Psychotropic Medications 101

In the practice of psychotherapy, therapists learn about and utilize many tools to help our clients find lasting change, improving their overall mental health and wellbeing, and psychotropic medications can be one of those tools.

​It is important to realize that not everyone needs medication to treat their mental health symptoms, and not everyone who needs medication will need it forever. The purpose of this article is to provide basic education about psychotropic medications, because I find that most of my clients who take psychotropic medications are under-educated about them, and many clients who do not take medications are scared to start for the same reason.

How do psychotropic medications affect the brain?

​Mental health disorders (anxiety, depression, bipolar disorder, etc…) are a result of chemical imbalances in the brain, specifically of the neurotransmitters serotonin, norepinephrine and dopamine.  These chemical imbalances can be endogenous (genetic factors, internally caused), exogenous (life events, trauma, external factors), or both.  Psychotropic medications work to create balance in neurotransmitters by adjusting how the receptors in the brain absorb the chemical, effectively reducing negative symptoms.  Different medications work on different neurotransmitters, and it varies individually what each person’s brain needs or will respond to, depending on symptoms and brain chemistry.  
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What are the types of psychotropic medication?

Anti-Anxiety Medications

• Benzodiazepines: Work on the GABA receptors in the brain, have the same effect on the brain as alcohol.  Can be addictive and can easily form a dependence resulting in withdrawal if not tapered. Examples: Xanax (Alprazolam), Klonopin (Clonozepam), Ativan (Lorazepam)
• Anxiolytics: Work on serotonin, dopamine, and noradrenaline receptors. Example: Buspar (Buspirone)
• Beta-Blockers: Slow down heart rate, reduce adrenaline, and block the physical symptoms of anxiety so the mental ones are easier to manage.  Generally used for short-term, event-related anxiety (public speaking, anxiety attacks, etc…. Example: Hemangeol (Propranolol)
• Alpha-Blockers: Used to treat high blood pressure, relax blood vessels so blood flows more freely.  This medication has had much success in eliminating nightmares related to anxiety and Post Traumatic Stress Disorder. Example: Minipress (Prazosin)
• Antihistamines: Affect serotonin and block histamine. Example: Vistaril (Hydroxyzine)
• Nerve Pain Medications: Slow down brain impulses, stop misfirings in the brain.  Also used for fibromyalgia and seizures.  Examples: Lyrica (Pregablin), Neurontin (Gabapentin)
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Anti-Depressant Medications

• Selective Serotonin Reuptake Inhibitors (SSRI): Increase serotonin levels, can also be used to treat anxiety. Examples: Celexa (Citalopram), Lexapro (Escitalopram), Zoloft (Sertraline), Paxil (Paroxetine), Prozac (Fluoxetine)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRI): Increase Serotonin and Norepinephrine.  Can also be used to treat anxiety.  Examples: Strattera (Atomoxetine), Cymbalta (Duloxetine), Effexor (Venlafaxine), Pristiq (Desvenlafaxine)
• Tricyclics: Increase norepinephrine and serotonin, and block acetylcholine, have a sedative effect.  These are older medications that are not widely prescribed after the advent of SSRI and SNRI medications.  Examples: Amitriptyline, Amoxapine, Tofranil (Imipramine), Pamelor (Nortriptyline)
• Monoamine Oxidase Inhibitors (MAOI): Limit monoamine oxidase, which removes norepinephrine, serotonin and dopamine.  These are older medications with many diet restrictions and side effects. Examples: Marplan (Isocarboxazid), Nardil (Phenelzine), Parnate (tranylcypromine)
• Serotonin Antagonist and Reuptake Inhibitors (SARI): Increase serotonin in the brain by blocking a specific receptor, have a sedative effect. Examples: Desyrel (Trazodone)
• Atypicals: work on serotonin, dopamine, and norepinephrine receptors. Examples: Viibryd (Villazadone), Trintellex (Vortioxetine), Wellbutrin (Bupropion), Remeron (Mirtazapine).​
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Antipsychotic Medications
Used to treat Bipolar Disorder, Schizophrenia, Personality Disorders, Severe Depression and Severe Anxiety.

