressful situations or anxiety attacks. However, some patients may need long-term treatment.
It is essential to talk with the doctor before discontinuing a benzodiazepine. A withdrawal reaction may occur if the treatment is stopped abruptly. Symptoms may include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, or in extreme cases, seizures. A withdrawal reaction may be mistaken for a return of the anxiety because many of the symptoms are similar. After a person has taken benzodiazepines for an extended period, the dosage is gradually reduced before it is stopped completely. Commonly used benzodiazepines include clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
The only medication specifically for anxiety disorders other than the benzodiazepines is buspirone (BuSpar). Unlike the benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an antianxiety effect and therefore cannot be used on an "as-needed" basis.
Beta blockers, medications often used to treat heart conditions and high blood pressure, are sometimes used to control "performance anxiety" when the individual must face a specific stressful situation—a speech, a presentation in class, or an important meeting. Propranolol (Inderal, Inderide) is a commonly used beta blocker.
Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing.
In general, the information throughout this booklet applies to these groups, but the following are a few special points to keep in mind.
The 1999 MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 21 percent of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder that caused at least some impairment. When diagnostic criteria were limited to significant functional impairment, the estimate dropped to 11 percent, for a total of 4 million children who suffer from a psychiatric disorder that limits their ability to function.6
It is easy to overlook the seriousness of childhood mental disorders. In children, these disorders may present symptoms that are different from or less clear-cut than the same disorders in adults. Younger children, especially, and sometimes older children as well, may not talk about what is bothering them. For this reason, it is important to have a doctor, another mental health professional, or a psychiatric team examine the child.
Many treatments are available to help these children. The treatments include both medications and psychotherapy—behavioral therapy, treatment of impaired social skills, parental and family therapy, and group therapy. The therapy used is based on the child's diagnosis and individual needs.
When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, and others who have charge of the child) is essential. Children should be watched and questioned for side effects because many children, especially younger ones, do not volunteer information. They should also be monitored to see that they are actually taking the medication and taking the proper dosage on the correct schedule.
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Childhood-onset depression and anxiety are increasingly recognized and treated. However, the best-known and most-treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD). Children with ADHD exhibit symptoms such as short attention span, excessive motor activity, and impulsivity which interfere with their ability to function especially at school. The medications most commonly prescribed for ADHD are called stimulants. These include methylphenidate (Ritalin, Metadate, Concerta), amphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat), and pemoline (Cylert). Because of its potential for serious side effects on the liver, pemoline is not ordinarily used as a first-line therapy for ADHD. Some antidepressants such as bupropion (Wellbutrin) are often used as alternative medications for ADHD for children who do not respond to or tolerate stimulants.
Based on clinical experience and medication knowledge, a physician may prescribe to young children a medication that has been approved by the FDA for use in adults or older children. This use of the medication is called "off-label." Most medications prescribed for childhood mental disorders, including many of the newer medications that are proving helpful, are prescribed off-label because only a few of them have been systematically studied for safety and efficacy in children. Medications that have not undergone such testing are dispensed with the statement that "safety and efficacy have not been established in pediatric patients." The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The National Institutes of Health and the FDA are examining the issue of medication research in children and are developing new research approaches.
The use of the other medications described in this booklet is more limited with children than with adults. Therefore, a special list of medications for children, with the ages approved for their use, appears immediately after the general list of medications. Also listed are NIMH publications with more information on the treatment of both children and adults with mental disorders.
Persons over the age of 65 make up almost 13 percent of the population of the United States, but they receive 30 percent of prescriptions filled. The elderly generally have more medical problems, and many of them are taking medications for more than one of these conditions. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication.
The elderly are also more likely to take too much of a medication accidentally because they forget that they have taken a dose and take another one. The use of a 7-day pill-box, as described earlier in this brochure, can be especially helpful for an elderly person.
The elderly and those close to them—friends, relatives, caretakers—need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications—not only those prescribed but also over-the-counter preparations and home, folk, or herbal remedies—the possibility of adverse drug interactions is high.
Women During the Childbearing Years
Because there is a risk of birth defects with some psychotropic medications during early pregnancy, a woman who is taking such medication and wishes to become pregnant should discuss her plans with her doctor. In general, it is desirable to minimize or avoid the use of medication during early pregnancy. If a woman on medication discovers that she is pregnant, she should contact her doctor immediately. She and the doctor can decide how best to handle her therapy during and following the pregnancy. Some precautions that should be taken are:7
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- If possible, lithium should be discontinued during the first trimester (first 3 months of pregnancy) because of an increased risk of birth defects.
- If the patient has been taking an anticonvulsant such as carbamazepine (Tegretol) or valproic acid (Depakote)—both of which have a somewhat higher risk than lithium—an alternate treatment should be used if at all possible. The risks of two other anticonvulsants, lamotrigine (Lamictal) and gabapentin (Neurontin) are unknown. An alternative medication for any of the anticonvulsants might be a conventional antipsychotic or an antidepressant, usually an SSRI. If essential to the patient's health, an anticonvulsant should be given at the lowest dose possible. It is especially important when taking an anticonvulsant to take a recommended dosage of folic acid during the first trimester.
- Benzodiazepines are not recommended during the first trimester.
