For many people dealing with mental health challenges, psychiatric medications are an effective treatment option, especially when combined with psychotherapy. However, many people have concerns about the safety of these medications, their side effects, the effects of long-term use, and how they affect the quality of life.

Psychiatric medications are safe and effective when prescribed and monitored by a qualified mental healthcare professional–typically a psychiatrist or psychiatric nurse practitioner. Like any medical treatment, they come with risks, and understanding the risks and weighing them against the benefits is an essential part of medication evaluations and subsequent management.

Psychiatric professionals work in collaboration with other healthcare professionals to understand the risks involved, prevent cross-drug interactions, and appropriately adjust the dosage to ensure side effects are minimal.

How Do Psychiatric Medications Work?

Psychiatric medications work by targeting neurochemical imbalances in the brain that are believed to contribute to mental health conditions in what is known as the disease-centered model of drug interaction. The disease-centered model posits that neurotransmitters–chemicals that transmit signals between nerve cells in the brain–, when imbalanced, create an abnormal brain state that leads to lower quality of life and symptoms that cause distress. Medications specifically target these imbalances to either enhance or block their effects and produce a balanced brain state.

The primary neurotransmitters that medications seek to modulate are:

• Dopamine: Regulates reward, motivation, mood, and pleasure
• Serotonin: Regulates mood, sleep, and appetite
• Norepinephrine (Noradrenaline): Regulates alertness, attention, and energy
• Gamma-Aminobutyric Acid (GABA): Regulates mood, stress, and fear

For our brains to operate effectively, the brain releases neurotransmitters that communicate with the rest of the nervous system. The way this process works is:

1. Neurotransmitters regulate the communication of one brain cell (neuron) to another. They are synthesized and stored in the ends of neurons (similar to how you would draft a work email for later use.
2. When signaled, neurons release the neurotransmitters into the space between one neuron and another with specific targets. This allows the neurons to communicate with each other. (the work email is sent to specific employees with specific instructions)
3. Neurotransmitters bind to their target cells and send a message from one neuron to another that creates a specific action (the employees read the email and carry out the action)
4. Once they complete their job, neurotransmitters are reabsorbed through the process of reuptake, where the transmitters are absorbed back into their parent neurons (the employees verify the action is complete and delete the email)

In cases where the functioning of neurotransmitters is abnormal, the mechanism of communication is altered so that the “message” being sent is out of proportion to the original stimulus that caused it.

For example, in individuals with depression, often there is excessive reuptake of serotonin from cells that still require it, leading to less serotonin in the brain than is needed for healthy mood functioning. SSRIs block reuptake, allowing the serotonin to remain in cells for an appropriate period before reabsorbing. Conversely, individuals prone to psychotic episodes may have too much dopamine being released and may receive antipsychotic medications that block the release of dopamine to stabilize brain function.

In most cases, psychiatric drugs affect the following mechanisms:

• Neurotransmitter Release: Increase the release of a specific neurotransmitter, e.g. stimulants increase the release of dopamine, norepinephrine, and/or serotonin.
• Receptor Binding: Agonists increase the binding potential of specific neurotransmitters, allowing more efficient release (e.g. Benzodiazepines increase the absorption of GABA-A). Antagonists block specific receptors to reduce their effect (e.g. Some antipsychotics block dopamine to reduce psychotic symptoms).
• Reuptake Inhibition: Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) block reuptake, allowing serotonin (and norepinephrine in SNRIs) to stay in the space between neurons longer.

What Are the Potential Risks and Side Effects of Medication?

Like all medications, psychiatric drugs come with potential risks that should be considered alongside their benefits and potential to ease symptom management. A significant risk and concern that comes up is dependence and withdrawal on drugs that are either addictive or become necessary for long-term mental health management.

Part of psychiatric prescription and medication management is ongoing supervision of dosage, how these medications affect you, and how they interact with other drugs by a qualified mental health professional. Dosage is adjusted to begin at fractional levels and increment until you are comfortable with the recommended dosage. Following treatment, psychiatric professionals likewise decrease dosage over time to ensure you are not abruptly stopping medications and can manage symptoms effectively without medication during this stage.

Additionally, because medications affect everyone differently, and due to the potential of cross-drug interactions (if you are on multiple medications), the medication you take may change throughout treatment. While it can be frustrating to try one thing and switch to another, these adjustments ensure you get the most significant benefit from medications while reducing both short-term and long-term side effects.

