Pros and Cons Of Mental Health Medication

The Benefits of Medications

There are many benefits to medications for mental illnesses. When a mental health condition becomes severe to the point that it affects an individual’s ability to work, interact with other people, and carry out routine daily tasks, medications should be strongly considered.

In treating psychotic conditions, medications have been shown to:

• Reduce the frequency of hospitalizations
• Decrease the severity of symptoms
• Reduce suicide attempts

The symptoms may not always completely resolve but can often improve to the extent that an individual can have some independence, be in a long-term relationship, and work a simple job.

Psychiatric conditions that require medications include psychotic conditions such as schizophrenia and schizoaffective disorder and mood disorders such as bipolar disorder. Depression and anxiety can improve without medications, but when these conditions become severe enough to cause thoughts of suicide and hospitalization, medications should be considered.

Without medications, individuals suffering from psychotic conditions can lose touch with reality and hear voices, see things that are not there, or believe they are being followed or watched. This can make them so paranoid that they cannot live in their own homes, eat food, or otherwise care for themselves. These individuals can become medically ill due to losing touch with reality.

Likewise, individuals who have untreated bipolar disorder may stay up for multiple nights without sleeping and take dangerous risks, such as jumping out of a moving vehicle or going outside in the winter without clothes on.

With consistent antipsychotic medications, these individuals can often live nearly normal lives. Bipolar disorder can go into remission, and individuals can hold a steady job and contribute meaningfully to society.

The Downside of Mental Health Medications

While there are many benefits to mental health medications, there are also side effects and risks that need to be considered when deciding if medications are the right choice for you.

Antidepressants

In general, antidepressants have mild side effects that can be bothersome, but these effects typically improve and go away in most people. These include nausea, headaches, and insomnia. Some antidepressants can cause weight gain, which can lead to more medical issues further down the road, such as increased risk of diabetes, high cholesterol, and high blood pressure. Many antidepressants can cause sexual side effects, which can be embarrassing and annoying to manage, especially in younger adults. These are temporary and usually resolve with discontinuation of the antidepressant.

There is also a rare side effect that occurs more commonly in adolescents to young adults up to the age of 24, which is an increased risk of suicidal thoughts when first starting an antidepressant.

Antianxiety Medications

Some antianxiety medications, such as benzodiazepines, can cause physical dependence and can be very difficult to stop once you have started on them. Long-term regular use of this class of medications has been linked to the development of memory issues.

Antipsychotic Medications

Antipsychotic medications can cause significant weight gain. They can also cause abnormal involuntary movements. This is less common in the newer antipsychotics but is still a possibility. There is a risk of developing a rare involuntary movement condition called tardive dyskinesia, which is irreversible.

When the diagnosis is correct, it is uncommon for medications to make mental illnesses worse. However, if the diagnosis is incorrect, using the incorrect medication can worsen symptoms of an individual’s mental illness.

Prescribing mental health medications is more of an art than a science, and a medication that works for one individual may not work for another individual. Some individuals find the right medication early in their treatment journey, while others may need to go through many trials before finding the right fit. The prolonged process of seeking the right medication can contribute to a feeling of despair and depression. These individuals may feel like they will never find the right medication.

The Efficacy of Medications

Data has found that psychiatric medications are effective when prescribed correctly in the appropriate doses.

• A meta-analysis published in The Lancet showed common antidepressants performing at least 50% better than placebo.
• A 2019 meta-analysis published in The Lancet examining the efficacy of antipsychotic medications in the treatment of schizophrenia showed all 32 antipsychotic medications consistently outperforming placebos.
• Mental health medications were more effective in the treatment of more severe psychiatric conditions and more beneficial in the treatment of symptoms of hallucinations and delusions in schizophrenia compared with symptoms such as loss of emotions, apathy, and disorganized thoughts.

Pharmacogenomic Testing

You may have heard about the availability of blood tests (known as pharmacogenomic testing) that claim the ability to predict which antidepressants will be most effective for you. These claims are misleading, as it is not standard practice to obtain pharmacogenomic tests if you have never taken any antidepressants before. These tests also look at mood stabilizers, antipsychotics, and stimulants, but antidepressants are the best-studied group.

These tests provide information about how your body breaks down psychiatric medications by looking for genetic variants in how an individual’s body breaks down psychiatric medications. Based on that information, a list of “recommended medications” is generated, but this does not guarantee these medications will work for you and is not any better than seeing a psychiatrist who takes a careful, detailed history of your symptoms.

This information will show which medications may be more likely to cause side effects, which you might need to start at lower than usual doses, or which you might be better off starting at higher than usual doses. Your psychiatrist can also deduce this information based on your response to medications. In rare instances, if your body has a unique pattern of breaking down psychiatric medications, this information may be helpful, but for the majority of people, completing this type of testing is unnecessary and can be misleading.