The decision to use a psychotropic medication should be made only after a careful discussion between the woman, her partner, and her doctor about the risks and benefits to her and the baby. If, after discussion, they agree it best to continue medication, the lowest effective dosage should be used, or the medication can be changed. For a woman with an anxiety disorder, a change from a benzodiazepine to an antidepressant might be considered. Cognitive-behavioral therapy may be beneficial in helping an anxious or depressed person to lower medication requirements. For women with severe mood disorders, a course of electroconvulsive therapy (ECT) is sometimes recommended during pregnancy as a means of minimizing exposure to riskier treatments.
After the baby is born, there are other considerations. Women with bipolar disorder are at particularly high risk for a postpartum episode. If they have stopped medication during pregnancy, they may want to resume their medication just prior to delivery or shortly thereafter. They will also need to be especially careful to maintain their normal sleep-wake cycle. Women who have histories of depression should be checked for recurrent depression or postpartum depression during the months after the birth of a child.
Women who are planning to breastfeed should be aware that small amounts of medication pass into the breast milk. In some cases, steps can be taken to reduce the exposure of the nursing infant to the mother's medication, for instance, by timing doses to post-feeding sleep periods. The potential benefits and risks of breastfeeding by a woman taking psychotropic medication should be discussed and carefully weighed by the patient and her physician.
A woman who is taking birth control pills should be sure that her doctor knows this. The estrogen in these pills may affect the breakdown of medications by the body—for example, increasing side effects of some antianxiety medications or reducing their ability to relieve symptoms of anxiety. Also, some medications, including carbamazepine and some antibiotics, and an herbal supplement, St. John's wort, can cause an oral contraceptive to be ineffective.
continue: List of all Psychiatric Medications
To find the section of the text that describes a particular medication in the lists below, find the generic trade (brand) name and look it up on the second list. If the name of the medication does not appear on the prescription label, ask the doctor or pharmacist for it. (Note: Some drugs are marketed under numerous trade names, not all of which can be listed in a short publication like this one. If your medication's trade name does not appear in the list—and some older medicines are no longer listed by trade names—look it up by its generic name or ask your doctor or pharmacist for more information. Stimulant medications that are used by both children and adults with ADHD are listed in the children's medications chart). (chemical) name and look it up on the first list or find the
- Alphabetical List of Medications by Generic Name
- Alphabetical List of Medications by Trade Name
- Children's Chart
Alphabetical List of Psychiatric Medications by Generic Name8
|Generic Name||Trade Name|
Combination Antipsychotic and Antidepressant Medication
|Symbyax (Prozac & Zyprexa)||fluoxetine & olanzapine|
|pimozide (for Tourette's syndrome)||Orap|
|divalproex sodium (valproic acid)||Depakote|
|lithium carbonate||Eskalith, Lithane, Lithobid|
|(All of these antianxiety medications except buspirone are benzodiazepines)|
|chlordiazepoxide||Librax, Libritabs, Librium|
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|Trade Name||Generic Name|
|Combination Antipsychotic and Antidepressant Medication|
|fluoxetine & olanzapine||Symbyax (Prozac & Zyprexa)|
|Orap (for Tourette's syndrome)||pimozide|
|Depakote||valproic acid, divalproex sodium|
|(All of these antianxiety medications except BuSpar are benzodiazepines)|
|Librax, Libritabs, Librium||chlordiazepoxide|
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|Trade Name||Generic Name||Approved Age|
|Adderall||amphetamine||3 and older|
|6 and older|
|6 and older|
|Cylert*||pemoline||6 and older|
|Dexedrine||dextroamphetamine||3 and older|
|Dextrostat||dextroamphetamine||3 and older|
|Focalin||dexmethylphenidate||6 and older|
|6 and older|
|Ritalin||methylphenidate||6 and older|
|*Because of its potential for serious side effects affecting the liver, Cylert should not
ordinarily be considered as first-line drug therapy for ADHD.
|Non-stimulant for ADHD|
|Strattera||atomoxetine||6 and older|
|Antidepressant and Antianxiety Medications|
|Anafranil||clomipramine||10 and older (for OCD)|
|BuSpar||buspirone||18 and older|
|Effexor||venlafaxine||18 and older|
|Luvox (SSRI)||fluvoxamine||8 and older (for OCD)|
|Paxil (SSRI)||paroxetine||18 and older|
|Prozac (SSRI)||fluoxetine||18 and older|
|Serzone (SSRI)||nefazodone||18 and older|
|Sinequan||doxepin||12 and older|
|Tofranil||imipramine||6 and older (for bedwetting)|
|Wellbutrin||bupropion||18 and older|
|Zoloft (SSRI)||sertraline||6 and older (for OCD)|
|Clozaril (atypical)||clozapine||18 and older|
|Haldol||haloperidol||3 and older|
|Risperdal (atypical)||risperidone||18 and older|
|Seroquel (atypical)||quetiapine||18 and older|
|Mellaril||thioridazine||2 and older|
|Zyprexa (atypical)||olanzapine||18 and older|
|Orap||pimozide||12 and older (for Tourette's
syndrome—Data for age 2 and
older indicate similar safety profile)
|Mood Stabilizing Medications|
|Cibalith-S||lithium citrate||12 and older|
|Depakote||valproic acid||2 and older (for seizures)|
|Eskalith||lithium carbonate||12 and older|
|Lithobid||lithium carbonate||12 and older|
|Tegretol||carbamazepine||any age (for seizures)|
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1. Fenton WS. Prevalence of spontaneous dyskinesia in schizophrenia. Journal of Clinical Psychiatry, 2000; 62 (suppl 4): 10-14.
