11 Psychiatric Medications and Treatment

How psychiatric medication treatment is chosen

Psychotropic medicines can reduce symptoms and improve functioning. They may be used alongside psychotherapy, social support, and treatment of physical health conditions.

There is no single best medicine for everyone. Selection and adjustment depend on diagnosis, symptom pattern, medical history, other medicines, patient preferences, and response over time. Benefits and adverse effects vary, so follow-up and shared decision-making are central to treatment.

Antidepressants and antipsychotics

Antidepressants and anxiety treatment

Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are used for depression and many anxiety disorders. Nausea, headache, sleep changes, sexual effects, and sometimes initial restlessness can occur. Follow-up should assess mood, functioning, adherence, and emerging suicidal thoughts, especially early in treatment and after dose changes. Screen for possible mania as well.

Some antidepressants and supplements affect serotonin. Combining serotonergic substances can cause serotonin syndrome, which needs urgent medical evaluation. Do not stop an antidepressant abruptly without a prescriber’s guidance; some require tapering.

Antipsychotics

Antipsychotics treat psychosis and may also be used for bipolar disorder or as augmentation for depression. Possible adverse effects include sedation, dizziness on standing, anticholinergic effects, and movement symptoms. Some second-generation antipsychotics can also cause weight gain, dyslipidemia, and elevated glucose. Monitoring may include weight, blood pressure, glucose or HbA1c, lipids, abnormal movements, and fall risk.

New muscle rigidity, fever, confusion, and unstable vital signs may signal neuroleptic malignant syndrome, a medical emergency. Clozapine has additional risks, including severe neutropenia, myocarditis, seizures, and severe constipation or bowel complications. Obtain a baseline absolute neutrophil count (ANC) and continue ANC monitoring according to current prescribing information. Although the FDA removed the Clozapine REMS effective June 13, 2025, ANC monitoring remains important.

Mood stabilizers and stimulants

Mood stabilizers

Mood stabilizers such as lithium and anticonvulsants including valproate are used mainly for bipolar disorder.

• Lithium: Fine tremor, thirst, increased urination, and gastrointestinal effects can occur. Monitor serum lithium, kidney function, thyroid function, and electrolytes. Dehydration, major changes in salt intake, and interacting medicines can raise lithium levels. Worsening tremor, vomiting or diarrhea, unsteady gait, slurred speech, or confusion may indicate lithium toxicity and require urgent assessment.

• Valproate: Possible effects include nausea, sedation, weight gain, liver injury, and low platelets. Monitoring may include liver tests and blood counts or platelets; check levels when clinically indicated. Because valproate can cause serious fetal harm, pregnancy potential and reproductive plans require careful discussion with the prescriber.

Stimulants

Stimulants are commonly used for ADHD. Reduced appetite, insomnia, headache, stomach upset, irritability, increased heart rate, and higher blood pressure may occur. Monitor symptoms, pulse, blood pressure, sleep, and appetite; for children, monitor growth as well. Assess for misuse, diversion, and new manic or psychotic symptoms. Store stimulants securely and never share them.

Anxiolytics and substance use treatment

Anxiolytics include SSRIs and SNRIs, as well as benzodiazepines for selected short-term situations. Benzodiazepines can cause sedation, slowed reaction time, falls, tolerance, dependence, and withdrawal if stopped suddenly. Combining them with alcohol, opioids, or other central nervous system depressants can dangerously slow breathing. Use them only as prescribed, and do not abruptly discontinue regular use without medical guidance.

Medication treatment can also be part of care for substance use disorders. FDA-approved medicines for opioid use disorder include buprenorphine, methadone, and naltrexone. Medicines for alcohol use disorder include naltrexone, acamprosate, and disulfiram. These are evidence-based treatments that can be combined with counseling and other supports.

Benzodiazepines used with buprenorphine or methadone increase sedation and overdose risk. However, treatment for opioid use disorder should not be categorically withheld; coordinate care and monitor closely.

Medication safety and monitoring

Begin with an accurate medication history, including prescriptions, over-the-counter products, supplements, allergies, prior reactions, alcohol and other substance use, and relevant medical conditions. Before treatment and during follow-up, establish patient-specific goals and assess symptoms, functioning, adverse effects, adherence, and safety risks.

Monitoring should match the medicine and the person. Examples include metabolic measures with many antipsychotics, blood counts with clozapine, kidney and thyroid function plus serum levels with lithium, and vital signs and growth with stimulants. Laboratory tests and vital-sign checks should follow current product labeling and the prescriber’s plan; one schedule does not fit everyone.

Use medication reconciliation during transitions of care and verify the medication and dose before administration. Teach patients what to expect and which warning signs need prompt attention. Encourage questions and collaborative reporting of side effects. Patients should not share prescriptions, change doses, or stop medication without consulting the prescriber; several medicines require gradual tapering.

Applying the safety principles

A patient taking lithium develops vomiting and a worsening tremor after several days of poor fluid intake. Dehydration can increase lithium concentration. The appropriate response is prompt assessment and urgent clinical evaluation, not treating the symptoms as routine side effects.

Seek urgent care for suspected overdose, severe allergic reaction, serotonin syndrome, neuroleptic malignant syndrome, lithium toxicity, or suicidal crisis. Takeaway: Match monitoring to the medicine, recognize serious warning signs, check for interactions, and seek clinical guidance before changing or stopping treatment.