It's Okay to Need Medication for Mental Health Treatment

by Zencare Team

Published on January 22, 2025 by Zencare Team. Written by Rebekah Ferguson, LMHC.

There are 298 mental health conditions currently recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-TR, which is the standard reference for clinical practice among trained, licensed mental health professionals, in the US. 1 in 4 people suffer from one or another form of mental illness in their lifetime.

Historically, there have been varying attitudes and methods for addressing mental illness. These methods included use of opium, prayer and even self-harm, when mental illness was seen as an expression of sin, or demonic possession. Despite advances in increased awareness of mental illness, and development of evidence-based treatments for mental illness, societal stigma remains a significant barrier to taking prescription medications for mental illness. This stigma is driven largely by lack of understanding, fear, marginalization, discrimination, and the assumption that if a person tries hard enough, follows a certain diet, or lifestyle, they should be able to manage the illness. Additionally, within some religious communities, use of psychotropic medications are seen as not trusting enough in God for “healing”, or as taking a shortcut instead of fasting, prayer, and avoiding behaviors deemed as sinful. Of note, the assumption that the cure for mental illness is as simple as taking a pill, without addressing other lifestyle factors, also reinforces societal stigma.

Why Do People Need Medication for Mental Health Conditions?

To understand the medical necessity of psychotropic medications for certain mental illnesses, fundamental knowledge of the brain can be helpful. There are neurons (nerve cells) and synapses (spaces between neurons). When neurons release a chemical like dopamine or serotonin — it crosses the synapse and binds to a receptor. This receptor will either continue or abort that signal.

All this to say, is that there are processes in our brain that allow these chemicals to have effects, and when these processes don’t work right, it’s called neuronal malfunction. This can lead to various emotional disturbances, dysregulation of the brain and psychiatric symptoms.

The role of medications in managing mental health disorders

Some mental health illnesses respond best to medication, some respond best to individual psychotherapy, and some respond best to a combination, or "multimodal" treatment approach.

For example, mental health conditions that fall under “Anxiety Disorders and Depressive Disorders” may be treatable with individual psychotherapy alone. However, if an individual’s symptoms are particularly severe, constant and unresponsive to therapy — it might make sense to include medication alongside therapy. Although anxiety and depressive conditions may be triggered by environmental stressors, they also may reflect disorders in your brain chemistry, so an individual may respond positively to antidepressants, beta blockers, or benzodiazepines.

For mental health conditions like ADHD, bipolar disorders, schizophrenia — these mental health conditions either are neurodevelopmental or have a significant genetic component. So psychiatric medication is the first line of treatment, and these conditions would generally not be appropriate for individual psychotherapy as the only intervention. However, psychotherapy can be very useful for learning effective coping skills, medication compliance and efficacy, and more.

While willpower, spiritual practices and other non clinical management tools are useful, they are not a replacement for medications, and understanding brain chemicals and some of their functions can be helpful in reducing harmful narratives around medication usage.

Common Myths About Mental Health Medications

Myth: Medication is a cure-all.

Fact: This myth contributes to social stigma around medications for mental illness, as it sets people up for unrealistic expectations. Psychiatric medications are an effective intervention, alongside individual psychotherapy, lifestyle changes, etc.

Myth: Medication changes who a person is.

Fact: Medication treats symptoms, not a person’s character, identity, or values. Sometimes, reaching a therapeutic effect can feel uncomfortable for people, because it’s new. And while there can be unwanted side effects, like with any medication, it’s important to keep your prescriber informed of these experiences.

Myth: Once you’re on medication, you have to be on them forever.

Fact: There are conditions where medications are indicated for ongoing symptom management like bipolar disorder. However some people are eligible for a shorter-term course of medications. Having honest conversations with your prescriber can help determine the appropriate length and dosage of medication you should be on.