2. Bowden CL, Calabrese JR, McElroy SL, Gyulai L, Wassef A, Petty F, et al. For the Divalproex Maintenance Study Group. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Archives of General Psychiatry, 2000; 57(5): 481-489.
3. VainionpÃ¤Ã¤ LK, RÃ¤ttyÃ¤ J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, et al. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-450.
4. Soames JC. Valproate treatment and the risk of hyperandrogenism and polycystic ovaries. Bipolar Disorder, 2000; 2(1): 37-41.
5. Thase ME, and Sachs GS. Bipolar depression: Pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 2000; 48(6): 558-572.
6. Department of Health and Human Services. 1999. Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Mental Health.
7. Altshuler LL, Cohen L, Szuba MP, Burt VK, Gitlin M, and Mintz J. Pharmacologic management of psychiatric illness during pregnancy: Dilemmas and guidelines. American Journal of Psychiatry, 1996; 153(5): 592-606.
8. Physicians' Desk Reference, 54th edition. Montavale, NJ: Medical Economics Data Production Co. 2000.
This addendum to the booklet Medications for Mental Illness (2005) was prepared to provide updated information on medications in the booklet and results of recent research on medications. This addendum also applies to the Medications Web page document.
Nefazodone — brand name Serzone
The manufacturer discontinued sales of the antidepressant in the U.S. effective June 14, 2004.
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FDA Warnings and Antidepressant Medications
Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2% of those receiving placebos.
This information prompted the FDA, in 2005, to adopt a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A "black box" warning is the most serious type of warning on prescription drug labeling.
The warning emphasizes that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the physician. The latest information from the FDA can be found on their Web site at www.fda.gov.
Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.28 The study was funded in part by the National Institute of Mental Health.
Also, the FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly-used "triptan" medications for migraine headache could cause a life-threatening "serotonin syndrome," marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. Although most dramatic in the case of the MAOIs, newer antidepressants may also be associated with potentially dangerous interactions with other medications.
Below are further details concerning side effects of antipsychotic medications found on pages 5 and 6 in the original Medications for Mental Illness booklet. The medications discussed below are primarily used to treat schizophrenia or other psychotic disorders.
The typical (conventional) antipsychotic medications include chlorpromazine (Thorazine®), haloperidol (Haldol®), perphenazine (Etrafon, Trilafon®), and fluphenzine (Prolixin®). The typical medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.
In the 1990s, atypical (second generation) antipsychotics were developed that are less likely to produce these side effects. The first of these was clozapine (Clozaril®, Prolixin®), introduced in 1990. It treats psychotic symptoms effectively even in people who do not respond to other medications. However, it can produce a serious but rare problem called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, patients who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people, but it is the drug of choice for those whose symptoms do not respond to other typical and atypical antipsychotic medications.
After clozapine was introduced, other atypical antipsychotics were developed, such as risperidone (Risperdal®), olanzapine (Zyprexa®), quietiapine (Seroquel®) and ziprasidone (Geodon®). The newest atypicals include aripiprazole (Abilify®) and paliperidone (Invega®). All are effective and are less likely to produce extrapyramidal symptoms or agranulocytosis. However, they can cause weight gain, which may result in an increased risk of diabetes and high cholesterol level.1,2
The FDA has determined that the treatment of behavioral disorders in elderly patients with atypical (second generation) antipsychotic medications is associated with increased mortality. These medications are not approved by the FDA for the treatment of behavioral disorders in patients with dementia.
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Children and Psychiatric Medications
In October 2006, the FDA approved risperidone (Risperdal®) for the symptomatic treatment of irritability in autistic children and adolescents ages 5 to 16. The approval is the first for the use of a drug to treat behaviors associated with autism in children. These behaviors are included under the general heading of irritability, and include aggression, deliberate self-injury and temper tantrums.
Fluoxetine (Prozac®) and sertraline (Zoloft®) are approved by the FDA for children age 7 and older with obsessive-compulsive disorder. Fluoxetine is also approved for children age 8 and older for the treatment of depression. Fluoxetine and sertraline are selective serotonin reuptake inhibitors (SSRIs). See above for the (FDA) warning concerning SSRIs and other antidepressants.
Research on Medications
In recent years, NIMH has conducted large scale clinical trials to identify effective treatments for schizophrenia, depression, and bipolar disorder. Researchers also wanted to determine the long- term success of different treatments and provide options for patients and clinicians that are based on sound research. The studies were held in many sites across the country to reflect the diversity of real world clinical settings. Details about these studies can be found by clicking on the links below. As additional information about the results of these studies becomes available, updates will be added to the NIMH Web site.
Clinical Antipsychotic Trials of Intervention Effectiveness Study (CATIE)
CATIE compared the effectiveness of typical antipsychotic medications (first available in the 1950s) and atypical antipsychotic medications (available since the 1990s) used to treat schizophrenia.
Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
The main goal of STAR*D was to identify the best "next steps" for people with depression who need to try more than one treatment when the first does not work.
Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
STEP-BD aimed to obtain long-term data on the chronic, recurrent course of bipolar disorder; identify the best treatments for those with the disorder; obtain data for predicting recurrence of a manic or depressive episode; and study whether adding any one of three medications improved the outcomes for patients with treatment-resistant bipolar disorder.
Treatments for Adolescents with Depression Study (TADS)
TADS compared the use of cognitive-behavioral therapy (CBT) alone, medication (fluoxetine) alone, or a combination of both treatments in adolescents with depression.
These studies provide answers to many, but not all questions about treatment options and help further the understanding of these disorders. NIMH will continue to investigate various approaches to understanding these and other disorders, as well as identify treatments that meet the individual needs of patients.
List of Antidepressant Medications
List of drugs receiving a "black box" warning, other product labeling changes, and a Medication Guide pertaining to pediatric suicidality:
- Anafranil (clomipramine)
- Asendin (amoxapine)
- Aventyl (nortriptyline)
- Celexa (citalopram hydrobromide)
- Cymbalta (duloxetine)
- Desyrel (trazodone HCl)
- Effexor (venlafaxine HCl)
- Elavil (amitriptyline)
- Etrafon (perphenazine/amitriptyline)
- fluvoxamine maleate
- Lexapro (escitalopram hydrobromide)
- Limbitrol (chlordiazepoxide/amitriptyline)
- Ludiomil (maprotiline)
- Marplan (isocarboxazid)
- Nardil (phenelzine sulfate)
- Norpramin (desipramine HCl)
- Pamelor (nortriptyline)
- Parnate (tranylcypromine sulfate)
- Paxil (paroxetine HCl)
- Pexeva (paroxetine mesylate)
- Prozac (fluoxetine HCl)
- Remeron (mirtazapine)
- Sarafem (fluoxetine HCl)
- Serzone (nefazodone HCl)
- Sinequan (doxepin)
- Surmontil (trimipramine)
- Symbyax (olanzapine/fluoxetine)
- Tofranil (imipramine)
- Tofranil-PM (imipramine pamoate)
- Triavil (perphenazine/amitriptyline)
- Vivactil (protriptyline)
- Wellbutrin (bupropion HCl)
- Zoloft (sertraline HCl)
- Zyban (bupropion HCl)
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For comprehensive information on psychiatric medications visit the HealthyPlace.com Psychiatric Medications Pharmacology Center here.
1Marder SR, Essock SM, Miller AL, et al. Physical Health Monitoring of Patients With Schizophrenia. Am J Psychiatry. August 2004;161(8):1334-1349.
2Newcomer JW. Clinical considerations in selecting and using atypical antipsychotics. CNS Spect. Aug 2005;10(8 Suppl 8):12-20.
Source: National Institute of Mental Health (NIMH) Medications Publication. Updated June 2008.
- Written by National Institute of Mental Health
Mental health patient rights agreed to by major organizations representing psychiatrists, psychologists, and other mental health therapists.
A Joint Initiative of Mental Health Professional Organizations
Principles for the Provision of Mental Health and Substance Abuse Treatment Services A Bill of Rights
Our commitment is to provide quality mental health and substance abuse services to all individuals without regard to race, color, religion, national origin, gender, age, sexual orientation, or disabilities.
Right to Know
Individuals have the right to be provided information from the purchasing entity (such as employer or union or public purchaser) and the insurance/third party payer describing the nature and extent of their mental health and substance abuse treatment benefits. This information should include details on procedures to obtain access to services, on utilization management procedures, and on appeal rights. The information should be presented clearly in writing with language that the individual can understand.
Individuals have the right to receive full information from the potential treating professional about that professional's knowledge, skills, preparation, experience, and credentials. Individuals have the right to be informed about the options available for treatment interventions and the effectiveness of the recommended treatment.
Individuals have the right to be informed by the treating professional of any arrangements, restrictions, and/or covenants established between third party payer and the treating professional that could interfere with or influence treatment recommendations. Individuals have the right to be informed of the nature of information that may be disclosed for the purposes of paying benefits.
Appeals and Grievances
Individuals have the right to receive information about the methods they can use to submit complaints or grievances regarding provision of care by the treating professional to that profession's regulatory board and to the professional association.
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Individuals have the right to be provided information about the procedures they can use to appeal benefit utilization decisions to the third party payer systems, to the employer or purchasing entity, and to external regulatory entities.
Individuals have the right to be guaranteed the protection of the confidentiality of their relationship with their mental health and substance abuse professional, except when laws or ethics dictate otherwise. Any disclosure to another party will be time limited and made with the full written, informed consent of the individuals. Individuals shall not be required to disclose confidential, privileged or other information other than: diagnosis, prognosis, type of treatment, time and length of treatment, and cost.
Entities receiving information for the purposes of benefits determination, public agencies receiving information for health care planning, or any other organization with legitimate right to information will maintain clinical information in confidence with the same rigor and be subject to the same penalties for violation as is the direct provider of care.
Information technology will be used for transmission, storage, or data management only with methodologies that remove individual identifying information and assure the protection of the individual's privacy. Information should not be transferred, sold or otherwise utilized.
Individuals have the right to choose any duly licensed/certified professional for mental health and substance abuse services. Individuals have the right to receive full information regarding the education and training of professionals, treatment options (including risks and benefits), and cost implications to make an informed choice regarding the selection of care deemed appropriate by individual and professional.
