3.11 Examples of Psychotherapeutic Agents

What are antidepressants?

Antidepressant medications are most commonly used to help relieve the distress of depression or anxiety. They are also used to help with other conditions such as chronic pain. Antidepressants help many people; they do not work for everyone. Even when they do work well, they can only do so much. They often work best when they are combined with therapy, support from family and friends and self-care (e.g., regular exercise, a nutritious diet and getting enough sleep). Antidepressants can take up to several weeks to be fully effective. Early signs that the medication is working include improved sleep, appetite and energy. Improvement in mood usually comes later.^[2]

How do antidepressants work?

Antidepressant medications increase the activity of chemicals called neurotransmitters in the brain. Increasing the activity of the neurotransmitters serotonin, norepinephrine and dopamine seems to help lessen the symptoms of depression and anxiety.  These medications help to relieve symptoms of depression and anxiety in up to 70 per cent of people who try them. This rate is even higher when people who do not get relief with one type of antidepressant try a second type.^[3]

What are the possible side effects of antidepressants?

All medications can have side-effects. Some people experience no side-effects. Others may find the side-effects distressing. In most cases, side-effects lessen as treatment continues.  Treatment is usually started at a low dose, to minimize side-effects, and then slowly increased until the ideal dose is found. The ideal dose is one that provides the greatest benefit with minimum side-effects.

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind other antidepressants.

How do anti-anxiety medications work?

Anti-anxiety medications “enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night”.^[4]

What are the possible side effects of anti-anxiety medications?

The common side effects of antipsychotic medication, depending on the medication include: drowsiness, sedation, dizziness and loss of balance.^[5]

Antipsychotic medicines are primarily used to manage “psychosis” (conditions that affect the mind, and in which there has been some loss of contact with reality).  Psychosis can include delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). Psychosis can be as symptom of a mental health disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”).^[6]  Psychosis can also be experienced through substance use.

How do antipsychotics work?

Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including: Attention Deficit Hyperactivity Disorder, Severe Depression, Eating Disorders, Post Traumatic Stress Disorder, Obsessive Complusive Disorder, and Generalized Anxiety Disorder. Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life.

What are the possible side effects of antipsychotics?

Certain symptoms, such as feeling agitated and having hallucinations, usually go away within days of starting an antipsychotic medication. Symptoms like delusions usually go away within a few weeks, but the full effects of the medication may not be seen for up to six weeks. Every patient responds differently, so it may take several trials of different antipsychotic medications to find the one that works best.  Some people may choose to stop taking medication (relapse). Some people stop taking the medication because they feel better or they may feel that they do not need it anymore, but no one should stop taking an antipsychotic medication without talking to their health care provider.

Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. Lithium which is an effective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of a bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat: Depression, Schizoaffective Disorder, disorders of impulse control, some mental health disorders in children.  Anticonvulsant medications are also examples of mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods.

How do mood stabilizers work?

Mood stabilizers are not yet “fully understood. It is thought that the drugs work in different ways to bring stability and calm to areas of the brain that have become overstimulated and overactive, or to prevent this state from developing”.^[7]

What are the possible side effects of mood stabilizers?

The side-effects of mood stabilizers vary with each medication. For example, if a person is prescribed Lithium, side effects include “thirst and urination, nausea, weight gain and a fine trembling of the hands. Less common side-effects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes (e.g., dry skin, acne) and slight muscle weakness”^[8]. Some people experience no side-effects and others may experience some or all of the side effects.  The good news is that side-effects usually lessen as treatment continues.^[9]

Chapter Credit

Adapted from Unit 4.1 in  Drugs, Health & Behavior by Jacqueline Schwab. CC BY-NC-SA. Updated with Canadian Content.