Types of Mental Health Medications and How They Work

Antidepressant Medications

Antidepressants work to help prevent the re-uptake of dopamine and serotonin — which helps regulate mood and behavior. They can be used to treat depression and anxiety. Taking antidepressants can help elevate mood, improve appetite and sleep patterns.

Types of antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs) — The most frequently prescribed medications for depression. Treatment includes symptom reduction and remission.
  • Tricyclic antidepressants — These are not used very often for depression due to side effects, toxicity, and suicide potential.
  • Monoamine oxidase inhibitors (MAOIs) — These are rarely used, mostly prescribed in the contexts of atypical depression and some refractory panic disorders.

Anti-Anxiety Medications

Anti-anxiety medications help reduce symptoms like extreme worry, fear and panic attacks by calming the nervous system. Some of them provide short-term relief and should not be taken long-term.

Types of anti-anxiety medications:

  • Anti-depressant medications
  • Benzodiazepines
  • Antihistamines
  • Beta blockers
  • Anticonvulsants

Mood Stabilizers

Mood stabilizers work by influencing the activity of neurotransmitters in the brain, essentially regulating the chemicals that control mood. They are essential for managing mental health conditions like bipolar disorder. However antipsychotics, benzodiazepines and other mood stabilizers have also been useful. Anticonvulsants have been useful in managing acute mania. These medications generally require regular lab schedules including close monitoring of blood levels, as determined by the prescribing medical provider.

Antipsychotic Medications

Antipsychotics primarily target dopamine receptors in the brain, essentially acting as a "blocker" to prevent dopamine from signaling as strongly as it normally would. They are an essential part of treatment for psychotic disorders to reduce symptoms, improve functioning, and reduce the chance of relapse. These medications also require regular lab monitoring, as determined by the prescribing medical provider.

Differences between antipsychotics:

  • First-generation antipsychotics: Traditional or “typical” antipsychotics are most effective in treating the positive symptoms of schizophrenia, such as hallucinations, delusions, and agitation. These are classified as low potency or high potency, and can also be ranked according to their tendency to produce side effects, as the side effects associated with first generation antipsychotics are considered to be more difficult.
  • Second-generation antipsychotics: New generation or “atypical” antipsychotics are generally better tolerated, with improved cognition and effectively treat both the positive symptoms associated with schizophrenia, as well as the negative symptoms like low energy, apathy, and feelings of emptiness. Side effects are generally less severe with atypical antipsychotics.

Stimulant Medications for ADHD

Stimulants are the first-line treatment for addressing hyperactivity and lack of focus in Attention Deficit Hyperactivity Disorder (ADHD). This class of medications is usually fast acting, with symptom reduction occurring 30-45 minutes after ingestion. Stimulants increase the release of dopamine and norepinephrine, while inhibiting the re-uptake of these chemicals, allowing for more of the chemicals to be available to bind with receptors in the brain, and improve focus.

Finding the Right Medication: What to Expect

In a world of information overload and social media, and self diagnosing, working with a health care provider such as a primary care physician, can be a first step towards exploring the need for mental health medications. While primary care medical providers are able to prescribe mental health medications, it is best to also meet with a psychiatric provider for assessment of medication regimen, and monitoring of response to medication. Due to the overlap in symptoms in certain classes of mental health conditions, it is important to consult with a mental health professional to identify the most likely cause of the condition, to help determine medication treatment options.

Finding the right medications can be a trial and error process, as medications can have negative side effects, and there can be a poor treatment response and or treatment resistance. Critical elements of determining a medication regimen include how the body processes a medication, including the absorption, distribution, metabolism, and excretion; each of these properties can be affected by the presence of other substances, including alcohol or other recreational drugs. Connecting with a provider who is collaborative, patient-centered, and with whom there is a therapeutic rapport, is essential to the treatment process.