In terms of side effects, these can be categorized into short-term, long-term, and severe. Short-term side effects are most often part of the adjustment process, where your body is becoming used to new changes but stabilizes over time. Long-term side effects are generally chronic, meaning they remain for the duration of medication management (but go away after use). Severe side effects are medically concerning and significantly affect quality of life.

The role of psychiatric professionals in prescribing and managing these medications is to prevent or eliminate severe side effects entirely (and make immediate adjustments if they arise), help individuals manage long-term effects, and prepare individuals for the short-term effects that occur during initial treatment. While these drugs carry significant risks, psychiatric professionals are trained to understand these risks and to provide treatment that maximizes effectiveness while minimizing the adverse effects of these drugs.

Short-Term Effects

Short-term side effects of psychiatric medications are usually mild and temporary as the body adjusts. Common effects include nausea, dizziness, headaches, or drowsiness, and are primarily physical, but can impact sleep, appetite, mood, and irritability.

While these short-term effects generally go away over time, they are most prominent at the beginning of treatment when medication is still beginning to take effect. For some individuals, this means that the first few weeks of medication management will be the most difficult, as the side effects are more noticeable than the medication itself. In these situations, it’s essential to talk to your mental health care provider about what you’re experiencing and any concerns you may have, as they can determine if these side effects are an expected part of treatment or indicative of something more serious.

Long-Term Effects

Long-term effects are generally persistent but vary widely depending on the type of medication. Common long-term concerns include dependence, weight gain, increased risk of diabetes, or muscle stiffness. Generally, the long-term effects caused by medication go away after medication management has ceased or can be managed alongside medication with psychotherapy, physical exercise, or other treatments.

However, as with short-term effects, it’s essential you communicate concerns and experiences with your mental healthcare provider so they can assess the risk and provide alternative treatment if necessary to manage these effects.

Severe Side Effects

Severe side effects are less common but can occur with psychiatric medications, particularly at higher doses or with long-term use. Severe effects can also occur due to allergic reactions or from cross-drug interactions where the combination of drugs creates a much more powerful effect than either medication would alone. If you are experiencing any severe side effects, including liver or kidney damage, difficulty breathing, vertigo or vision problems, seek immediate medical attention and discuss any issues with your mental healthcare professional as soon as appropriate.

How to Weigh the Benefits vs. Risks

Deciding whether to take psychiatric medication involves a complex balancing act as it’s difficult to determine if the benefits will outweigh the risks, or if it’s the most appropriate option for you long-term.

The best option you have when weighing the benefits is to talk to a psychiatrist or psychiatric nurse practitioner, as they have the most specialized training in psychopharmacology, or the ethical and appropriate administration of medication for psychological conditions. These professionals can guide you through the process and conduct psychiatric evaluations to determine if medication or another treatment option is the most appropriate for you. They also have training and clinical experience in overseeing medication management and adjusting dosage to minimize risk while maximizing the benefits.

Additionally, when considering treatment, psychotherapy should also be considered, as it is an evidence-based option that’s effective in managing mental health conditions without the side effects associated with medication. That’s not to say that psychotherapy can replace medication in all circumstances. Severe and complex conditions often require medication for complete symptom remission, and the combination of psychotherapy with medication is often the most effective treatment option. The choice of treatment options is highly individual, but you can make informed decisions by consulting with an experienced mental health care professional.

Contact Start My Wellness Today to Learn More About Psychiatric Medication

Psychiatric medication is a powerful tool that helps many individuals find relief from symptoms and engage more fully in both psychotherapy and life. However, these medications also come with short- and long-term risks that should be carefully weighed against their benefits. Psychiatric professionals are vital in helping you navigate these questions and make informed decisions about your mental health treatment.

At Start My Wellness, we are committed to providing personalized care that considers all treatment options, including medication and psychotherapy. Our team of psychiatric nurse practitioners has extensive experience in medication management and can guide you through managing medications while minimizing potential risks.

If you have any questions about medication management or are interested in a psychiatric evaluation to determine if medication is right for you, contact us at (248)-514-4955 and meet our psychiatric nurse practitioners to discuss options.

Sources

1. Start My Wellness: Medication Management + Psychotherapy = Better Outcomes
2. British Medical Journal: How do Psychiatric Drugs Work?
3. MIT: Drug Mechanisms, Use, and Side Effects
4. Start My Wellness: What is Psychiatric Medication and How Can it Help Me?
5. National Institute of Health: Mental Health Medications
6. The Journal of Lifelong Learning in Psychiatry: Ethical Issues in Psychopharmacology