Determination of Treatment
Recommendations regarding mental health and substance abuse treatment shall be made only by a duly licensed/certified professional in conjunction with the individual and his or her family as appropriate. Treatment decisions should not be made by third party payers. The individual has the right to make final decisions regarding treatment.
Individuals have the right to receive benefits for mental health and substance abuse treatment on the same basis as they do for any other illnesses, with the same provisions, co-payments, lifetime benefits, and catastrophic coverage in both insurance and self-funded/self-insured health plans.
Individuals who use mental health and substance abuse benefits shall not be penalized when seeking other health insurance or disability, life or any other insurance benefit.
The individual is entitled to the entire scope of the benefits within the benefit plan that will address his or her clinical needs.
Whenever both federal and state law and/or regulations are applicable, the professional and all payers shall use whichever affords the individual the greatest level of protection and access.
To assure that treatment review processes are fair and valid, individuals have the right to be guaranteed that any review of their mental health and substance abuse treatment shall involve a professional having the training, credentials and licensure required to provide the treatment in the jurisdiction in which it will be provided. The reviewer should have no financial interest in the decision and is subject to the section on confidentiality.
Treating professionals may be held accountable and liable to individuals for any injury caused by gross incompetence or negligence on the part of the professional. The treating professional has the obligation to advocate for and document necessity of care and to advise the individual of options if payment authorization is denied.
Payers and other third parties may be held accountable and liable to individuals for any injury caused by gross incompetence or negligence or by their clinically unjustified decisions.
American Association for Marriage and Family Therapy (membership: 25,000)
American Counseling Association (membership: 56,000)
American Family Therapy Academy (membership: (1,000)
American Nurses Association (membership: 180,000)
American Psychological Association (membership: 142,000)
American Psychiatric Association (membership: 36,000)
American Psychiatric Nurses Association (membership: 3,000)
National Association of Social Workers (membership: 155,000), National Federation of Societies for Clinical Social Work (membership: 11,000)
Mental Health America.
National Depressive and Manic-Depressive Association
American Group Psychotherapy Association
American Psychoanalytic Association
National Association of Drug and Alcohol Abuse Counselors
For comprehensive information on Mental Illness, visit the HealthyPlace.com Mental Illness Information Center here.
Complete list of psychiatric disorders and the adult symptoms of mental health disorders. Also overviews of mental illness, anxiety disorders, depression, childhood psychiatric disorders and more.
Just a note of caution:
This list is intended for use by adults only. It is not meant to replace a doctor's or licensed mental health professional's diagnosis, advice and care. Please keep in mind, that just because a person exhibits certain symptoms of a disorder, it does not necessarily mean the individual is afflicted with the disorder. (It may be confusing, but certain symptoms can be associated with any number of disorders.) Only a trained doctor or licensed mental health professional can make that diagnosis and assessment. If you have any questions regarding mental health symptoms (symptoms of psychiatric disorders), we suggest you contact your doctor or a licensed mental health professional.
Remember, the psychiatric symptom's list is strictly intended as an educational tool and it's use for any other purpose is strictly prohibited. Also, keep in mind, the symptom's list is not complete and covers mostly symptoms of adult psychiatric disorders. It is meant to give our visitors some insight into various mental health disorders.
List of Adult Psychiatric Disorders
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- Written by HealthyPlace.com Staff Writer
How do you know if you're being abused? Definition and warning signs of domestic violence plus mental health effects of domestic violence.
What Is Domestic Violence?
Domestic violence is control by one partner over another in a dating, marital or live-in relationship. The means of control include physical, sexual, emotional and economic abuse, threats and isolation.
Survivors face many obstacles in trying to end the abuse in their lives although most are able to...psychological and economic entrapment, physical isolation and lack of social support, religious and cultural values, fear of social judgment, threats and intimidation over custody or separation, immigration status or disabilities and lack of viable alternatives. Increased public, legal and healthcare awareness and improved community resources enable survivors to rebuild their lives.
Who Is Affected by Domestic Violence?
Domestic violence occurs in every culture, country and age group. It affects people from all socioeconomic, educational and religious backgrounds and takes place in same sex as well as heterosexual relationships. Women with fewer resources or greater perceived vulnerability—girls and those experiencing physical or psychiatric disabilities or living below the poverty line—are at even greater risk for domestic violence and lifetime abuse. Children are also affected by domestic violence, even if they do not witness it directly.
How Do You Know if You Are Being Abused?
Abusers use many ways to isolate, intimidate and control their partners. It starts insidiously and may be difficult to recognize. Early on, your partner may seem attentive, generous and protective in ways that later turn out to be frightening and controlling. Initially the abuse is isolated incidents for which your partner expresses remorse and promises never to do again or rationalizes as being due to stress or caused by something you did or didn't do.
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EARLY WARNING SIGNS OF ABUSE:
- Quick whirlwind romance
- Wanting to be with you all the time; tracking what you're doing and who you're with
- Jealousy at any perceived attention to or from others
- Attempts to isolate you in the guise of loving behavior (You don't need to work or go to school; we only need each other, criticizing friends/family for not caring about you)
- Hypersensitivity to perceived slights
- Quick to blame others for the abuse
- Pressures you into doing things you aren't comfortable with (If you really love me, you'll do this for me)
QUESTIONS TO ASK YOURSELF:
- Are you ever afraid of your partner?
