For most people diagnosed with any sort of mental health condition, the first step to recovery is often medication. Depending on your condition, mental health medication can be split into 4 main categories; Antidepressants, Antipsychotics, Benzodiazepines and Mood Stabilisers. From there, each one is split again. It wouldn't be any fun if it was easy would it!
This is our simple guide to those different types of medication. Of course, medication is a very personal issue, so you need to seek professional medical help in terms of what would suit you and your personal circumstances. This is only intended to be a heads-up so you have some background knowledge on what you’re putting in your body.
ANTIDEPRESSANTS . . .
There are many different types of medication that are categorised as antidepressants. They will likely be prescribed by your Doctor if they have diagnosed you with depression in its moderate or severe states. They have little effect for those with mild depression.
They may also be prescribed if you suffer with Obsessive Compulsive Disorder (OCD), anxiety or Post-Traumatic Stress Disorder (PTSD). Whilst they may not 'cure' depression (or any other illness), they can help ease the symptoms.
If you've read our page about depression, (if not, you really should take a look), you'll know that the cause of depression is a grey area (or should that be grey 'matter' area).
No-one can definitely say what causes it, which, as you can imagine, makes treating it effectively just as difficult. Because of this, there's no clear definition about whether antidepressants work.
If you subscribe to the thought that depression is caused by lower levels of serotonin or noradrenaline in the brain, then antidepressants are there to increase the work of these neurotransmitters. Those two in particular can help your emotions and overall mood. Whilst they may help the symptoms, they can't address the cause, whatever that may be.
As we said, there are many different types of antidepressants and each one will affect different people in different ways and may also offer different side-effects. Because of this, you may need to try and number of different types before you find one that works for you.
To feel any effect of anti-depressants takes a little time. Most people won't feel any improvement until they've been taking the drug for between 4-6 weeks. If, after that time, you feel no better, refer back to your Doctor who may try a different pill or increase the dosage. Again, you may find it takes time before the effects 'kick-in'.
So what types of antidepressants are there. Well, they can be broken down into 5 sub-categories. Let's take a look at them now.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most widely-used type of antidepressants. If it's your first taste of medication for mental illness, they may well be the first option used by your Doctor.
They generally cause fewer (and less unpleasant) side effects and also any overdose of them is likely to result in less serious problems. They usually appear in tablet form and, if it's your first time taking them, you'll usually be put on the lowest dose for your particular symptoms. They have only been around since the late 1980s but have now generally replaced the older tricyclic medication.
They work by blocking the re-absorption (or 'reuptake') of serotonin, a neurotransmitter. Serotonin, like any neurotransmitter, carries signals (think of them as messages) between nerve cells in the brain.
In normal circumstances, once the message has been delivered, the nerve cell that released it reabsorbs (or reuptakes) it. SSRIs block (or inhibit) the reuptake so that more serotonin is now available to pass more messages around the brain.
By prolonging its effect and rebalancing the serotonin, SSRIs help the brain send and receive its chemical messages which should help improve your mood. The most widely known SSRI is fluoxetine, or as you you may have heard it, Prozac, but there are many more including Citalopram (marketed as Cipramil), paroxetine (offered as Seroxat) or sertraline (which you may know as Lustral).
Serotonin and Norephinephrine Reuptake Inhibitors (SNRIs)
SNRIs are similar to SSRIs described above, but were designed to be more effective. Whether this is actually the case is open for discussion. The fact is some people respond better to SNRI medication, while others respond better to SSRIs.
The side effects are very similar to SSRIs, but there are some caveats. Some medication, Venlafaxine for example, should not be taken if you suffer from heart problems. Your Doctor will advise you if you have pre-existing conditions.
They came to market in the 1990s and are newer than SSRIs, which are pill-like children of the 1980s. They also work in much the same way, but rather than inhibiting just serotonin, they work on noradrenaline too.
If your depression has been categorised as severe or suffer with anxiety, you are more likely to prescribed SNRI medication like Duloetine (which you may know as Cymbalta or Yentreve) and Venlafaxine (Efexor).
Tricyclic medication have largely been superseded by SSRI and SNRI medication, but not completely. If you suffer with severe depression, have tried the other types and seen little improvement or for those with treatment-resistant depression, then your Doctor may prescribe tricyclic medication.
It is also used if you suffer with obsessive compulsive disorder (OCD) or bipolar. You should be aware that tricyclic medication is more potent and, as such, has more unpleasant side effects and are more dangerous if used as part of an overdose.
If you are feeling suicidal, PLEASE talk to someone who can help.
The side-effects of tricyclic medication are known as antimuscarinic effects (or anticholingeric effects). This means that because of the way the drug works, affecting your brain chemicals, they can also have a knock-on effect to other brain chemicals that control certain functions in your body.
Tricyclics have been around since the 1950s. They work by increasing the levels of norephinephrine and serotonin, whilst blocking the action of acetylcholine.
