Mental Health: When Is Medication the Right Choice?

The stigma may tell a different story, but mental health illnesses are among the most common disorders in the United States. Nearly one in five Americans live with a mental illness, with an estimated 21.4% of adults experiencing a mood disorder during their lives and 19.1% dealing with an anxiety disorder in the past year. 

As prominent as these figures are, the reality is many mental health illnesses go untreated. Take, for example, this statistic from the National Institute of Mental Health: just 42.6% of people received mental health treatment in 2017 — 47.6% of women compared to 34.8% of men

Getting help is the first step to conquer mental illness. Once you can identify an issue, it’s imperative you weigh all the options in choosing the best course of treatment. There isn’t a right or wrong answer. Some patients find talk therapy helpful, while your doctor may prescribe medication if necessary. But, how or when do you know if medication is the right choice? This guide will help you understand your options and the various types of mental health medications on the market. 

Weighing Your Treatment Options

Everyone has moments of anxiety or sadness, but they become problematic with repeated episodes that don’t go away or evolve into something worse. 

Contact your doctor if these feelings get in the way of your daily life. Together, you can evaluate the problem. Your psychologist or doctor will want to know where the mental health problem originates. Is it hereditary? Is it from stress or trauma? Be prepared to answer their questions. 

Once you define the problem, you can try therapy, medication, or a combination of both. Depending on the severity of the mental health issue, medications may be the only way to treat the disorder. Ultimately, you should consult with your doctor to determine which medications are right for you. 

Here are some topics to consider:

  • Discuss with your doctor how medications can improve your symptoms. If the impact is minimal, psychotherapy may be a better option.
  • Talk about how medications can work in conjunction with existing or future therapy treatments.
  • Weigh the pros and cons of the medications, including side effects.
  • Consider the impact certain medications can have with preexisting conditions.
  • Think about how medications can have unintended consequences, such as lifestyle changes.
  • Create a budget to see how much anxiety or depression medications would cost each month.

Exploring Psychotherapy

In psychotherapy, you meet with a psychiatrist, psychologist, or another licensed counselor to discuss your thoughts, feelings, and actions. Psychotherapy is also known as talk therapy because you verbalize your experiences to better understand how you respond to certain triggers. It’s a safe, low-risk treatment option. 

Cognitive-behavioral therapy (CBT) is one of the most popular treatment options for helping someone with depression. It helps you recognize negative thoughts and how to better control your feelings and emotions. In these sessions, you’ll learn specific problem-solving skills to take home and practice. 

Within CBT, your therapist may use cognitive therapy or exposure therapy to treat anxiety disorders. Exposure therapy helps you tackle certain fears that lead to specific types of anxiety, such as social anxiety disorder or various phobias.

You can also try interpersonal therapy if you have major depressive disorder. This type of treatment doesn’t focus on depression symptoms, rather, your therapist places an emphasis on how you interact with others in times of grief, conflict, or other life events. 

Depression can reach a stage where you need hospitalization or in-patient therapy. If neither psychotherapy or medications work, your doctor could suggest electroconvulsive therapy (ECT) or transcranial magnetic stimulation. Other brain therapy options include vagus nerve stimulation, magnetic seizure therapy, and deep brain stimulation. 

These methods use electric currents and stimulation to help neurotransmitter function. Results are generally more rapid than medication, as you can see benefits within a week of treatment. 

Alternative treatments also exist for anxiety. Biofeedback involves studying brain-wave patterns on an electroencephalograph so you can better control your emotions.

How to Choose the Right Antidepressant

There are three main neurotransmitters — serotonin, norepinephrine, and dopamine — that help your brain communicate. Serotonin impacts your sleep, appetite, and memory; norepinephrine aids in stress control; and dopamine is key in how you think, plan, and experience pleasure. 

Antidepressants help regulate these neurotransmitters to improve your mood and stress. For some patients, newer medications are better suited to treat mental health disorders. Others find success in medications, such as tricyclic antidepressants, that have been around for decades.

Since certain medications treat specific disorders and symptoms, check with your primary care doctor or a psychiatrist to see what will work for you. Be patient, too. It may take four to eight weeks to see a response.

Atypical Antidepressants

Each drug impacts serotonin, norepinephrine, and dopamine levels. Some, like bupropion, are dopamine reuptake inhibitors, while others, like mirtazapine, block stress receptors. Then there are combination drugs, such as Symbyax, that combine a selective serotonin reuptake inhibitor., or SSRI, (fluoxetine) with an antipsychotic (olanzapine). 

