The term “mental illness” refers to many mental health-related conditions that can affect your mood, thoughts, and behaviour. According to the World Health Organization, 1 in 8 people worldwide suffers from mental illness; in some countries, the incidence is much higher. In fact, in the most recently published “Mental State of the World” report, South Africa ranked the lowest in quality of mental health in the world based on scores from a test called the Mental Health Quotient (MHQ). Mental illness can cause significant mental, emotional, and even physical distress, impaired functioning, and risk of self-harm or suicide. It can cause major problems in family, social, and work interactions. Types of mental illness include anxiety, depression, behaviour disorders, eating disorders, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), and neurodevelopmental disorders (ex- autism spectrum disorders, attention-deficit hyperactivity disorder/ADHD). This is not a complete list. There are many possible mental health diagnoses. Treatment for mental illness usually includes a combination of medication and psychotherapy/counselling, and in the most severe cases, brain stimulation therapy.
There are several medication treatment options for mental health disorders/mental illness. Some are fast-acting for immediate relief of distressing and debilitating symptoms, and others are taken every day to help maintain a higher level of functioning and mental well-being. It is common to need more than one, or to try several different types of medication before finding one that works best for you. The most commonly prescribed medications for mental illness are discussed below.
Antidepressants help improve symptoms of depression, anxiety, and other mental health conditions by affecting brain chemicals associated with emotion, including serotonin, dopamine, and norepinephrine. There are several classes of antidepressants.
Selective Serotonin Reuptake Inhibitors (SSRIs) increase levels of serotonin in the brain to treat depression symptoms. Examples include citalopram, escitalopram, fluoxetine, sertraline, and paroxetine
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) increase levels of norepinephrine and serotonin in the brain. Examples include venlafaxine, desvenlafaxine, and duloxetine
Bupropion treats depression by increasing dopamine levels in the brain. It is in its own class.
Cyclic Antidepressants increase levels of dopamine and serotonin in the brain to treat depression symptoms. They also affect other chemical messengers in the brain, which increases side effects. Examples include doxepin, amitriptyline, nortriptyline, imipramine, desipramine
Monoamine Oxidase inhibitors (MAOIs) were the first antidepressant drugs developed. They prevent the chemical breakdown of norepinephrine, serotonin, and dopamine in the brain and therefore increase their levels. They also work on other chemicals messengers in the body, which increases side effects. They have several potentially dangerous food and drug interactions. Therefore, they are usually only used in treatment-resistant depression. Examples include isocarboxazid, phenelzine, selegiline, tranylcypromine
SSRIs, SNRIs, and Bupropion are the most prescribed and well-tolerated antidepressants. Older antidepressants such as cyclic antidepressants and MAOIs may be used in depression or other conditions that don’t respond well to other treatments.
SSRIs/SNRIs- In addition to treating depression, SSRIs and SNRIs are very effective at treating anxiety and are usually the drug of choice to begin treating anxiety disorders, since these medications are not addictive. Examples- fluoxetine, sertraline, citalopram, venlafaxine, duloxetine
Benzodiazepines are known as central nervous system depressants. They act as sedatives, essentially slowing down brain activity to decrease anxiety. These medications can be very addictive. There are several different benzodiazepines- some that are short-acting, and others that are long-acting. However, they are all faster-acting agents that can be used to provide immediate relief of anxiety symptoms, unlike SSRIs and SNRIs, which are used for long-term control of anxiety. Examples- alprazolam, lorazepam, diazepam, temazepam, clorazepate, clonazepam
Buspirone is not related to other anti-anxiety medications. It is taken daily for anxiety disorders. It is not known exactly how buspirone works, but it is thought to decrease the amount of serotonin in the brain to relieve anxiety symptoms.
Beta Blockers lower heart rate and blood pressure and are usually used to treat high blood pressure and heart conditions. However, they also work to relieve some of the distressing symptoms of anxiety such as heart palpitations and are sometimes used to treat anxiety/panic attacks. Examples- propranolol, atenolol, metoprolol
Antihistamines are generally used to treat allergic conditions, but because they have a common side effect of sedation, they are sometimes used to treat symptoms of anxiety. Examples- diphenhydramine, hydroxyzine
Stimulants are used to treat narcolepsy and attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD). They work by increasing levels of chemical transmitters (usually norepinephrine and dopamine) in the brain that improve attention span, motivation and focus, and decrease physical hyperactivity. Stimulants can be addictive, but usually aren’t when used as prescribed in ADHD treatment. Examples- methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine
Some non-stimulant medications that may be used in treatment of ADHD include clonidine, guanfacine, and atomoxetine.
“Psychosis” is a symptom of several mental health disorders that causes the loss of a sense of reality. It may be severe and disruptive enough to require around-the-clock psychiatric care when not adequately treated. Antipsychotics are used to treat disorders including schizophrenia, bipolar disorder, and sometimes severe depression.
First Generation Antipsychotics, also called “typical antipsychotics” or “conventional antipsychotics” were the first antipsychotic drugs developed. They work by blocking the action of several brain chemicals, including dopamine, acetylcholine, histamine. Because they work on several chemicals, this increases the risk of side effects, and some can be particularly problematic. Examples- fluphenazine, thioridazine, perphenazine, chlorpromazine, haloperidol
Second Generation Antipsychotics, also called “atypical antipsychotics,” act more specifically on dopamine in the brain than the first-generation antipsychotics, and in most cases have less undesirable side effects. Examples- clozapine, risperidone, aripiprazole, olanzapine, quetiapine, cariprazine, ziprasidone. Clozapine is only used when other antipsychotics don’t work, because it requires careful monitoring of blood counts.
Mood Stabilizers are used to treat “mood swings” (manic episodes and severe depressive episodes) associated with bipolar or other mood disorders. They may also be used in addition to antidepressants in severe cases of depression. Examples of mood stabilizers include lithium as well as several anti-seizure medications that have been found to help stabilize mood (divalproex, valproic acid, topiramate, carbamazepine, lamotrigine). Some of these, particularly lithium, may require monitoring of blood levels to avoid toxicity.
There are many herbal medications and health supplements that are advertised as effective for treating mental illness. A few well-known examples include St. Johns Wort, ashwagandha, ginseng, and chamomile. Often, a vitamin deficiency can contribute to depression or other mental health disorders, so supplementation can sometimes be a good idea. However, it is important to remember that even though they do not need a prescription, many herbal supplements have potentially dangerous side effects and drug interactions, so it is important to consult your doctor and/or pharmacist before taking them.
There are several possible side effects of mental illness medications. Most are manageable, but some may increase the risk of other health problems and require a change in therapy or medical intervention.
Common Side Effects
It is important to always take mental health medication as prescribed and have regular appointments with your doctor. If you are experiencing bothersome side effects, discuss these with your prescriber. Remember that many medications may take a few weeks to reach their maximum level of effectiveness and that you may have to try a few different medications before finding the best one for you. If you are experiencing symptoms of serotonin syndrome or suicidal thoughts, this is considered a medical emergency, and you should seek medical help right away. Medication therapy for mental illness is more effective when combined with counselling and/or psychotherapy.