By balancing those three neurotransmitters (hence the name 'tri'), it is believed that they can alleviate depression. There are also some tricyclic-related drugs which work in a similar way, but do have more severe side-effects, but will be less likely to cause the antimuscarinic effects mentioned earlier.
If you look in your medicine cabinet and see Amitriptyline (or Tryptizol), Lofepramine (Gamanil) or Clomipramine (Anafranil) (et al) then you're taking tricyclic medication.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase Inhibitators (let's just call them MAOIs from now on shall we?) are another older form of medication that are rarely prescribed today.
Monoamine Oxidase is a natural enzyme that breaks down serotonin, epinephrine and dopamine and this type of medication blocks the effect of this. By blocking those neurotransmitters, your brain will receive a 'boost'. While the upside seems great, the downside can be much worse.
They prevent the body's ability to break down other medicines metabolised by this enzyme including Sudafed or other stimulants. By doing this, it increases your risk of high blood pressure to quite dangerous levels, particularly if you eat foods containing Tyramine, such as cheese and pickled fish.
Because you will generally be unaware of this, you will need to follow a carefully selected diet. You will only likely be prescribed MAOI medication by a specialist, rather than your GP, and only if you've tried all the others and they haven't worked for you.
Noradrenergic and Specific Serotonin Antidepressants (NaSSA)
What a mouthful! NaSSA medication were first introduced in the mid-1980s and have continued to be up until more recently. They share many similar side effects to SSRIs including feeling drowsy, weight gain but are less likely to affect your sex drive.
They work by blocking receptors called alpha-2 receptors found on the nerve cells of the brain, which enhances the actions of serotonin and noradrenaline.
By blocking them, it permits selective receptor stimulation which, in turn, limits the occurrence of the more troublesome serotonergic side-effects. They are used to treat Post-Traumatic Stress Disorder amongst other conditions. NaSSA medication includes Mirtzapine, popularly known as Zispin.
ANTIPSYCHOTICS . . .
If you've been prescribed antipsychotic medication by your doctor or other health care professional, then chances are you (or someone you know) has been diagnosed with psychosis, mania (also a symptom of bipolar), hypomania or even depression.
This could be either as a one-off episode or part of an ongoing condition. Like any mental health medication, antipsychotics won't cure your condition, but may help relieve some of the symptoms of it making life seems a little more 'normal'.
They work by reducing the amount of a chemical called dopamine in the brain. Dopamine is one of the chemicals that helps carry messages around your brain. Too much dopamine, scientists believe, is what causes your brain to work differently, thus causing the symptoms of psychosis.
Once in your system, they have the effect of feeling like your slowing down and sleepy. It has been suggested that they work by causing the physical and psychological symptoms that resemble Parkinsonism, which is also caused by the loss of dopamine.
Depending on your dosage, patients have described as feeling like a 'zombie', with little expression on your face and slow movements. The drugs also affect other brain chemicals including serotonin and noradrenaline (see above for more information on those little troublemakers).
Antipsychotic medications are divided into 2 categories; 'first generation' and (not surprisingly) 'second generation'. First generation drugs, sometimes referred to as 'typical' medications are the older varieties, whereas the second generation, or 'atypical' medication are newer. You may be prescribed more than one antipsychotic drug (i.e. one older and one newer). This is known as polypharmacy.
'Typical' antipsychotics have been around since the 1950s. As you would expect today, you are more likely to be prescribed the newer variants, first developed in the 1990s, as the side-effects are generally found to be easier to cope with.
As a caveat to that and like antidepressants, the same antipsychotic medication may affect people who take them differently and come complete with their own individual set of side-effects, which are is main difference between the two types. You may decide that the help the medication offers is worth the side effects they cause.
Just like their anti-depressive cousins, you may need to try a number of different meds until you find one that works for you or one where the side-effects are less problematic for you. There is a particular second generation drug called Clozapine prescribed for those with schizophrenia, which can only be prescribed after you've tried, and failed to respond to, two other types of medication. This is known as 'treatment resistant'.
It can also cause a more serious side-effect where the number of your white blood cells begins to drop affecting your immune system, although this is rare.
Whilst most antidepressant medication comes in tablet form, antipsychotics can either come as a tablet, a syrup-like liquid or as a deep, slow-release injection into the muscle called a 'depot injection'.
Injections are administered every 2-6 weeks and are useful if you think your condition means you may forget to take it as a tablet or if you may be at risk of overdosing.
Unlike antidepressants, the effects of antipsychotic meds occurs quite quickly. As a tablet or syrup, you will feel the effect in just a few hours (the syrup would act slightly quicker than the tablet). Because of their slow-release nature, injections do not act as quickly as the other two and would only be offered if you've previously tried the tablet and it has been of benefit to you.
In an emergency situation, an injection can be administered which will work in around 60 minutes, this is known as 'rapid tranquillisation' and can occur if it is deemed that your behaviour is putting you or others at risk and / or you are detained under the Mental Health Act 1983.