Commonly prescribed atypical antidepressants include: 

Monoamine Oxidase iInhibitors (MAOIs)

MAOIs inhibit the brain from breaking down too much dopamine, norepinephrine, and serotonin. Low levels of any of these three neurotransmitters can lead to depression or anxiety. 

Commonly prescribed MAOIs include: 

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs inhibit, or block, serotonin from reabsorbing into brain cells. The additional serotonin helps improve and regulate your mood. 

Commonly prescribed SSRIs include:

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Similar to SSRIs, these medications block serotonin absorption and also inhibit norepinephrine absorption, which helps regulate stress. 

Commonly prescribed SNRIs include: 

Tricyclic Antidepressant

These medications are older, first-generation antidepressants. They prevent brain cells from absorbing too much norepinephrine and serotonin to help regulate mood and stress. The “tri” in tricyclic structurally defines the three chemical rings. 

Commonly prescribed tricyclic antidepressants include:

Anxiety Medications

While you can’t cure anxiety, various medications exist to reduce the fear, worry, and panic associated with anxiety.

Benzodiazepines

Benzodiazepines are the most common anti-anxiety medication. They act on the neurotransmitter gamma-Aminobutyric acid to slow down your brain and make it less sensitive to stimulation. Benzodiazepines are often the primary treatment option for generalized anxiety disorder, while antidepressants, mainly SSRIs, are popular choices for chronic panic and phobia disorders. 

To help you differentiate the two medications, benzodiazepines have a physiological effect on tension and panic, while SSRIs improve cognitive issues associated with excessive worrying and rumination. 

Benzodiazepines don’t last long in your system and resolve symptoms quicker than antidepressants, but prolonged use can lead to increased tolerance and dependence. Since benzodiazepines are more effective in short-doses, your doctor may prescribe buspirone (BuSpar), a non-benzodiazepine medication for chronic anxiety. 

Commonly prescribed benzodiazepines include:

Beta-Blockers

These medications don’t treat the root of the problem. Instead, they relieve symptoms you often experience from an anxiety attack or other phobia. Beta-blockers can help control your heart rate or any trembling or shaking you may experience. You’ll take these as needed when symptoms appear. 

Commonly prescribed beta-blockers include: 

Antidepressants

Antidepressants don’t just treat depression. Your doctor may prescribe SSRIs, SNRIs, or tricyclic antidepressants to help combat anxiety. SSRIs, which help tone down anxious thoughts and feelings, are the most common of the three. Many of the same SSRIs used for depression are effective in treating anxiety, such as escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft).

Other Mental Health Medications

We’ve covered the main medications associated with depression and anxiety, but there are various other drugs used to treat mental health disorders.

Antipsychotics

In more severe cases of depression and anxiety, antipsychotics impact dopamine receptors to end hallucinations, delirium, or episodes of paranoia. 

The following is a list of newer atypical antipsychotics. Older antipsychotics, such as chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), and perphenazine (Trilafon), are first-generation medications. 

Mood Stabilizers

As the name suggests, these medications help regulate mood swings if you’re diagnosed with bipolar disorder or other mental health illnesses that deal with manic episodes. Mood stabilizers regulate brain activity at a more consistent rate. Doctors may also prescribe anticonvulsants — primarily used to treat seizures — to control mood swings. 

Commonly prescribed mood stabilizers include: 

Stimulants

Stimulants speed up your brain function to treat attention deficit hyperactivity disorder (ADHD). Many people who suffer from ADHD have trouble paying attention and focusing on tasks, so these medications help increase alertness, blood pressure, and heart rate to stay on task. 

Commonly prescribed stimulants include:

Risk Factors

Mental health drugs don’t work for everyone. Some antidepressants, antipsychotics, stimulants, and mood stabilizers have side effects and may adversely interact with other drugs you take. 

Certain medications, such as antidepressants, must have a warning label to inform you it may increase the risk of suicide. This label shouldn’t scare you. Instead, it magnifies the importance of monitoring medications and being open and honest with your doctor. 

You should also be aware of how these medications may interact with existing medical conditions or drugs you take for other ailments. Older adults need to be even more proactive as there are many drugs to avoid as you age

For example, the sedative qualities in antidepressants become problematic for the elderly and can increase your risk of falls or accidents. Additionally, your risk of stroke and chance of death are higher if you have dementia and take antipsychotics. Benzodiazepines can lead to cognitive impairment in older adults, making you more prone to falls or vehicle crashes. 

Remember to take your medications as prescribed and for the entire duration. Your symptoms may subside and you may feel inclined to stop taking the drugs, but depression or anxiety can return if you don’t follow orders. 

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