Medication Management

You may have heard about how antidepressant drugs can help ease symptoms or anxiety and depression, stabilize your mood and give you more clarity to get the most out of treatment. But how do antidepressants work?

Addiction and mental illness make tangible, adverse changes to the brain. Antidepressants work to modify the way your brain uses certain chemicals (known as neurotransmitters) in charge of mood, emotion and behavior. They may also work to form new connectivity between brain cells that can help elevate your mood, a concept known as neuroplasticity.

Typically, there are four main types of medication management for anxiety and depression:

• Selective Serotonin Reuptake Inhibitors, or SSRIs
• Serotonin-Norepinephrine Reuptake Inhibitors, or SNRIs
• Tricyclic Antidepressants, or TCAs
• Monoamine Oxidase Inhibitors, or MAOIs

One of the most commonly prescribed antidepressants, SSRIs work to increase serotonin levels in your brain, a neurotransmitter that plays a role in regulating mood and facilitating communication between nerve cells. Specifically, when your brain delivers serotonin, it reabsorbs it, making its benefits unavailable. This reabsorption is called “reuptake,” which an SSRI blocks, making serotonin more readily active in your brain to help with depression and anxiety.

According to the Cleveland Clinic, SSRIs can come with some side effects, such as dizziness, dry mouth, headaches, trouble sleeping, upset stomach, weight gain and sexual dysfunction, so keep these in mind and don’t exceed your instructed dosage.

SSRIs come packaged in a number of different brand names, including Prozac, Zoloft, Lexapro, Celexa and Paxil, among others.

SNRIs perform a similar function to SSRIs, but with the addition of providing your brain with better access to norepinephrine — a neurotransmitter and hormone charged with decreasing depression and anxiety that also plays a role in determining our bodies’ fight-or-flight response.

Just like an SSRI, SNRIs prevent the same reuptake of both serotonin and norepinephrine, maximizing your brain’s opportunity to use them more readily to help your mood when depression and/or anxiety are factors in a co-occurring disorder. And this can have a positive impact not only on your treatment, but on drinking or drug/substance use where anxiety or depression play a part.

You can expect very few mild side effects (if at all) when taking an SNRI. In general, most are similar to those of an SSRI, including possible sweating, weight gain or high blood pressure.

If you’re prescribed an SNRI, yours may be one of several brand names like Cymbalta, Effexor, Pristiq or Fetzima.

TCAs function very similarly to SSRIs and SNRIs and were actually one of the original antidepressants used in anxiety, depression and dual diagnosis treatment. TCAs are widely effective but used much less often today due to their tendency to create side effects.

For example, some adverse risks, including dry mouth, constipation, urinary retention, blurred vision and rapid heartbeat are due to TCAs’ blocking of other receptors in the body.

Some common TCA brand names include Anafranil, Norpramin and Doxepin.

An MAOI, as its name implies, inhibits or blocks the production of an enzyme in your brain called monoamine oxidase, which can break down feel-good, mood-regulating neurotransmitters like serotonin, norepinephrine and dopamine.

MAOIs, like TCAs, are in the original class of antidepressants used in mainstream rehab treatment for depression, panic disorder and social phobia, among others mental illnesses. But they aren’t as popular or common because of several concerning risks, like suicidal thoughts or high blood pressure, seizures or nausea due to serotonin syndrome, a life-threatening condition from having too much serotonin in the body.

As always, if you’re prescribed an MAOI like Nardil, Marplan, Emsam or Parnate, take it as instructed to avoid any adverse side effects.

What is a benzodiazepine? It’s a type of medication that’s widely used to treat symptoms accompanying anxiety and panic disorders, like panic attacks, a lingering sense of fear or worry, nervousness, physical tension or rapid heartbeat.

These and other symptoms are all part of anxiety’s ability to make your nervous system taxed and overactive. Because it acts as a depressant, a benzodiazepine’s function is to assuage an overanxious nervous system by releasing a calming neurotransmitter called GABA, or gamma-aminobutyric acid.

Benzodiazepines are prescribed under the names Xanax, Valium, Ativan and Librium very cautiously in clinical settings since they can carry a high risk of addiction and dependence. According to the National Center for Drug Abuse Statistics, 3.4 million people abuse benzodiazepines each year, accounting for 24.4% of prescriptions drug abusers and 1.2% of American adults.

About 15 to 100 out of 100,000 people develop psychosis each year, a condition where someone loses touch with reality, notes the National Institute of Mental Health.

Antipsychotic drugs work in a similar fashion to antidepressants and anti-anxiety medications, amending how the brain’s neurotransmitters — primarily dopamine — communicate to diminish symptoms consistent with psychosis, like hallucinations (seeing or hearing things that aren’t there), delusions (holding unrealistic, false beliefs about something untrue), disorganized thinking and drug-induced psychosis.

Research shows that substance abuse is common among people with schizophrenia (of which psychosis is a symptom), making antipsychotic drugs like Abilify, Risperdal, Seroquel, Zyprexa and Clozaril important parts of dual diagnosis treatment. Take note that antipsychotics carry some potentially discomforting side effects like muscle contractions and movement disorders, immune disruption and dry mouth, among others.

A mood stabilizer is the primary form of medication used to treat bipolar disorder, a condition characterized by extreme mood swings, vacillating between periods of elevated mood and energy known as mania (or a lesser version called hypomania) and depression. Bipolar I and II are the two main types of bipolar disorder, where a person with the former will experience mania but hypomania in the latter.

Mood stabilizers work by stabilizing the neurotransmitter levels in your brain, helping to minimize manic symptoms and behaviors, like racing, tangential thinking, intense emotional changes and risky behaviors. “(Mood stabilizers) can also help prevent these symptoms from returning and the need for more intense treatment, like hospitalization,” notes the Cleveland Clinic.

Lithium (under brand names Eskalith, Lithobid and Lithonate) and anticonvulsants (brand names Depakote, Lamictal and Tegretol) are the two main types of mood stabilizers, but antipsychotic drugs may also be used when someone’s bipolar mania leads to psychosis.

While stimulants are often a drug with abuse and addiction potential, they’re often used clinically in dual diagnosis treatment, particularly for treating conditions like attention-deficit/hyperactivity disorder (ADHD) and narcolepsy.

Research shows that someone with ADHD possesses lower levels of certain neurotransmitters, resulting in difficulty focusing and hyperactive, often impulsive behaviors. Stimulants help to correct these imbalances by raising levels of neurotransmitters like dopamine and norepinephrine. Stimulants also aid narcolepsy by stimulating the nervous system and helping one stay awake throughout the day.

Studies show that stimulant medication produces a lower risk of substance abuse — about 31% — in people struggling with ADHD. Common brand names for stimulants prescribed in dual diagnosis rehab (both short- and long-acting) are Adderall, Ritalin, Concerta and Vyvanse