BENZODIAZEPINES . . .
Benzodiazepines, or 'benzos', are a form of anxiety medication. They act as a minor tranquilliser and are often used to also treat insomnia and other sleeping problems. They can be used to treat depression too, but not as a standalone treatment.
If your anxiety is severe or you find yourself becoming very distressed, then your Doctor may prescribe benzodiazepines for a short period of time. Why short? Well that's because 'benzo' meds can be addictive. You should not take them for longer than a month and coming off them should be monitored by your Doctor or healthcare professional.
There are a number of organisations who can help with addiction to sedative medication on our Where To Turn pages. They also become less effective over time as your body becomes used to the effect they cause. Which is what exactly? Great question!
As a tranquilliser / sedative, they work by slowing down the functions of your body. It sounds serious, but in real terms what is happening is that they increase the effect of an existing brain chemical you have called Gamma Amino Butyric Acid, or GABA for short.
In normal circumstances, GABA effectively calms your brain down, but 'benzos' makes it even more powerful. The impact of this is that they reduce the area of the brain responsible for rational thought, your memory, your emotions and even breathing. As they slow down your body and brain, so your thinking and reaction times follow suit. You've seen the warning on many tablets that say 'don't drive or operate heavy machinery?'. This REALLY applies to benzodiazepines.
There are two types of benzodiazepines; those that act in the short-term and those that are more longer-acting. The shorter type are called 'hypnotics' and use to treat conditions like insomnia and the longer acting ones are called 'anxiolytics', used for symptoms of sever anxiety.
Like all mental illness medication, benzodiazepines have side-effects which include, not surprisingly given their purpose, becoming drowsy or sleepy and dizziness. These are fairly common, but rarer side effects include headache, confusion poor memory recollection.
There are a number of different types of benzodiazepines medication. Common 'hypnotics' include Loprazolam or Temazapan (known as Restoril) and are used to help sleep problems.
Anxiolytic medication is used to treat anxiety disorders but they can vary if you have any underlying conditions, e.g. alcohol withdrawl. You may know them as Diazepam (Valium), Alprazolam (Xanax) or Lorazepam (Ativan).
MOOD STABILISERS . . .
If you are taking mental health medication as part of a long-term treatment plan, chances are you'll have mood stabilisers as part of your medicinal arsenal.
These are psychiatric drugs used to treat conditions like bipolar disorder, mania or recurrent episodes of depression in its severest forms.
Whilst medication that comes together under the 'mood stabiliser' umbrella can often quite different in themselves, but all can help to stabilise mood, especially if you experience swings between extreme highs and extreme lows. As always, different mood stabilisers can affect people in different ways and the side effects can be just as diverse.
Mood stabilisers can be generally grouped into 3 types; mineral, anticonvulsants and 'other' antipsychotic medication, which will talk more about below.
Lithium is the 'classic' mineral mood stabiliser you may be aware of. Lithium isn't just a Nirvana album, but a element that occurs naturally, rather than being a man-made manufactured drug.
Lithium (or lithium carbonate to give it its full Sunday-best name) has been used for some time to treat mania over a sustained period. It takes about a week to 'kick in', so is often prescribed if your symptoms aren't too severe. It also helps to reduce the risk of suicide.
If you take lithium, you will be required to undertake quarterly blood tests to ensure the amount in your system isn't at a dangerous level.
Prolonged lithium dosage can cause the level of salt in your body to change, making lithium levels rise and, in some circumstances, become toxic.
It's important to discuss your diet if taking lithium as a low-salt diet can create problems.
Anticonvulsant medication (also known as antiepileptic medication) can be further categorised into 3 distinct, commonly prescribed types; carbamezapine, lamotrigine and valproate.
They were originally designed for epilepsy, a neurological disorder that causes sufferers to have seizures, but have also been licensed to treat mania.
As a first choice, valproate is often the first stop when it comes to long-term medication to treat mania, but it's not recommended if you're thinking of starting a family.
Lamotrigine, often called Lamictal, is used to treat bipolar disorder when depression is the main problem, but is not recommended for mania or as a first choice for those suffering bipolar disorder.
The final drug is carbamazepine (or Tegretol), widely taken for bipolar disorder. It is not recommended for treating recurrent depression or acute mania.
One interesting aspect of carbamazepine is that it can affect the metabolism of many other drugs, including some you can buy over-the-counter, so you should always discuss this with your Doctor or pharmacist when buying additional meds.
The final 'other' type of mood stabiliser is asenapine. Asenapine is actually an atypical antipsychotic medication, but despite this, it is only really used as a mood stabiliser. In this regard, it is used to treat the symptoms of psychosis, including delusions, paranoia and hallucinations.
If you'd like to share your experiences of medication (or any other treatment) with our community so they can better understand how it helped you, please take a look at our 'Men Tell' section.