- Has your partner ever actually hurt or threatened to hurt you physically or someone you care about?
- Does your partner ever force you to engage in sexual activities that make you uncomfortable?
- Do you constantly worry about your partner's moods and change your behavior to deal with them?
- Does your partner try to control where you go, what you do and who you see?
- Does your partner constantly accuse you of having affairs?
- Have you stopped seeing family or friends to avoid your partner's jealousy or anger?
- Does your partner control your finances?
- Does he/she threaten to kill him/herself if you leave?
- Does your partner claim his/her temper is out of control due to alcohol, drugs or because he/she had an abusive childhood?
If you answer yes to some or all of these questions, you could be suffering abuse. Remember you are not to blame and you need not face domestic violence alone.
How Common Is Domestic Violence?
According to a National Violence Against Women Survey, 22 percent of women are physically assaulted by a partner or date during their lifetime and nearly 5.3 million partner victimizations occur each year among U.S. women ages 18 and older, resulting in two million injuries and 1,300 deaths.
- Nearly 25 percent of women have been raped and/or physically assaulted by an intimate partner during their lives.
- 15.4 percent of gay men, 11.4 percent of lesbians and 7.7 percent of heterosexual men, are assaulted by a date or intimate partner during their lives.
- More than 1 million women and 371,000 men are stalked by partners each year.
What Are the Mental Health Effects of Domestic Violence?
MENTAL HEALTH EFFECT
Domestic violence can lead to other common emotional traumas such as depression, anxiety, panic attacks, substance abuse and posttraumatic stress disorder. Abuse can trigger suicide attempts, psychotic episodes, homelessness and slow recovery from mental illness. Children exposed to domestic violence are at risk for developmental problems, psychiatric disorders, school difficulties, aggressive behavior, and low self-esteem. These factors can make it difficult for survivors to mobilize resources. Nonetheless, many domestic violence survivors do not need mental health treatment and many symptoms resolve once they and their children are safe and have support. For others, treatment is in their plan for safety and recovery.
What You Can Do if You Are Being Abused
While you cannot stop your partner's abuse—only he or she can do that—you can find help and support for yourself.
- Talk with someone you trust: a friend or relative, a neighbor, coworker or religious or spiritual advisor. Tell your physician, nurse, psychiatrist or therapist about the abuse.
- Call the National Domestic Violence Hotline [1-800-799-SAFE (7233)], your state domestic violence coalition, and/or a local domestic violence agency.
- Call the police if you are in danger.
- Remember, you know your situation better than anyone else. Don't let someone talk you into doing something that isn't right for you.
For comprehensive information on domestic violence and other forms of abuse, visit the HealthyPlace.com Abuse Community.
For more information, please contact:
American Psychiatric Association (APA)
1000 Wilson Blvd., Suite 1825
Arlington, VA 22209
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National Domestic Violence
Hotline: 800-799-SAFE (7233)
or 800-787-3224 (TTY)
National Coalition Against Domestic Violence
National Network to End Domestic Violence
The Family Violence Prevention Fund
National Resource Center on Domestic Violence
The Battered Women's Justice Project
The Domestic Violence and Mental Health Policy Initiative
Rape Abuse and Incest National Network (RAINN)
Source: American Psychiatric Association fact sheet on Domestic Violence. April 2005.
- Written by HealthyPlace.com Staff Writer
Thorough overview of Post-traumatic Stress Disorder (PTSD). Description of PTSD- PTSD symptoms and causes, treatment for PTSD.
What is Post-traumatic Stress Disorder (PTSD)
It's been called shell shock, battle fatigue, accident neurosis and post rape syndrome. It has often been misunderstood or misdiagnosed, even though the disorder has very specific symptoms that form a definite psychological syndrome.
The disorder is post-traumatic stress disorder (PTSD) and it affects hundreds of thousands of people who have been exposed to violent events such as rape, domestic violence, child abuse, war, accidents, natural disasters and political torture. Psychiatrists estimate that up to one to three percent of the population have clinically diagnosable PTSD. Still more show some symptoms of the disorder. While it was once thought to be a disorder of war veterans who had been involved in heavy combat, researchers now know that PTSD can result from many types of trauma, particularly those that include a threat to life. It afflicts both females and males.
In some cases the symptoms of PTSD disappear with time, while in others they persist for many years. PTSD often occurs with other psychiatric illnesses, such as depression.
Not all people who experience trauma require treatment; some recover with the help of family, friends, a pastor or rabbi. But many do need professional help to successfully recover from the psychological damage that can result from experiencing, witnessing or participating in an overwhelmingly traumatic event.
Although the understanding of post-traumatic stress disorder is based primarily on studies of trauma in adults, PTSD also occurs in children as well. It is known that traumatic occurrences--sexual or physical abuse,loss of parents, the disaster of war--often have a profound impact on the lives of children. In addition to PTSD symptoms, children may develop learning disabilities and problems with attention and memory. They may become anxious or clinging, and may also abuse themselves or others.
