Types of psychiatric medication: a plain guide to the prescription in your hand

Types of psychiatric medication and their names: the big picture

Types of psychiatric medication fall into five main families, close to how the US National Institute of Mental Health (NIMH) groups them: antidepressants, antipsychotics, mood stabilizers, anti-anxiety medicines with some sleep medicines, and the stimulants used for ADHD. Each generic name has brand names that vary by company and by country. This guide helps you identify your medicine's family and what to expect from it, but it does not replace asking your doctor.

The family name does not define your diagnosis: antidepressants may also be prescribed for anxiety, pain and insomnia, as NIMH notes, and some mood stabilizers were first made to treat epilepsy, according to Cleveland Clinic.

Antidepressants vs antipsychotics: what is the difference?

Antidepressants

They are used for depression and many anxiety disorders. SSRIs are among the most prescribed, because they help a wide range of depressive and anxiety disorders with fewer side effects than older types, as NIMH explains. Names listed by the UK's Royal College of Psychiatrists include:

• SSRIs: sertraline (Lustral), escitalopram (Cipralex), fluoxetine (Prozac) and paroxetine (Seroxat).
• Other types: venlafaxine (Efexor) and duloxetine (Cymbalta) from the SNRI class, mirtazapine, and amitriptyline (Tryptizol) from the tricyclic class.

So what is sertraline used for? According to MedlinePlus (US National Library of Medicine), it treats depression, obsessive-compulsive disorder, panic attacks, post-traumatic stress disorder and social anxiety disorder, and eases severe mood symptoms before a period. It is also sold as Zoloft.

Antipsychotics

They are mainly used for schizophrenia, bipolar disorder and episodes of mania, and also for depression with psychotic symptoms and severe agitation, as Cleveland Clinic explains. Examples include haloperidol (Haldol) from the first generation and, from the second, quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal) and aripiprazole (Abilify).

The reassuring difference: an antipsychotic on your prescription does not necessarily mean you have schizophrenia. The Royal College of Psychiatrists notes it can help anxiety or depression that is severe or hard to treat, and MedlinePlus says Seroquel is prescribed for schizophrenia, bipolar disorder and major depressive disorder. So ask your doctor: why did you choose this medicine for me?

Mood stabilizers, anxiety and sleep medicines, and ADHD medicines

Mood stabilizers

They are mainly used for bipolar disorder. The best known is lithium (Lithobid). Too high a lithium level in the blood can be dangerous, according to Cleveland Clinic, so your doctor will ask for regular blood tests of its level and of kidney and thyroid function, as NIMH notes. Keep to these tests, and ask your doctor which signs mean calling them straight away. Others were first made for epilepsy: valproate (for example Depakote), lamotrigine (Lamictal) and carbamazepine (Tegretol), according to Cleveland Clinic.

Anxiety and sleep medicines

A doctor may treat anxiety with an antidepressant; with buspirone, which is taken daily and needs three to four weeks for its full effect; or with beta-blockers to calm physical symptoms such as a racing heart, as NIMH explains. Benzodiazepines relieve severe anxiety in the short term; examples are alprazolam (Xanax), clonazepam, diazepam (Valium) and lorazepam (Ativan). Some sleep medicines, such as zolpidem, act on the same brain receptors, according to Cleveland Clinic.

ADHD medicines

They include stimulants such as methylphenidate, whose brand names include Ritalin and Concerta, according to the UK's National Health Service (NHS). Stimulants increase alertness, attention and energy, as NIMH explains. Read more about ADHD in adults.

How long do antidepressants take to work, and why do many people stop too early?

