A Patient’s Guide to Psychiatric Medication

What each main group of medication is for

Psychiatric medications fall into several groups, each with its own uses and risks.

• SSRIs and SNRIs are closely related antidepressants, prescribed for depression and for a range of anxiety disorders. SSRIs act mainly on serotonin, and SNRIs act on serotonin and norepinephrine. Exactly how that leads to feeling better is less settled. Read how SSRIs and SNRIs work.
• Mood stabilizers, mainly lithium and certain anticonvulsants, are used mainly for bipolar disorder. NIMH says lithium or valproate can help prevent mood episodes or reduce their severity, though the Depakote (valproate) label says safety and effectiveness for long-term use in mania, meaning more than 3 weeks, has not been shown in controlled trials. They differ in what they treat, the monitoring they need and their risks. Boxed warnings cover lithium toxicity, which can occur at doses close to treatment levels; liver failure, fetal risk and pancreatitis with valproate; serious rashes that can be life-threatening with lamotrigine; and serious skin reactions and blood disorders with carbamazepine. On lamotrigine, call your prescriber right away about any rash, even a mild one, and ask what to do about your next dose. On lithium, call right away, before your next dose, about diarrhea, vomiting, drowsiness, muscle weakness or poor coordination. Go to the nearest ER if symptoms are severe or you cannot reach anyone. Anticonvulsant labels also warn of suicidal thoughts or behavior, so use the crisis contacts below if those appear. Read what mood stabilizers are.
• ADHD medications come in two main groups. Stimulants act quickly. Non-stimulants take longer to act, though the CDC notes their effect can last up to 24 hours.
• Benzodiazepines are fast-acting sedating medications that can help with severe anxiety, panic, seizures and some other conditions, usually for a limited time. Their main risks are physical dependence, withdrawal when stopped too quickly, misuse and addiction, and dangerous sedation when combined with opioids or alcohol. Their FDA boxed warning says stopping abruptly or lowering the dose quickly after continued use can cause withdrawal reactions that can be life-threatening, so do not stop or lower the dose on your own. Call 911 or go to the emergency room for trouble breathing or seizures. Read benzodiazepine uses and risks.
• Atypical antipsychotics are the newer antipsychotics, and several are FDA-approved for mood disorders. Being prescribed one does not necessarily mean a clinician thinks you have psychosis. The labels reviewed for the article linked here, including quetiapine and aripiprazole, carry two boxed warnings: increased risk of death in elderly patients with dementia-related psychosis, and suicidal thoughts and behaviors. Read why they are prescribed for mood disorders.

Whichever group you take, do not stop, restart or change a dose on your own. Talk with your prescriber first.

How long until it helps?

NIMH says antidepressants usually take about 4 to 8 weeks to work. Problems with sleep, appetite and concentration often improve before mood lifts, and NIMH's summary of one large study notes that full benefits may not be realized until 10 or 12 weeks. A slow start does not by itself mean the medication has failed, but do not wait to report a problem. Study averages describe groups and cannot predict one person's course. Read how long antidepressants take to work.

What side effects are common?

NIMH lists upset stomach, headache and sexual dysfunction among the common side effects of SSRIs and other antidepressants, and says these are generally mild and tend to fade over time. That varies, and sexual or weight changes may not fade for some people. Early side effects can also arrive before any benefit.

Why the first months need close attention

Antidepressants carry an FDA boxed warning. It says they increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. All treated patients should be closely monitored, and the label says this matters most during the first few months of treatment and at times of dose changes. Call your prescriber right away about thoughts of suicide or dying, new or worse depression, anxiety, agitation, trouble sleeping, or unusual changes in behavior or mood.

If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

Primary care doctor or psychiatrist?

For many people with uncomplicated depression or anxiety, a primary care doctor can be a reasonable prescriber, especially when follow-up is regular. A psychiatrist usually makes more sense when the diagnosis is unclear, the first treatments have not worked, bipolar disorder or psychosis may be involved, or the medication plan is complex. The research does not show that one kind of prescriber is always better, so this is practical reasoning and not a rule from a trial.

	Primary care doctor	Psychiatrist or psychiatric NP
Typical starting point	Common depression and anxiety, first medication	Complex or uncertain diagnosis, treatment that has not worked
Your medical history	Often already knows it	Learns it during the evaluation; needs your records and medication list
Access and cost	Often already in your insurance plan	Varies widely; ask about network status and costs up front

You do not have to choose one forever, and you can read more on choosing a prescriber. Mind Body Seven is an out-of-network practice and does not accept Medicare or Medicaid, including managed Medicaid. See fees and insurance.

Stimulant or non-stimulant for ADHD?