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The symptoms of PTSD may initially seem to be part of a normal response to an overwhelming experience. Only if those symptoms persist beyond three months do we speak of them being part of a disorder. Sometimes the disorder surfaces months or even years later. Psychiatrists categorize PTSD's symptoms in three categories: intrusive symptoms, avoidant symptoms, and symptoms of hyperarousal.
Often people suffering from PTSD have an episode where the traumatic event "intrudes" into their current life. This can happen in sudden, vivid memories that are accompanied by painful emotions. Sometimes the trauma is "re-experienced." This is called a flashback_a recollection that is so strong that the individual thinks he or she is actually experiencing the trauma again or seeing it unfold before his or her eyes. In traumatized children, this reliving of the trauma often occurs in the form of repetitive play.
At times, the re-experiencing occurs in nightmares. In young children, distressing dreams of the traumatic event may evolve into generalized nightmares of monsters, of rescuing others or of threats to self or others.
At times, the re-experience comes as a sudden, painful onslaught of emotions that seem to have no cause. These emotions are often of grief that brings tears, fear or anger. Individuals say these emotional experiences occur repeatedly, much like memories or dreams about the traumatic event.
Symptoms of Avoidance
Another set of symptoms involves what is called avoidance phenomena. This affects the person's relationships with others, because he or she often avoids close emotional ties with family, colleagues and friends. The person feels numb, has diminished emotions and can complete only routine, mechanical activities. When the symptoms of "re-experiencing" occur, people seem to spend their energies on suppressing the flood of emotions. Often, they are incapable of mustering the necessary energy to respond appropriately to their environment: people who suffer post-traumatic stress disorder frequently say they can't feel emotions, especially toward those to whom they are closest. As the avoidance continues, the person seems to be bored, cold or preoccupied. Family members often feel rebuffed by the person because he or she lacks affection and acts mechanically.
Emotional numbness and diminished interest in significant activities may be difficult concepts to explain to a therapist. This is especially true for children. For this reason, the reports of family members, friends, parents,teachers and other observers are particularly important.
The person with PTSD also avoids situations that are reminders of the traumatic event because the symptoms may worsen when a situation or activity occurs that reminds them of the original trauma. For example, aperson who survived a prisoner-of-war camp might overreact to seeing people wearing uniforms. Over time, people can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them.
Others--many war veterans, for example--avoid accepting responsibility for others because they think they failed in ensuring the safety of people who did not survive the trauma. Some people also feel guilty because they survived a disaster while others--particularly friends or family--did not. In combat veterans or with survivors of civilian disasters, this guilt may be worse if they witnessed or participated in behavior that was necessary to survival but unacceptable to society. Such guilt can deepen depression as the person begins to look on him or herself as unworthy, a failure, a person who violated his or her pre-disaster values. Children suffering from PTSD may show a marked change in orientation toward the future. A child may, for example, not expect to marry or have a career. Or he or she may exhibit "omen formation," the belief in an ability to predict future untoward events.
PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings.
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Symptoms of Hyperarousal
PTSD can cause those who suffer with it to act as if they are threatened by the trauma that caused their illness. People with PTSD may become irritable. They may have trouble concentrating or remembering current information, and may develop insomnia. Because of their chronic hyperarousal, many people with PTSD have poor work records, trouble with their bosses and poor relationships with their family and friends.
The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding.At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated. Many traumatized children and adults may have physical symptoms, such as stomachaches and headaches, in addition to symptoms of increased arousal.
Other Associated Features
Many people with PTSD also develop depression and may at times abuse alcohol or other drugs as a "self-medication" to blunt their emotions and forget the trauma. A person with PTSD may also show poor control over his or her impulses, and may be at risk for suicide.
Treatment for PTSD
Psychiatrists and other mental health professionals today have effective psychological and pharmacological treatments available for PTSD. These treatments can restore a sense of control and diminish the power of past events over current experience. The sooner people are treated, the more likely they are to recover from a traumatizing experience. Appropriate therapy can help with other chronic trauma-related disorders, too.
Psychiatrists help people with PTSD by helping them to accept that the trauma happened to them, without being overwhelmed by memories of the trauma and without arranging their lives to avoid being reminded of it.
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It is important to re-establish a sense of safety and control in the PTSD sufferer's life. This helps him or her to feel strong and secure enough to confront the reality of what has happened. In people who have been badlytraumatized, the support and safety provided by loved ones is critical. Friends and family should resist the urge to tell the traumatized person to "snap out of it," instead allowing time and space for intense grief and mourning. Being able to talk about what happened and getting help with feelings of guilt, self-blame, and rage about the trauma usually is very effective in helping people put the event behind them. Psychiatrists know that loved ones can make a significant difference in the long-term outcome of the traumatized person by being active participants in creating a treatment plan--helping him or her to communicate and anticipating what he or she needs to restore a sense of equilibrium to his or her life. If treatment is to be effective it is important, too, that the traumatized person feel that he or she is a part of this planning process.
Sleeplessness and other symptoms of hyperarousal may interfere with recovery and increase preoccupation with the traumatizing experience. Psychiatrists have several medications--including benzodiazepines and the new class of serotonin re-uptake blockers--that can help people to sleep and to cope with their hyperarousal symptoms. These medications, as part of an integrated treatment plan, can help the traumatized person to avoid the development of long-term psychological problems.