Rough timeframes, which vary from person to person:

• Antidepressants: they usually start to work within one to two weeks, according to the Royal College of Psychiatrists, but the benefit usually becomes clear after four to eight weeks, as NIMH explains; sleep, appetite, energy and concentration often improve before mood.
• Antipsychotics: agitation and hallucinations may settle within days, false beliefs (delusions) usually take a few weeks, and the full effect may take up to six weeks, according to NIMH.
• Mood stabilizers: their effect may take several weeks to show, according to Cleveland Clinic.
• ADHD medicines: the doctor usually starts with a small dose and raises it gradually, so the full effect may take a few weeks; once the dose is right, methylphenidate works shortly after it is taken, according to the NHS.

Why do many people stop too early?

• Side effects before benefits: the Royal College of Psychiatrists notes that feeling tense, shaky or anxious at first is a common reason people stop antidepressants, especially if nobody warned them, although it usually eases after about two weeks.
• Thinking that feeling better means it's over: the Royal College advises that after a first or second episode, it is best to keep taking an antidepressant for at least six months after feeling better, as stopping earlier makes the symptoms more likely to return.
• Fear of addiction: the answer depends on the family, as you will see shortly.

In its 2019 leaflet on antipsychotics, the Royal College notes that for people with more than one episode of schizophrenia, stopping these medicines more than doubles the risk of relapse and hospital admission. Read also about how long recovery from depression takes.

Side effects: which settle on their own, and which need the doctor?

Many antidepressant side effects, such as nausea, headache, dry mouth and disturbed sleep, are mild and usually ease within about two weeks as your body adjusts, according to the Royal College of Psychiatrists and NIMH. Some can last, so if something like weight gain or sexual problems bothers you, don't suffer in silence: tell your doctor.

As for whether antipsychotics cause drowsiness, Cleveland Clinic lists sleepiness, dizziness and weight gain among their side effects, and the Royal College adds stiffness, shakiness and a restlessness that makes it hard to sit still, noting that the doctor aims for a dose that helps without making you too sleepy. MedlinePlus warns that quetiapine can cause drowsiness, made worse by alcohol, so don't drive until you know how it affects you. With second-generation antipsychotics, the doctor may monitor weight, blood sugar and blood fats, according to NIMH.

When to call the doctor at once or get emergency help

MedlinePlus leaflets for some of these medicines list symptoms that mean calling the doctor at once or getting emergency help (ambulance 123 in Egypt, or your local emergency number elsewhere), including:

• Thoughts of harming yourself, or depression suddenly getting worse. NIMH warns that these thoughts may increase with antidepressants in people under 25, especially in the first weeks or after a dose change, and that close monitoring matters at every age. If they come, don't wait for your next appointment or stop the medicine on your own: if you're in danger, call an ambulance on 123 now; if not, the mental-health hotline 16328 or Oxygen's emergencies line +20 100 006 6752. The MedlinePlus sertraline leaflet advises that your family know these signs so they can call the doctor if you can't
• Taking more than was prescribed, or someone losing consciousness, being hard to wake, having a seizure or struggling to breathe: MedlinePlus advises calling an ambulance straight away
• Seizures, severe confusion or agitation, or a rash, swelling and difficulty breathing
• Fever with stiff muscles, sweating, confusion and a fast or irregular heartbeat
• Movements you can't control in the face, tongue or limbs, or tightness in the neck or throat muscles with difficulty swallowing or breathing

Are psychiatric medications addictive? And why should you never share yours?

The answer differs from one family to another:

• Antidepressants: the Royal College of Psychiatrists explains that difficulty stopping them is physical dependence, meaning the body has adapted to the medicine. This is not the same as addiction, and it is why they are reduced gradually.
• Antipsychotics and mood stabilizers: they are not addictive, according to the Royal College and Cleveland Clinic, but stopping them suddenly can cause discomfort or bring symptoms back.
• Benzodiazepines: the clearest dependence risk of these families. The Royal College lists them among substances that can cause addiction, and Cleveland Clinic explains that addiction is unlikely if you take them exactly as prescribed, but still possible. Physical dependence is different: the body can adapt to the medicine even when it is taken exactly as prescribed, especially with long-term use, so stopping can bring on withdrawal, according to Cleveland Clinic. NIMH notes that long-term use may lead to tolerance or even dependence, so doctors usually prescribe them for short periods and reduce them slowly. Don't combine them with alcohol, and tell your doctor if you take opioid painkillers or cough medicines, as this combination can cause serious breathing problems, according to Cleveland Clinic and MedlinePlus.
• Stimulants: misuse or dependence is unlikely when they are taken as prescribed, according to NIMH, and the risk rises when they are taken more than prescribed, as the NHS explains. The NHS also warns that stopping methylphenidate suddenly can cause withdrawal symptoms such as depression, so stop it only on your doctor's advice.

