Psychotropic Medications: Uses, Types, Side Effects, & Risks

What Are Psychotropic Medications?

Psychotropic medications can be broken into five main categories: antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers. Some medications are only used to treat one disorder. Others can be used as a treatment for multiple disorders. It is common for multiple psychotropic medications to be used together for the best treatment.¹

Treatment with psychotropic medications can sometimes involve trial and error. It is important to work closely with your doctor while finding the optimal treatment. You may be instructed to change doses or replace some medications with others. Understanding why you are taking each medication is key to ensuring safe treatment with antipsychotics.¹

What Are Psychotropic Medications Used to Treat?

Psychotropic medications affect different chemical pathways in the brain to correct symptoms of mental health disorders. A full evaluation by a qualified licensed healthcare professional is required to determine which medication or combination of medications could be right for you. Having a diagnosis and identifying symptoms associated with that condition is the first step to choosing a psychotropic medication.

Psychotropics can be used to treat anxiety, depression, ADHD, bipolar disorder, and other less common mental health conditions as well. A few psychotropics can treat multiple mental health disorders. The dose and directions of medications may change based on the condition it is being used to treat. It is also important to note that some medications not classified as psychotropics may be used to treat mental health disorders as well. If you are unsure about the medication you are taking, ask your prescriber or pharmacist for more information before you begin.

Types of Psychotropic Medications

The five main types of psychotropic medications include antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers. Within each of these categories, there are further groups of medications that can be grouped together. Knowing what type of medication you are taking can help you understand how the medication should work and what side effects you may encounter.

Antidepressants

Antidepressant medications are drugs that all help to improve overall mood and relieve symptoms of depression. They work on chemicals in the brain like serotonin, norepinephrine, and dopamine. These are some of the most commonly prescribed psychotropic medications, as they work well and have minimal side effects when used properly. Antidepressants have been in use for decades and while some older drugs are still in use, the most common are newer antidepressants.²

Disclaimer: Antidepressant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Here are the different types of antidepressants:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) work in the brain to increase the amount of active serotonin in the brain. This chemical helps regulate mood, sleep, anxiety, and appetite. They are currently a first-line treatment for depression in most populations.

Some commonly prescribed SSRIs include:

• Fluoxetine (Prozac)*
• Sertraline (Zoloft)*
• Citalopram (Celexa)*
• Escitalopram (Lexapro)*
• Paroxetine (Paxil)*
• Fluvoxamine (Luvox)*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

The most common side effects of SSRIs may include:

• Nausea, vomiting, diarrhea
• Nervousness, agitation, or restlessness
• Dizziness
• Reduced sexual desire
• Trouble achieving an orgasm
• Insomnia, drowsiness
• Weight gain or loss
• Headache

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) work similarly to SSRIs, working to increase the amount of active serotonin and norepinephrine in the body. These medications can be helpful.²

Some commonly prescribed SNRIs include:

• Venlafaxine (Effexor)*
• Duloxetine (Cymbalta)*
• Desvenlafaxine (Pristiq)*
• Milnacipran (Savella)*
• Levomilnacipran (Fetzima)*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

The most common side effects of SNRIs may include:

• Nausea, vomiting, diarrhea
• Nervousness, agitation, or restlessness
• Dizziness
• Reduced sexual desire
• Trouble achieving an orgasm
• Insomnia, drowsiness
• Hypertension
• Headache

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) also work by increasing the amount of active norepinephrine and serotonin in the body. However, they work on different receptors than SSRIs and SNRIs, which is why TCAs tend to have more sedative side effects. These medications are older and less favorable due to more severe side effects.²

Here are some of the more commonly prescribed TCAs:

• Desipramine (Norpramin)*
• Imipramine (Tofranil)*
• Nortriptyline (Pamelor)*
• Amitriptyline (Elavil)*
• Clomipramine (Anafranil)*
• Doxepin*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

The most common side effects of TCAs may include:*

• Dry mouth
• Sexual dysfunction
• Nausea, decreased appetite
• Urinary retention, constipation
• QRS prolongation (heartbeat disruptions)
• Orthostatic hypotension (low blood pressure)

*All medications, including TCAs, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs work to treat depression by increasing the amount of active serotonin, norepinephrine, and dopamine in the body. These chemicals help to regulate mood, memory, and other feelings. MAOIs also work at chemical receptors in the gut and in blood vessels. Because most MAOI drugs work all throughout the body, the side effects can be numerous.²

Some commonly prescribed MAOIs include:

• Selegiline*
• Tranylcypromine*
• Isocarboxazid*
• Phenelzine*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Some common side effects of MAOIs may include:

• Potential for serotonin syndrome
• Sexual dysfunction
• Hypertension crisis
• Headache
• Appetite changes

Atypical Antidepressants

Atypical antidepressants work in various ways that are different from the previously mentioned antidepressants. The most popular atypicals, like mirtazapine and bupropion, work to increase the amount of active norepinephrine and dopamine. These antidepressants have additional specific side effects that can be useful for specific patients. For example, Wellbutrin is not known for having negative sexual side effects, and mirtazapine is known to increase appetite as well as mood.²