In people whose trauma occurred years or even decades before, the professionals who treat them must pay close attention to the behaviors--often deeply entrenched--which the PTSD sufferer has evolved to cope with his or her symptoms. Many people whose trauma happened long ago have suffered in silence with PTSD's symptoms without ever having been able to talk about the trauma or their nightmares, hyperarousal, numbing, or irritability. During treatment, being able to talk about what has happened and making the connection between past trauma and current symptoms provides people with the increased sense of control they need to manage their current lives and have meaningful relationships.
Relationships are often a trouble spot for people with PTSD. They often resolve conflicts by withdrawing emotionally or even by becoming physically violent. Therapy can help PTSD sufferers to identify and avoid unhealthy relationships. This is vital to the healing process; only after the feeling of stability and safety is established can the process of uncovering the roots of the trauma begin.
To make progress in easing flashbacks and other painful thoughts and feelings, most PTSD sufferers need to confront what has happened to them, and by repeating this confrontation, learn to accept the trauma as part of their past. Psychiatrists and other therapists use several techniques to help with this process.
One important form of therapy for those who struggle with post-traumatic stress disorder is cognitive/behavior therapy. This is a form of treatment that focuses on correcting the PTSD sufferer's painful and intrusive patterns of behavior and thought by teaching him or her relaxation techniques, and examining (and challenging) his or her mental processes. A therapist using behavior therapy to treat a person with PTSD might, for example, help a patient who is provoked into panic attacks by loud street noises by setting a schedule that gradually exposes the patient to such noises in a controlled setting until he or she becomes "desensitized" and thus is no longer so prone to terror. Using other such techniques, patient and therapist explore the patient's environment to determine what might aggravate the PTSD symptoms and work to reduce sensitivity or to learn new coping skills.
Psychiatrists and other mental health professionals also treat cases of PTSD by using psychodynamic psychotherapy. Post-traumatic stress disorder results, in part, from the difference between the individual's personal values or view of the world and the reality that he or she witnessed or lived during the traumatic event. Psychodynamic psychotherapy, then, focuses on helping the individual examine personal values and how behavior and experience during the traumatic event violated them. The goal is resolution of the conscious and unconscious conflicts that were thus created. In addition, the individual works to build self-esteem and self-control, develops a good and reasonable sense of personal accountability and renews a sense of integrity and personal pride.
Whether PTSD sufferers are treated by therapists who use cognitive/behavioral treatment or psychodynamic treatment, traumatized people need to identify the triggers for their memories of trauma, as well as identifying those situations in their lives in which they feel out of control and the conditions that need to exist for them to feel safe. Therapists can help people with PTSD to construct ways of coping with the hyperarousal and painful flashbacks that come over them when they are around reminders of the trauma. The trusting relationship between patient and therapist is crucial in establishing this necessary feeling of safety. Medications can help in this process also.
Group therapy can be an important part of treatment for PTSD. Trauma often affects people's ability to form relationships--especially such traumas as rape or domestic violence. It can profoundly affect their basic assumption that the world is a safe and predictable place, leaving them feeling alienated and distrustful, or else anxiously clinging to those closest to them. Group therapy helps people with PTSD to regain trust and a sense of community, andto regain their ability to relate in healthy ways to other people in a controlled setting.
Most PTSD treatment is done on an outpatient basis. However, for people whose symptoms are making it impossible to function or for people who have developed additional symptoms as a result of their PTSD, inpatient treatment is sometimes necessary to create the vital atmosphere of safety in which they can examine their flashbacks, re-enactments of the trauma, and self-destructive behavior. Inpatient treatment is also important for PTSD sufferers who have developed alcohol or other drug problems as a result oftheir attempts to "self medicate." Occasionally too, inpatient treatment can be very useful in helping a PTSD patient to get past a particularly painful period of their therapy.
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The recognition of PTSD as a major health problem in this country is quite recent. Over the past 15 years, research has produced a major explosion of knowledge about the ways people deal with trauma--what places them at risk for development of long-term problems, and what helps them to cope. Psychiatrists and other mental health professionals are working hard to disseminate this understanding, and an increasing number of mental healthprofessionals are receiving specialized training to help them reach out to people with Post-traumatic Stress Disorder in their communities.
For comprehensive information on post-traumatic stress disorder (PTSD) and other anxiety disorders, visit the HealthyPlace.com Anxiety-Panic Community.
(c) Copyright 1988 American Psychiatric Association
Produced by the APA Joint Commission on Public Affairs and the Division of Public Affairs. This document contains the text of a pamphlet developed for educational purposes and does not necessarily reflect opinion or policy of the American Psychiatric Association.
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continue:PTSD Resources-Phone Numbers
van der Kolk, B.A. Psychological Trauma. Washington, DC: American Psychiatric Press, Inc., 1987.
van der Kolk, B.A. "Group Therapy with Traumatic Stress Disorder," in Comprehensive Textbook of Group Psychotherapy, Kaplan, HI and Sadock, BJ, Eds. New York: Williams & Wilkins, 1993.
Anxiety Disorders Association of America, Inc.
International Society for Traumatic Stress Studies
National Center for Child Abuse and Neglect
National Center for Post-traumatic Stress Disorder
National Institute of Mental Health
National Organization for Victim Assistance
U.S. Veterans Administration-Readjustment Counseling Service
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