If your question is about pregabalin (Lyrica), read our article on pregabalin dependence.

Why not take a relative's medicine or give yours to anyone?

NIMH and MedlinePlus advise never taking a medicine prescribed for someone else and never giving yours to anyone, for practical reasons:

• Similar symptoms don't mean the same diagnosis, and the doctor chose your relative's medicine after assessing their condition, not yours.
• Drug interactions: the doctor needs to know all your medicines and supplements before prescribing, which never happens with someone else's medicine.
• Risks for certain groups: NIMH and MedlinePlus note that antipsychotics are linked to a higher risk of stroke and death in older people with dementia, so never give an older person a "calming" medicine from someone else's prescription. But if your older relative takes one prescribed by their own doctor, don't stop it yourself; talk to that doctor.
• Better focus doesn't prove a diagnosis: NIMH notes that stimulants improve attention in most people whatever their diagnosis, so feeling sharper on your brother's medicine doesn't mean you need it. Taking it before exams is not treatment but taking a medicine not prescribed for you.

Questions to take to your next doctor's appointment

Write these down before your appointment. NIMH advises telling your doctor about all your medicines and supplements and asking about side effects and what to expect; the Royal College of Psychiatrists advises asking your doctor or pharmacist whether the medicine interacts with foods or other medicines:

1. What is the generic name of this medicine, which family does it belong to, and why did you choose it for me?
2. What benefit should I expect, and what are the risks?
3. When should I expect to feel better, and when will we review together whether it is working?
4. Which side effects will settle, and which mean I should call you at once?
5. Does it interact with my other medicines, herbs, alcohol or certain foods?
6. Will I need blood tests, or checks on my weight and blood sugar?
7. Can it cause dependence? And how will we stop it when the time comes?

Tell your doctor about any allergy or past bad experience with a medicine. If you are pregnant, planning a pregnancy or breastfeeding, say so: this is one of the factors in choosing a medicine, as Cleveland Clinic notes, and some medicines, such as valproate, are known to be risky in pregnancy, as the Royal College notes. If you find out you are pregnant while taking a psychiatric medicine, don't stop it suddenly; see your doctor as soon as possible.

When should you get help?

Contact your doctor soon if:

• Weeks have passed without improvement, or you are getting worse
• Side effects are unbearable or have lasted more than a few weeks
• You find yourself taking more of a sedative or sleeping medicine on your own, or struggling to do without it
• You are thinking of stopping your medicine, or another doctor has prescribed you a new one

How does medication treatment work at Oxygen?

In psychiatry, medicine is part of a plan, not the whole plan. At Oxygen, the path starts with an appointment with a psychiatrist, who assesses your condition, explains why a medicine was chosen and what to expect, then follows up with you to adjust treatment to your response. Medicine is often combined with psychotherapy sessions that work on thoughts, behaviors and everyday skills.

Doctor appointments and therapy sessions are open to men and women aged 15 and over, with a guardian's consent for anyone under 18. If your condition needs closer follow-up and medication adjustments under daily supervision, there is inpatient psychiatric treatment, for males only, aged 15 and over. Your family can also come alone first to ask about the right next step. To get in touch: +20 101 687 0711 (phone and WhatsApp) or +20 45 320 0011.