Addressing Potential Side Effects

All psychiatric medications have potential for unwanted side effects. Antidepressants can cause decreased sex drive, weight gain, nausea, dry mouth, and other side effects. Some anti-anxiety medications can be addictive, and are therefore recommended for short term use only. Individuals who are prescribed antipsychotics are generally monitored for metabolic effects, including high blood sugar, and irregular cholesterol levels. Ensuring timely follow up on labs ordered, and ongoing communication with medical and psychiatric providers is a key element of addressing side effects.

Alternative Treatments: Are Medications the Only Option?

Strategies for mitigating mental health challenges include acknowledgement, connection, social support and oftentimes mental health treatment. Mental Health treatment can include: medication management, individual therapy, couples’ counseling, family therapy, group therapy, and various levels of hospitalization.

Depending on the mental health condition, medications are a crucial component to a comprehensive treatment plan, particularly for severe and persistent conditions such as bipolar. Psychiatric medications can also be beneficial in reducing symptoms so that other treatments such as individual psychotherapy can be more effective. Additionally, they can offer more effective short term relief during crises like panic attacks, where other interventions such as individual psychotherapy would take more time.

Determination of whether or not to take psychiatric medications is part of a comprehensive treatment plan discussion with a licensed psychiatric medical provider.

Medication for Different Groups

Young People and Mental Health Medications

Parents and guardians might have concerns about medications being habit forming, however most children do not abuse their medications, and only two classes of medication, stimulants and benzodiazepines, have the potential for abuse. However, stimulants don’t produce euphoria in children who have ADHD, and when clinically indicated, these stimulants reduce the risk of substance misuse.

Many major illnesses begin in childhood, and the risk of leaving illness untreated may outweigh any risks from treatment.

Older Adults and Medication

Older adults take more prescription medication than any other age group. Approximately 30% of all prescriptions are taken by people over 65. Issues of aging such as poor vision, and memory can make medication adherence complicated. With older adults it is especially necessary to obtain a clear history of lifelong symptoms as they are less likely to have obtained psychiatric treatment. To manage side effects, prescribers may take measures such as initiating lower doses of medications, ruling out medical issues, and continued assessment and monitoring of medical comorbidities.

People With Treatment-Resistant Conditions

Treatment-resistant depression, also known as refractory depression, represents about 30% of patients with Major Depressive Disorder. Most prescribers will use MAOIs as a last resort, when more conventional medications have failed. Newer antidepressant medications that have the potential to have synergistic effects with other medications, such as Venlafaxine, Mirtazapine, and Duloxetine have proven helpful in addressing treatment resistant depression, with less severe side effects and dietary restrictions. Combining SSRIs with NRIs (norepinephrine reuptake inhibitors) may help achieve remission more readily.

The Role of Healthcare Providers and Support Systems

Collaboration amongst mental health providers and primary care providers allows for more integrated, and comprehensive treatment interventions. Additionally, for medications that require regular labs, such as antipsychotics and some mood stabilizers, ongoing communication amongst providers allows for more seamless monitoring of both medication response, and monitoring of side effects.Increased frequency of visits may be part of the monitoring process for newly initiated treatment regimens.

Pharmacists can also serve as a secondary source of support to help fill the gaps of medication education. Trusted loved ones such as friends or family members, can attend appointments as well, and to learn how to best offer support.

Final Thoughts: Medication Is Just One Part of Mental Health Care

Medication is just a tool in mental health care. Most symptom relief from medication is further improved with psychotherapy interventions. The role of lifestyle, stress management, sleep hygiene, and use of substances are all factors also that impact mental health.

In a society where self-diagnosing is on the rise, it is beneficial to seek advice from a licensed mental health professional, to ensure correct assessment, diagnosis, and treatment regimen. Additionally, longevity with a provider, versus continually changing providers, is best for continuity of care and to best understand symptoms and patterns over time.

Unfortunately, harmful stigma persists around mental illness and this not only leads to reduced chance of seeking treatment, but also adversely impacts ongoing engagement in treatment, and can lead to social isolation of people who have mental illness. Addressing myths in mental health and taking medication is one step forward so that individuals feel empowered to make informed choices about their mental health and their well-being.