• Typical (older) Antipsychotics: Block a specific type of dopamine receptor, have a sedative effect. Examples: Thorazine (Chlorpromazine), Haldol (Haloperidol), Prolixin (Fluphenazine)
• Atypical (newer) Antipsychotics: Block a specific type of serotonin and dopamine receptor. Examples: Abilify (Aripiprazole), Seroquel (Quetiapine), Geodon (Ziprasidone), Risperdal (Risperidone), Zyprexa (Olanzapine)
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Mood Stabilizers

Used to treat the mood swings of Bipolar Disorder, and sometimes to enhance the effect of other medications when treating Depression. Reduce excitability in the brain, to calm overstimulated and overactive neurons. Many anticonvulsant medications are used as mood stabilizers. Examples: Lithium (Eskalith), Depakote (Divalproex Sodium), Lamictal (Lamotrigine), Tegretol (Carbamazepine), Topamax (Topiramate), Trileptal (Oxcarbazepine)
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Stimulants

Used to treat Attention Deficit Hyperactivity Disorder (ADHD), increase dopamine and norepinephrine. Can be addictive and can easily form a dependence. Examples: Adderall (Amphetamine), Vyvanse (lisdexamfetamine), Focalin (dexmethylphenidate), Ritalin/Concerta (methylphenidate), Dexedrine (dextroamphetamine)
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Who can prescribe psychotropic medications?

While a licensed therapist or counselor may be knowledgeable about psychotropic medications, only medical professionals can prescribe them. The medical professionals with the most knowledge and training in prescribing psychoactive medications are Psychiatrists.  Psychiatrists are medical doctors (MD) that have completed residency and training in psychiatry.  Most psychiatrists do not engage in talk therapy; they focus on symptom and medication management in brief (15-20 minute) appointments.
 
Other medical professionals able to prescribe psychotropic medications are Primary Care Physicians (MD/GP), Physician Assistants (PA), Psychiatric/Mental Health Nurse Practitioners (PMHNP), Nurse Practitioners (NP), Certified Nurse Midwives (CNM), and Gynecologists/Obstetricians (OB/GYN).
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How do I know if I need psychotropic medications?

In my practice, for someone who is not currently taking psychotropic medications, I will generally recommend medications if we seem to continue hitting a wall with ongoing negative symptoms, despite all reasonable efforts to improve them.  If adding structure, recognizing and changing thinking, improving overall physical health, learning emotional identification and expression, and addressing spiritual health doesn’t improve symptoms markedly, this indicates to me that the symptoms are endogenous in nature, and need chemical help to mitigate.
 

What do I need to be aware of if I start taking psychotropic medications?

All medications generally have some risk of side-effects, some more troublesome than others.  Speaking with your prescribing physician and doing your own research are important before starting on any psychotropic medication.  Most common side-effects for psychotropic medications are disturbances in sleep and appetite.  Some of these can be mitigated by adjusting the time of day they are taken (morning if the medication is activating to your brain at night), and taking them with food to reduce nausea.
 
Research has shown that the most effective treatment for mental health disorders is a combination of medication and therapy.  Taking psychotropic medications without including therapy will not result in lasting change and improvement in symptoms.  For real and sustained life change, medications can help provide enough of a lift or relief of symptoms so work can happen in therapy, to prevent recurrence of negative symptoms.
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Author Jamie Cullen, LCMHC, LMHC, LCPC is a Licensed Clinical Mental Health Counselor and Clinical Coordinator at Banyan Tree Counseling & Wellness specializing in adult and childhood trauma, addictions, disordered eating, grief and loss, and co-occurring disorders. She has experience working with both chemical and process addictions, specifically their root in trauma, and is passionate about helping individuals enter and maintain recovery, utilizing therapy, psychoeducation, and community supports.

References:
http://www.drugs.com
http://www.pdr.net