Some commonly prescribed atypical antidepressants include:

• Bupropion (Wellbutrin)*
• Mirtazapine (Remeron)*

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Some common side effects of atypical antidepressants may include:

• Nausea, vomiting, diarrhea
• Nervousness, agitation, or restlessness
• Dizziness
• Headache
• Seizures – Bupropion
• Vivid dreams – Bupropion
• Sedation – Mirtazapine
• Weight gain – Mirtazapine

Antianxiety Medications

Anxiety is one of the most common mental health disorders and affects many people at all ages. Anti-anxiety medications are used when anxiety symptoms become burdensome and interfere with a person’s daily life. Treatment with medication can be specific to each person and varies from being used daily, to only needed in specific instances. The goal of these medications is to reduce symptoms of anxiety.³

Disclaimer: Antianxiety medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Benzodiazepines

Benzodiazepines suppress the central nervous system to decrease symptoms of anxiety. They work quickly upon administration.  These medications cause sedation that, when severe, can cause respiratory suppression, which can be deadly. Benzodiazepines should always be used as directed.³

Some commonly prescribed benzodiazepines include:

• Clonazepam (Klonopin)*
• Lorazepam (Ativan)*
• Alprazolam (Xanax)*
• Diazepam (Valium)*

*This medication has black box warnings, the most serious kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.

Side Effects of Benzodiazepines

The most common side effects of benzodiazepines may include:

• Fatigue
• Dizziness, drowsiness
• Slow reaction time
• Impaired driving skills
• Cognitive functions may be impaired
• Memory problems
• Dependence
• Slowed breathing

Buspirone

Buspirone is thought to work in the brain to increase serotonin activity, specifically in the amygdala, which is responsible for anxiety and fear.³

The most common side effects of buspirone may include:

• Abnormal dreams
• Confusion, dizziness, drowsiness
• Excitement or nervousness
• Headache
• Blurred vision
• Diarrhea or nausea
• Musculoskeletal pain or weakness

Beta-blockers

Beta-blockers work on the heart and cardiovascular system to reduce the force and speed at which the heart works. In patients specifically with ‘performance anxiety’ or anxiety from public speaking, this type of medication can sometimes be prescribed. Beta-blockers work quickly. It is important that patients with asthma do not take certain beta blockers.⁴

Some commonly prescribed beta-blockers include:

• Atenolol (Tenormin)
• Propranolol
• Carvedilol
• Metoprolol

The most common side effects of beta-blockers may include:

• Slow heartbeat
• Abdominal pain or nausea
• Erectile dysfunction
• Wheezing/bronchospasms
• Drowsiness
• Fatigue

Stimulants

Stimulants are most often used to treat attention-deficit hyperactivity disorder (ADHD) and, less frequently, narcolepsy. They work in the body at specific receptors to increase the activity of norepinephrine and dopamine. This action leads to increased energy levels and higher cognition.⁵

Disclaimer: Stimulant medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Some commonly prescribed stimulants include:

• Dextroamphetamine and amphetamine combination (Adderall)*
• Methylphenidate (Ritalin, Concerta)*
• Dextroamphetamine (Dexedrine)*
• Dexmethylphenidate (Focalin)*
• Lisdexamfetamine (Vyvanse)*

*The stimulant medication class has a black box warning, the most serious warning from the FDA for the risk of medication misuse or abuse.

The most common side effects of stimulants may include:

• Anxiety
• Jitteriness
• Headaches
• Weight loss
• Insomnia
• Itching or sweating
• Palpitations and chest pain
• Hypertension
• Seizures
• Arrhythmias

Antipsychotics

Antipsychotic medications can be separated into two categories: typical antipsychotics (first generation) and atypical antipsychotics (second generation). Both types work mainly by blocking dopamine receptors in the brain. Typical antipsychotics also act on histamine and cholinergic receptors, while atypical antipsychotics also act on serotonin receptors.

These medications are used to treat many types of mental health disorders, including schizophrenia, bipolar disorder, psychosis, delirium, and sometimes symptoms of certain personality disorders. They work to stabilize mood and treat symptoms of the above disorders. In certain disorders, they are used together with other psychotropic medications.⁶

Disclaimer: Antipsychotic medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Typical Antipsychotics

These medications are also known as first-generation antipsychotics. These medications usually come with a risk of more severe side effects that need to be monitored. Additionally, these medications often are required to be taken multiple times per day. Some are available as long-term injectables as well.

Some commonly prescribed typical antipsychotics include:

• Trifluoperazine (Stelazine)
• Haloperidol (Haldol)
• Perphenazine
• Prochlorperazine
• Loxapine
• Aripiprazole (Abilify)

Atypical Antipsychotics

These medications are newer and offer some improvements in side effects and dosing schedules. Still, they require close monitoring throughout therapy. Some are available as long-term injectables as well.

