Treating Mental Illness with Medication

Mental illness is a condition in the brain that changes thinking, emotions, behavior, or a combination of these. When a person struggles with a mental illness, they will often begin to struggle with personal relationships, work, and school. Those who struggle with mental illness have trouble with daily life and activities. No two mental health problems are alike, even when two people receive the same diagnosis – their experiences of these conditions will vary.

What Is Mental Illness?

Multiple underlying causes are associated with the development of mental illness. Genetics, environmental factors, life stress, trauma, and even certain substances can all cause or trigger a mental illness.

Although mental illness can be very disruptive to a person’s life, these brain changes are very common. The National Alliance on Mental Illness (NAMI) reports that one in five US adults experiences a mental illness every year, and one in 17 lives with a severe mental illness, such as schizophrenia or bipolar disorder. Half of these mental conditions develop in adolescence, often around age 14, while others develop in adulthood. Around 75 percent of mental illnesses present by 24 years old.

The Substance Abuse and Mental Health Services Administration (SAMHSA) found that, in 2014, about 4.1 percent of people ages 18 and older (about 9.8 million adults), had a serious mental illness. Between 1 percent and 20 percent of children struggled with a serious emotional disturbance (SED), which may develop into a later substance abuse or mental health disorder if left untreated.

Categories of mental illnesses include:

• Anxiety disorders: General anxiety disorder, panic disorders, specific phobias, social phobia, and post-traumatic stress disorder all fall into this category.
• Depression: Major depression, dysthymic disorder, clinical depression, postpartum depression, and unipolar depression are all forms of depressive disorders.
• Bipolar disorder: There are three primary forms of bipolar disorder – bipolar disorder I, II, and cyclothymic disorder. However, the DSM-5 also recognizes unspecified bipolar disorder, and many clinical psychologists are debating the place of seasonal affective disorder, which is a mood disorder like both depression and bipolar disorders.
• Personality disorders: These disorders involve a rigid, uncompromising view of the world and the inability to deal socially with others. These include:
  • Cluster A: schizoid personality disorder, paranoid personality disorder, and schizotypal personality disorder
  • Cluster B: antisocial personality disorder, borderline personality disorder, and narcissistic personality disorder
  • Cluster C: avoidant personality disorder, dependent personality disorder, and obsessive-compulsive disorder
• Psychotic disorders: This is a broader, vaguer category for mental health compared to other listed mental illnesses, and they are primarily characterized by psychotic episodes. Some conditions that fall under psychotic disorders include postpartum psychosis, schizoaffective disorder, and schizophrenia.

One in 12 people who struggles with a mental illness also struggles with a substance use disorder. Treating these conditions with specific medications, alongside regular talk therapy sessions, is very important to help these individuals maintain normal, healthy lives. People with both a mental illness and a substance use disorder – a combination called co-occurring disorders – often begin to abuse substances to self-medicate or regulate their brain chemistry. Sometimes, an individual with a substance use disorder will develop a mental health problem due to brain chemistry changes from intoxicating substances. Prescribed medication with the oversight of a psychiatrist, and therapy with a psychologist or counselor, is safe and effective; self-medicating is dangerous and can lead to death.

Getting a great team of medical professionals to treat mental illness and co-occurring substance abuse helps many people live well by managing these chronic conditions. The team will include:

• Primary care physicians
• Nurses and physician assistants
• Psychiatrists
• Psychotherapists
• Pharmacists
• Social workers
• Family and close friends

Some of these team members will help to manage medications.

Psychiatric Prescription Medications and the Mental Health Conditions They Treat

There are several general types of psychiatric medications prescribed to treat various mental conditions. These categories include:

• Antidepressants: These medications adjust neurotransmitters, usually serotonin, but sometimes also norepinephrine and dopamine. The most prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), but other forms include serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and monoamine oxidase reuptake inhibitors (MAORIs). There are some other forms of antidepressants, but they are used much more rarely.Most forms of depression respond well to a combination of antidepressants – starting with SSRIs and adjusting to other, stronger antidepressants if needed – and talk therapy. Some antidepressants function well in the treatment of anxiety, too, as some forms of anxiety include depression, and vice versa.
• Anti-anxiety medications: Pharmaceuticals prescribed for the short-term or “as-needed” symptoms of anxiety include sedatives like benzodiazepines: Xanax, Klonopin, Valium, and more. Long-term pharmacological treatment of anxiety is not safe with these drugs, as the body rapidly develops a tolerance to them, so the dose must increase too fast to be healthy. Instead, a psychiatrist will likely prescribe an antidepressant that also works for anxiety if the individual would benefit from long-term medication.Overall, various approaches to talk therapy work best in treating anxiety, with short-term medication use at the start to reduce symptoms and help the person focus on psychotherapeutic appointments.
• Mood-stabilizing medications: Drugs designed to stabilize mood include lithium, carbamazepine, valproate, lamotrigine, oxcarbazepine, topiramate, and gabapentin. For the most part, these medicines treat bipolar disorder, with lithium being the most effective treatment for bipolar I and II; however, other pharmaceutical treatments have been developed because lithium can build up in the body and become toxic.
• Antipsychotic medications: These medicines treat symptoms of psychosis, including hallucinations, paranoia, delusions, and anhedonia. Some include aripiprazole, asenapine, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone. Many of these prescription drugs focus on treating mania and stabilizing mood, and they are intended for long-term treatment. Benzodiazepines may be used for short-term mood-stabilizing treatment if an individual suffers a psychotic episode during which they become hospitalized.

While these medications are extremely effective, and a deeply important part of treating mental illness, medication alone is never the answer. People who struggle with mental illness, regardless of what kind, must get help from psychotherapists. Through several forms of talk therapy, people with mental illnesses can understand how their symptoms manifest and how to adjust their behaviors when reacting to symptoms.

Prescription medication has sometimes been treated as a cure for mental illness, but it is not. The combination of talk and pharmaceutical therapies has helped thousands of people lead happy and healthy lives, but mental illness is typically a chronic condition lasting a lifetime. There is no cure; instead, many effective combinations of treatment can keep the person stable, active in their community, and safe. The Centers for Disease Control and Prevention (CDC) notes that 78 percent of adults with symptoms, and 89 percent of adults without symptoms, agree that getting appropriate, evidence-based care helps them lead normal lives.

However, only 25 percent of those struggling with mental illness believe that people care about and support those around them with mental health conditions. This belief is one explanation for why so few people struggling with mental illness, substance abuse, or both get the treatment they need.

Pros and Cons of Prescription Psychiatric Medications

Medications that stabilize mental health, alongside talk therapy, are very beneficial to those who need this kind of treatment. However, there are some side effects associated with these drugs.

• Antidepressants do not have too many long-term side effects, although weight gain and sexual dysfunction have been the most concerning. Some older antidepressants, like MAO Inhibitors, react poorly to some foods and beverages, so a person’s diet may be limited if they need these drugs.
• Even when taken as prescribed, the body rapidly develops a dependence on, and tolerance to, these medications. They are typically not prescribed for consistent use for more than two weeks, but some people who struggle with anxiety may develop an addiction to these drugs. Long-term, benzodiazepines may affect cognition and memory, and they interact poorly with other substances, especially alcohol and opioids, which increases the risk of overdose or poisoning.
• Side effects from other mood-stabilizing medicines include weight gain, drowsiness, nausea or vomiting, and increased thirst. Lithium, while the most effective treatment for most types of bipolar disorder, also builds up in the body over time, and it can damage organ systems, including the cardiovascular system, thyroid, kidneys, gastrointestinal system, and endocrine system. Sometimes, it can cause neurological side effects.
• A long-term side effect from antipsychotic medicines include tardive dyskinesia, which causes a person to develop involuntary muscle movements, especially around the mouth. Other side effects include rigidity, persistent muscle spasms, restlessness, and tremors.

Most psychiatric medications are not abused for nonmedical reasons, but benzodiazepines and stimulant drugs, which treat attention deficit hyperactivity disorder, may be sold illegally for recreational abuse. This is very dangerous and can lead to addiction and life-threatening side effects.

People who struggle with mental illness have many options for treatment in the modern world. Getting started on this treatment may feel like a struggle, but for many people, the combination of prescription medication and talk therapy is extremely effective.