Understanding Psychotropic Drugs

Psychotropic drugs are medications that alter mood, perception, and behavior. When used in combination with psychotherapy, psychotropic drugs can be powerful tools in managing conditions such as borderline personality disorder (BPD), anxiety, bipolar disorder, depression, and schizophrenia.

About 20% of respondents in the 2020 National Health Interview Survey (NHIS) reported taking psychotropic drugs.

How Psychotropics Work

Psychotropic drugs help control symptoms of mental illness such as mood swings, explosive anger, hallucinations and delusions, and other issues that can interfere with therapy. With these symptoms under better control, you can focus on developing skills to cope with and better manage your mental health.

Psychotropic drugs work by altering the balance of neurotransmitters such as serotonin, dopamine, and γ-Aminobutyric acid (GABA) in your body. These chemical messengers carry signals between your organs to help regulate their functions.

In the brain, they help neurons communicate with each other to control mood, concentration, perception, and other aspects of brain function. They're specific to the cells they target.

Types of Psychotropic Medicines

Depending on your mental health condition and symptoms, your healthcare provider might prescribe one of the following types of psychotropics.

Antidepressants

The five main categories of antidepressants (and examples of each) are:

• Selective serotonin reuptake inhibitors (SSRIs): Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), Viibryd (vilazodone), Zoloft (sertraline)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): Cymbalta (duloxetine), Effexor (venlafaxine), Fetzima (levomilnacipran), Pristiq (desvenlafaxine), Savella (milnacipran)
• Tricyclic antidepressants (TCAs): Anafranil (clomipramine), Asendin (amoxapine), Elavil (amitriptyline), Norpramin (desipramine), Pamelor (nortriptyline), Sinequan (doxepin)3, Surmontil (trimipramine), Tofranil (imipramine), Vivactil (protriptyline)
• Monoamine oxidase inhibitors (MAOIs): Emsam (selegiline), Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine)
• Atypical antidepressants: Oleptro (trazodone), Brintellix (vortioxetine), Remeron (mirtazapine), Symbax, Wellbutrin (bupropion)

Healthcare providers may prescribe other antidepressants for treatment-resistant depression. Antidepressants may also be combined with other types of medications in an attempt to improve their results.

Like all drugs, antidepressants can have side effects. These vary by medication, and not all people experience them. The most common are gastrointestinal issues (upset stomach and diarrhea), headache, drowsiness, and sexual dysfunction, with more serious side effects including suicidal ideation, overdose, and serotonin syndrome.

Antipsychotics

Antipsychotics are prescribed to treat symptoms of psychosis. They fall into two categories: atypical and typical.

Atypical antipsychotics were introduced in the 1990s as an alternative to their typical (first-generation) counterparts and carry a lower risk of side effects. Still, a healthcare provider might prescribe typical antipsychotics if atypical antipsychotics don't work.

Common atypical antipsychotics include:

• Abilify (aripiprazole)
• Clozaril (clozapine)
• Invega (paliperidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Common typical antipsychotics include:

• Thorazine (chlorpromazine)
• Loxitane (loxapine)
• Navane (thiothixene)
• Trilafon (perphenazine)
• Compro (prochlorperazine)
• Depixol (flupentixol)
• Haldol (haloperidol)
• Mellaril (thioridazine)
• Prolixin (fluphenazine)
• Stelazine (trifluoperazine)
  

The side effects of antipsychotics can range from mild to severe and include dry mouth, sedation, sexual dysfunction, weight gain, and tardive dyskinesia. In some cases, their side effects can be life-threatening, causing inflammation of the heart (myocarditis) or extremely low white blood cell count.

Anxiolytics

Anxiolytics are medications designed to prevent or treat anxiety. There are a few different types available that work in different ways.

• Benzodiazepines and some other anti-anxiety medications work by increasing GABA levels in your brain to keep you calm and help you sleep. Non-benzodiazepines such as Ambien (zolpidem) are chemically different, but they also boost GABA.
• Beta-blockers, usually prescribed for heart problems, are sometimes given to help with phobias and fear of certain situations. They help control sweating, shaking, and an elevated heart rate
• Barbiturates such as phenobarbital are similar to but much stronger than benzodiazepines and have been used to treat seizures in children. They're also prescribed to help with insomnia (see below).

Hypnotics

This class includes drugs that induce and lengthen sleep. When used this way, they include barbiturates, quinazolinones, benzodiazepines, nonbenzodiazepines, melatonin, antihistamines, and antidepressants,

Mood Stabilizers

Mood stabilizers are typically used to treat bipolar disorder, schizoaffective disorder, borderline personality disorder (BPD), and depression. They target chemical imbalances to control extreme mood swings. They include:

• Abilify (aripiprazole)
• Geodon (ziprasidone)
• Latuda (lurasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)

Stimulants

Stimulants increase brain activity to raise mood and alertness. They include common substances such as caffeine and nicotine, as well as illicit drugs such as cocaine and methamphetamine.

Prescription stimulants affect the central nervous system and the autonomic nervous system, enhancing the effects of dopamine and norepinephrine. They can increase blood pressure, respiratory function, and euphoria. These psychotropic medicines are most often used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy.

Common prescriptions in this class include:

• Ritalin (methylphenidate)
• Adderall (dextroamphetamine-amphetamine)
• Dexedrine (dextroamphetamine)
  

Side Effects of Psychotropic Medicines

Like all drugs, psychotropics come with a range of side effects, some of these include:

• Cardiac issues
• Changes in appetite
• Dizziness
• Drowsiness
• Fatigue
• Sexual side effects
• Sleep disturbances
• Weight gain

Although psychotropic drugs can help regulate your emotions and mood, they can also adversely impact your emotions. For example, you might have a hard time crying when you truly feel sad.

Risks and Black Box Warnings

Different psychotropic medicines come with different risks. These risks may be higher for certain populations or those with specific health conditions.

Before taking psychotropic drugs, be sure to share with your healthcare provider any known medical issues, such as heart conditions, diabetes, or high blood pressure, to ensure the medication won't aggravate these preexisting conditions.

The increased risk of suicide with antidepressants tends to be highest during the initiation of treatment. It is essential to carefully monitor your thoughts and behaviors during treatment and reach out for help if you experience worsening depressive symptoms or suicidal ideation.