Some commonly prescribed atypical antipsychotics include:

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine
• Quetiapine
• Ziprasidone
• Aripiprazole
• Lurasidone
• Brexpiprazole

The most common side effects of antipsychotics may include:

• Sedation
• Extrapyramidal effects
• Dry mouth
• Constipation & urinary retention
• Abnormal heartbeat
• Weight gain
• Anxiety
• Increased appetite
• Dizziness

Mood Stabilizers

Mood stabilizers work to treat bipolar disorder symptoms by regulating or slowing certain processes in the body. This helps to inhibit neural excitation and leads to mood stabilization. Two main mood stabilizers are also anticonvulsants that work to reduce the activity of the neurons throughout the CNS system.⁷

Disclaimer: Mood stabilizer medications have a risk of side effects, including serious side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

Lithium

It is not well-understood how Lithium works, but studies show that it slows and reduces neuronal excitation. This action leads to stabilizing the CNS system and improved symptom relief in mood disorders. Like all medications, Lithium can cause side effects and should not be used in patients with kidney or heart disease. Pregnant patients should also not take lithium.⁷

The most common side effects of lithium may include:

• Tremors
• Weight gain
• Hypothyroidism
• Frequent urination

Antipsychotics

Antipsychotics can also be used as mood stabilizers. A select few have been studied and approved for use in bipolar disorder. They are often used in addition to lithium, divalproex, or carbamazepine to stabilize patients in times of mania. After some time stabilized the antipsychotic is usually discontinued slowly.⁶

Anticonvulsants

Divalproex and Lamotrigine are both anticonvulsants used as mood stabilizers. They both work in the nervous system to slow the action of excited neurons. Divalproex is used along with other mood stabilizers to treat acute episodes, while Lamotrigine is only used as a maintenance treatment. It is important to follow your prescriber’s directions exactly when taking lamotrigine and not to stop and start the medication without supervision.⁷

Some commonly prescribed anticonvulsants as mood stabilizers include:

• Lamictal
• Carbamazepine
• Divalproex

The most common side effects of anticonvulsants may include:

• Weight gain
• Nausea/vomiting
• Diarrhea
• Tremors
• Rash
• Alopecia
• Bruising

Risks & Precautions for Psychotropic Medications

There are many significant risks that come with taking psychotropic medications. It is important to understand these risks and know how to address them if they occur. Each type of psychotropic medication carries its own risk and can range from risk of self-harm, to developing diabetes, to dangerous irregular heartbeats.

Black Box Warnings for Psychotropic Medications

Black box warnings are important life-saving warnings that should never be ignored. A black box warning means there has been a severe life-threatening risk identified with taking medications.  Your doctor and pharmacist should discuss this warning with you when you first start your therapy.

Some psychotropic medications with boxed warnings include:

• Antidepressants: These psychotropic medications carry an increase in suicidal thoughts for certain people, especially younger patients.
• Benzodiazepines: These medications have a risk of abuse or misuse, risk of physical dependence, and risk of serious side effects, including death, when combined with an opioid.
• Stimulants: These medications have a serious risk of abuse and misuse.
• Antipsychotics: These medications can increase the risk of death when used in elderly patients with dementia.

Drug Interactions with Psychotropic Medications

There are many medications that should not be taken with psychotropic medications. We cannot cover all of them here but each medication has important interactions to be aware of. Taking a medication that interacts with a psychotropic medication can be very dangerous. It can cause severe reactions with deadly side effects, or cause the medications not to work as prescribed. Always be sure to alert your prescriber and pharmacist of all medications you take to ensure your safe treatment with psychotropic medication.

Some common drugs and substances that can interact with psychotropic medications include:

• Alcohol
• Opioids
• St John’s wort
• Serotonergic medications
• Seizure medications
• Asthma medications

Other Precautions for Taking Psychotropic Medications

Psychotropic medications are not for everyone and special caution should be used in specific circumstances. Discussing your personal health with your prescriber can help identify any risks that may be specific to you.

• Pregnancy and breastfeeding: Many psychotropic medications can be harmful to fetuses and nursing infants. The choice to take a psychotropic medication while pregnant or breastfeed should always be a discussion of risks and benefits between you and your doctor.
• Pre-existing health conditions: Many health conditions can put you at a high risk of injury on certain psychotropic medications. Seizures, heart disease, kidney disease, suicide risk, and liver disease are all important topics to discuss with your prescriber.
• Do not stop medications without supervision:  Many psychotropic medications require special care when stopping. It is important and safest to follow your provider’s directions to stop.

How to Get a Prescription for Psychotropic Medication

All psychotropic medications discussed in this article require a prescription from a licensed healthcare provider. Those who can prescribe these types of medications may vary from state to state.  It is important to make an appointment and be prepared to discuss your health history, symptoms, and goals for treatment.

If you receive psychotropic medications in a time of crisis, you should follow up with a provider as soon as you can to continue therapy. Remember that online psychiatry services may be a helpful option to consider if access is an issue.