Ultimately, more research is needed to determine the role of pharmacogenomic testing in standard practice.

When to Request Medications

If your mental health condition is severe enough to lead to an inability to work at your job, results in hospitalization, or causes serious thoughts of suicide, it is appropriate to request medications to help speed up your recovery.

If you have tried alternative forms of treatment for at least three months and have not seen much progress or are feeling worse, it would be reasonable to discuss medications with your doctor.

Types of Mental Health Medications

There are medications to treat every major category of mental illness. The most common mental health medications are antidepressants. This class of medication also treats multiple types of anxiety conditions, such as obsessive-compulsive disorder and posttraumatic stress disorder, postmenopausal symptoms, bulimia, and premature ejaculation. Some common antidepressants include:

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Venlafaxine (Effexor)
• Bupropion (Wellbutrin)

There are also antianxiety medications separate from the antidepressants. Many people are familiar with benzodiazepines, which are effective for immediate relief and intended for short-term use due to the risk of physical dependence and misuse. This class includes:

• Lorazepam (Ativan)
• Alprazolam (Xanax)
• Clonazepam (Klonopin)

There are miscellaneous antianxiety medications that have a lower risk of physical dependence and can still provide immediate relief. These medications come from a wide variety of classes, including:

• Hydroxyzine (Atarax/Vistaril) – an antihistamine that also works for anxiety
• Propranolol (Inderal) – a blood pressure medication that helps with anxiety attacks
• Gabapentin (Neurontin) – an antiseizure medication that works to help anxiety
• Buspirone (Buspar) – structurally similar to an antidepressant but more specific for anxiety

Antipsychotic medications are used to treat psychotic conditions such as schizophrenia and schizoaffective disorder. They are also indicated in bipolar disorder and to augment the treatment of anxiety and depression. Some common antipsychotic medications include:

• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)
• Aripiprazole (Abilify)
• Risperidone (Risperdal)
• Lurasidone (Latuda)
• Cariprazine (Vraylar)

Mood stabilizers are primarily used in the treatment of bipolar disorder but are also beneficial as add-on treatments for depression and anxiety. They are also sometimes substituted for antidepressants in individuals who do not respond to antidepressants or cannot tolerate them due to side effects. Some common mood stabilizers include:

• Lamotrigine (Lamictal)
• Lithium
• Valproic Acid (Depakote)

There are stimulant and non-stimulant options for the treatment of attention deficit hyperactivity disorder. Options for treatment of ADHD include:

• Methylphenidate Extended-Release (Concerta)
• Methylphenidate Immediate Release (Ritalin)
• Dextroamphetamine-Amphetamine Salts Extended Release And Immediate Release (Adderall XR And IR)
• Lisdexamfetamine (Vyvanse)
• Atomoxetine (Strattera)
• Viloxazine (Qelbree)

Atomoxetine and viloxazine are nonstimulant medications for the treatment of ADHD that are more similar in structure to antidepressants. Non-stimulant medications need to be taken daily to work, while stimulant medications work more immediately and do not have to build up in the system before being effective.

Alternative Treatments for Mental Health

Medications are not the only option for the treatment of mental health illnesses.

Psychotherapy

Psychotherapy is also effective in the treatment of mild to moderate depression and anxiety. Just as there are many different types of medications, there are different types of therapy to target your specific symptoms. Cognitive behavioral therapy (CBT) is a common form of therapy that examines negative thoughts and works on correcting those thoughts.

Therapy also has a role in the treatment of bipolar and psychotic disorders; however, it is unlikely to be effective on its own, as medications are necessary for the improvement and remission of symptoms in these conditions. If you tried therapy for three to four months and did not see any positive results, speak with your therapist about trying a different type of therapy.

Brain Therapy

There are some non-medication treatment options for non-responders of standard medications and therapy. One such treatment is transcranial magnetic stimulation, a non-invasive treatment that uses magnetic fields to generate electrical impulses in the brain in specific areas. This treatment has been approved for use in treatment-resistant depression, OCD, and depression with anxious distress. It is currently being studied for use in bipolar depression as well.

Electroconvulsive therapy is a form of treatment that has been around for a long time and is very effective and primarily used in treatment-resistant depression. It has also been shown to be effective in treatment-resistant bipolar disorder and schizophrenia. It involves the use of an electrical current to generate a brief seizure, creating changes in brain chemistry.

Can Mental Health Medications Make Mental Illness Worse?

Mental health medications are very effective in reducing symptoms of mental health illness, preventing hospitalizations, and helping improve overall brain health.

However, medications do not come without side effects. While most side effects are more of a nuisance, there are some negatives to medications for mental illness, including more serious side effects that may have a longer-lasting impact. Careful discussion with your doctor about other potential treatments and the severity of your condition can better inform your decision about when to start medications.