Understanding Psychotropic Drugs

Conceptual Close-Up Of A Pill
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What is the most important information I should know about psychotropic medicines?

  • Psychotropic medicines may cause side effects and pose risks that you should discuss with your healthcare provider.
  • Never take psychotropic drugs (or any prescription medications) without a prescription.

Psychotropic drugs are medications that alter mood, perceptions, and behavior. Particularly when used in combination with psychotherapy, psychotropic drugs can be powerful tools in managing conditions such as borderline personality disorder (BPD), anxiety, bipolar disorder, depression, and schizophrenia.

About 20% of respondents in the 2020 National Health Interview Survey (NHIS) reported taking psychotropic drugs.

How Psychotropics Work

Psychotropic drugs help control symptoms of mental illness such as mood swings, explosive anger, hallucinations/delusions, and other issues that can interfere with therapy. With these symptoms under better control, you can focus on developing skills to cope with and better manage your mental health.

These drugs work by altering the balance of neurotransmitters—such as serotonin, dopamine, and γ-Aminobutyric acid (GABA)—in your body. These chemical messengers carry signals among your organs to help regulate their functions.

In the brain, they help neurons communicate with each other to control mood, concentration, perception, and other aspects of brain function. They're specific to the cells they target.

The National Institute of Mental Health found that people with depression who were prescribed a psychotropic drug showed more progress in two months than those who went without treatment showed their entire lives.

Types of Psychotropic Medicines

Depending on your mental health condition and symptoms, your doctor might prescribe one of the following types of psychotropics.

Antidepressants

The five main categories of antidepressants (and examples of each) are:

  • Selective serotonin reuptake inhibitors (SSRIs). Celexa (citalopram), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), Viibryd (vilazodone), Zoloft (sertraline).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs). Cymbalta (duloxetine), Effexor (venlafaxine), Fetzima (levomilnacipran), Pristiq (desvenlafaxine), Savella (milnacipran).
  • Tricyclic antidepressants (TCAs). Anafranil (clomipramine), Asendin (amoxapine), Elavil (amitriptyline), Norpramin (desipramine), Pamelor (nortriptyline), Sinequan (doxepin)3, Surmontil (trimipramine), Tofranil (imipramine), Vivactil (protriptyline).
  • Monoamine oxidase inhibitors (MAOIs). Emsam (selegiline), Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine).
  • Atypical antidepressants. Oleptro (trazodone), Brintellix (vortioxetine), Remeron (mirtazapine), Symbax, Wellbutrin (bupropion).

Healthcare providers may prescribe other antidepressants for treatment-resistant depression.

Antidepressant Side Effects

Like all drugs, antidepressants can have side effects; these vary by medication, and not all people experience them. The most common are anxiety, blurred vision, constipation, dizziness, dry mouth, fatigue, numbness, insomnia, nausea, sexual issues, and weight gain. More serious side effects include suicidal ideation, allergic reactions, mania, seizures, hyponatremia (low sodium levels), and serotonin syndrome.

Antipsychotics

Antipsychotics are prescribed to treat symptoms of psychosis. They fall into two categories: atypical and typical.

Atypical antipsychotics were introduced in the 1990s as an alternative to their typical (first-generation) counterparts and carry a lower risk of side effects. Still, a healthcare provider might prescribe typical antipsychotics if atypical antipsychotics don't work.

Common atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Clozaril (clozapine)
  • Invega (paliperidone)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)

Common typical antipsychotics include:

  • Thorazine (chlorpromazine)
  • Loxitane (loxapine)
  • Navane (thiothixene)
  • Trilafon (perphenazine)
  • Compro (prochlorperazine)
  • Depixol (flupentixol)
  • Haldol (haloperidol)
  • Mellaril (thioridazine)
  • Prolixin (fluphenazine)
  • Stelazine (trifluoperazine)

Antipsychotic Side Effects

The side effects of atypical antipsychotics can include weight gain, metabolic problems, and sexual issues. Those of typical antipsychotics tend to be more severe and can include tremors, spasms, muscle rigidity, and loss of control and coordination, any of which can become permanent even after treatment cessation.

Anxiolytics

Anxiolytics are designed to prevent or treat anxiety. There are a few different types available that work in different ways.

  • Some, such as benzodiazepines, work by increasing GABA levels in your brain to keep you calm and help you sleep. Non-benzodiazepines such as Ambien (zolpidem) are chemically different, but they also boost GABA.
  • Beta-blockers, usually prescribed for heart problems, are sometimes given to help with phobias and fear of certain situations. They help control sweating, shaking, and an elevated heart rate
  • Barbiturates such as phenobarbital are similar to but much stronger than benzodiazepines and have been used to treat seizures in children. They're also prescribed to help with insomnia (see below).

