Psychiatric Medication Basics

Psychiatric medications impact the chemical messengers that carry signals between brain cells (or neurons). These chemical messengers include neurotransmitters and neuromodulators, but medications that affect neurotransmitters (e.g., serotonin) are the most common.

The brain’s cells have receptor sites on their surface. When a medication reaches a receptor site in the brain, it can exert several different mechanisms of action, such as (Cummings, 2018):

There are other ways in which psychiatric medications influence the availability and transmission of neurotransmitters in the brain; however, this is beyond the scope of this series.

Categories of Psychiatric Medications

This course refers to medications by their generic names and provides their common trade names (brand names used by pharmaceutical companies) in parentheses after the generic names.

This series will discuss four major categories of psychiatric medications:

•           Antipsychotics
•           Mood stabilizers
•           Antidepressants
•           Anxiolytics, or antianxiety medications

These medications are sometimes prescribed alone (as monotherapy), but an individual may be treated with medications from more than one category. The names of the categories should not be construed as their sole indication.

Some types of medications can successfully treat various types of disorders. For example, antidepressants are used to treat not only depressive disorders but also anxiety disorders and obsessive-compulsive and related disorders.

Furthermore, some medications could be placed in more than one category. For example, you may see SSRIs categorized as either antidepressants or antianxiety medications elsewhere.

FDA Approval and Off-Label Use

The Food and Drug Administration (FDA) “labels” a drug as approved when it receives sufficient research that the medication is effective in treating a particular condition. However, prescribers can still legally prescribe many drugs “off label” without the FDA’s approved label.

This occurs when they deem its use for another condition beneficial, based upon research studies indicating the utility of these medications for conditions other than those approved by the FDA. For example, some antipsychotic medications may be approved by the FDA for the treatment of schizophrenia, but they are also sometimes prescribed for anxiety or depression “off-label.”

People may differ in their response to psychiatric medications. A person may need to try more than one medication of the same class to find one that works well and has minimal side effects.

Similarly, some individuals may respond well to lesser drug doses, while others require larger doses to work optimally.

A medication’s effects can depend upon the person’s physical characteristics, such as:

•           Age
•           Sex
•           Weight
•           Medical conditions
•           Personal body chemistry

Substance use or misuse can also affect the medication’s effectiveness and can lead to serious outcomes. Smoking, caffeine, and alcohol can interfere with how a medication is metabolized. For example, the tar in cigarettes affects enzymes that are involved with the metabolism of the antipsychotic medication clozapine.

When an individual suddenly stops smoking, such as when admitted to an inpatient facility where smoking is banned, the person’s blood levels of the medication can rise significantly and lead to adverse reactions (Al-Jaffar, 2017).

Genetic factors can play a role, with some people carrying different forms of, or even lacking, certain enzymes involved in the process of metabolizing the medications.

Medications can also influence each other’s metabolism, so you need to be aware of all the medical and psychiatric medications the individual is taking. Therefore, you should remind the people you see to tell their prescribing provider about all medicines they take, including:

•           Over-the-counter medications
•           Vitamins or supplements
•           Alcohol or illicit drug use

Some foods can also increase the risk of side effects of medications. For instance, foods containing the compound called tyramine (found in cheese and fava beans) can cause severe side effects when used with monoamine oxidase inhibitors (MAOIs).

As a behavioral health provider, you must have a basic understanding of psychiatric medications. This information is also helpful in facilitating medication adherence and being an influential member of an integrated treatment team.

Psychiatric medications work by affecting chemical messenger systems in the brain. Due to physical characteristics and behaviors (such as whether they are using substances or vitamins and supplements), medications have different effects on each person. Off-label prescription of medications is common in psychiatry, and in fact, this has led to the discovery and standardization of many medications for new indications.