The stimulants compared in this ADHD medication article are Schedule II controlled substances with a boxed warning about abuse, misuse and addiction. Atomoxetine has a boxed warning about suicidal thoughts in children and teens, viloxazine has one that calls for closely monitoring all treated patients, and the guanfacine ER and clonidine ER labels have no boxed warning. A 2018 analysis of 133 trials supported methylphenidate in children and adolescents and amphetamines in adults as preferred first choices for short-term treatment. Confidence in many of its comparisons was low, it lacked enough long-term data, and viloxazine was not included.

Is an add-on antipsychotic worth it for depression?

A clinician may suggest adding a medication when an antidepressant has helped only partly, or not at all. A 2013 analysis of 14 short-term trials of four add-on options found better remission and depression scores than placebo, yet the average change was modest. On functioning and quality of life, they produced no benefit or a very small one, except risperidone, which had a small-to-moderate effect on quality of life. The authors warned that study design problems may have inflated the benefits and understated the side effects, which included restlessness, sedation, metabolic lab changes and weight gain. For some people the trade-off is worth it, and for others it may not be.

Will medication change who you are?

In a 2017 internet survey of 669 people taking antidepressants for depression, 46 percent reported emotional blunting, a narrower range of emotion. The survey relied on self-reports, and blunting scores rose alongside depression scores, so the authors said it cannot be described simply as a side effect. If you feel flat, tell your prescriber, because there may be options to address it, and avoid stopping suddenly because of it. Read whether medication changes who you are.

If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

Getting ready for a prescribing visit

Bring a list of all your medications, including supplements and over-the-counter products. Mention any personal or family history of bipolar disorder, since antidepressants can bring on mania or hypomania in people with bipolar disorder. Mention pregnancy plans too. Good first questions:

• When is my first follow-up, and who do I call if something worries me before then?
• How will we decide whether this is working?
• Which side effects need a call right away?

For help here, see medication management. You can request a consultation, and the intake team confirms fit, scheduling and costs.

If a side effect is bothering you

Write down what changed and when it started, then raise it directly at your next visit, or sooner if it makes you want to stop treatment. Do not stop, lower or skip doses on your own, and call right away about sudden mood or behavior changes. Depression itself can cause sexual problems and weight changes, so timing helps your prescriber. Your prescriber may discuss waiting and watching, adjusting the dose or timing, adding a medication aimed at the side effect, or switching. Each has trade-offs. Read more on sexual side effects and weight changes.

If it is not helping

Ask whether the medication has had enough time, whether doses were missed and whether the diagnosis still fits. If you are considering a switch, a 2018 meta-analysis found switching was not superior to staying on the first antidepressant in the few trials it reviewed. That is not a reason to stay on, stop or combine medications without your prescriber. Switching for side effects is a straightforward reason. Some switches can be done within days, others take weeks, and some need a planned gap of weeks, so your prescriber sets the steps. Do not try to switch on your own or start another antidepressant from an old prescription, because certain combinations can be dangerous and stopping suddenly can cause withdrawal-type symptoms. Ask for the plan in writing, including who to call between visits, since a switch usually involves the first months of treatment and dose changes, when the boxed warning calls for close monitoring. Read how switching works.

If you are thinking about stopping

Talk with your prescriber first. With antidepressants, discontinuation symptoms usually start within days to about a week of stopping or cutting back, and often include dizziness, nausea or electric shock feelings. Relapse usually develops more gradually and looks more like your original depression or anxiety. Those patterns are guides and cannot settle the question for one person. In a 2021 UK primary care trial of adults with repeated depression or at least 2 years on an antidepressant, who felt well enough to consider stopping, relapse by 52 weeks occurred in 56 percent of those assigned to taper and stop and 39 percent of those assigned to continue. That does not mean no one should ever stop. It means stopping is worth doing with a plan and with follow-up. Serious changes have also been reported. The venlafaxine label describes suicide, suicidal thoughts, aggression and violent behavior during dose reduction or discontinuation, and the sertraline label lists seizures among discontinuation reactions. Treat sharp changes in mood or thoughts, seizures or severe confusion as urgent and use the crisis contacts below. Other medications have their own risks when stopped suddenly, including benzodiazepines, lithium, lamotrigine, valproate, guanfacine and clonidine. If you feel unwell after stopping or lowering a medication, call your prescriber. Do not restart, stop or change doses on your own. Read discontinuation symptoms vs relapse.

If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

Staying safe and supplied

Request refills well before you run out, and read refills, prior authorizations and shortages. Tell your prescriber exactly what alcohol or cannabis you use, and read how they mix with medication. Some medications also need regular blood tests.