Risk for Addiction

It is important to note that some anxiolytics, including barbiturates and benzodiazepines, can be addictive. Healthcare providers generally prescribe them only for short periods. You should not stop taking these medications without talking to your doctor first, since withdrawal symptoms can be dangerous.

Hypnotics

This class includes drugs that induce and lengthen sleep. When used this way, they include barbiturates, quinazolinones, benzodiazepines, nonbenzodiazepines, melatonin, antihistamines, and antidepressants,

Mood Stabilizers

Mood stabilizers are typically used to treat bipolar disorder, schizoaffective disorder, borderline personality disorder (BPD), and depression. They target chemical imbalances to control extreme mood swings. They include:

Stimulants

Stimulants increase brain activity to raise mood and alertness. They include common substances such as caffeine and nicotine, as well as illicit drugs such as cocaine and methamphetamine.

Prescription stimulants affect the central nervous system and the autonomic nervous system, enhancing the effects of dopamine and norepinephrine. They can increase blood pressure, respiratory function, and euphoria.

These psychotropic medicines are most often used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy.

Common prescriptions in this class include:

Stimulant Risks

Stimulants have the potential for addiction. People who take these medications for long period in high doses, or those who have a history of substance use disorders may be at a higher risk.

Side Effects of Psychotropic Medicines

Like all drugs, psychotropics come with a range of side effects, some of these include:

  • Cardiac issues
  • Changes in appetite
  • Dizziness
  • Drowsiness
  • Fatigue
  • Sexual side effects
  • Sleep disturbances
  • Weight gain

Although psychotropic drugs can help regulate your emotions and mood, they can also adversely impact your emotions. For example, you might have a hard time crying when you truly feel sad.

If psychotropics make you feel "not like yourself," tell your doctor so they can find alternative medications or treatments.

Risks & Black Box Warnings

Different psychotropic medicines come with different risks. These risks may be higher for certain populations or those with certain health conditions.

Before taking psychotropic drugs, be sure to share with your healthcare provider any known medical issues, such as heart conditions, diabetes, or high blood pressure, to ensure the medication won't aggravate these preexisting conditions.

Black Box Warning for Psychotropic Medicines

  • Benzodiazepines have a black box warning of abuse, addiction, and withdrawal risk.
  • Antipsychotics carry a black box warning of an increased risk of death in older people with dementia-related psychosis. These psychotropic medications are contraindicated in this population.
  • All antidepressants carry a black box warning for an increased risk of suicide in young people under 25.
  • Prescription stimulants carry a boxed warning for risks of misuse, abuse, addiction, and overdose.

The increased risk of suicide with antidepressants tends to be highest during the initiation of treatment. It is essential to carefully monitor your thoughts and behaviors during treatment and reach out for help if you experience worsening depressive symptoms or suicidal ideation.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Frequently Asked Questions

  • How do children react to psychotropic medications?

    Many psychotropic drugs are not designed to work instantly. For some, the medications can take several weeks to have their full effect, while others may need to try several different medications before finding the right one. Everyone responds to medication differently, so do your best to be patient and keep your healthcare provider informed on how you're feeling.

  • Are psychotropic drugs habit-forming?

    Some, such as stimulants and anti-anxiety drugs, can be addictive. For this reason, healthcare providers typically prescribe these only for short-term use.

  • How quickly do psychotropic drugs begin to work?

    In some cases, you'll notice side effects right away, but you might not feel the full beneficial effects for a few weeks or even months. If you don't think your medication is working, talk with your doctor to find alternatives. Don't ever stop taking a psychotropic on your own; this can be dangerous and uncomfortable. Your doctor will know how to titrate your dosage down over time to avoid this.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Terlizzi EP, Norris T. Mental health treatment among adults: United States, 2020. NCHS Data Brief, no 419. National Center for Health Statistics. doi:10.15620/cdc:110593

  3. Rizo J. Mechanism of neurotransmitter release coming into focusProtein Sci. 2018;27(8):1364-1391. doi:10.1002/pro.3445

  4. Bet PM, Hugtenburg JG, Penninx BW, Hoogendijk WJ. Side effects of antidepressants during long-term use in a naturalistic settingEur Neuropsychopharmacol. 2013;23(11):1443-1451. doi:10.1016/j.euroneuro.2013.05.001

  5. National Institute of Mental Health. Mental health medications.

  6. U.S. Food and Drug Administration. FDA requiring boxed warning updated to improve safe use of benzodiazepine drug class.

  7. U.S. Food and Drug Administration. FDA updating warnings to improve safe use of prescription stimulants used to treat ADHD and other conditions.

Additional Reading

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.