Commonly prescribed psychiatric medications include antidepressants and antipsychotics, in fact, sometimes they are even prescribed together. But do you know what antidepressants and antipsychotics really are? Did you know that antidepressants are commonly prescribed for things other than depression and antipsychotics and commonly prescribed for things other than psychosis? Read on to learn about the differences between antipsychotics and antidepressants, how they work, what they are used for and how to use them safely.
What Are Antidepressants and Antipsychotics – The Differences
The definition of “antidepressant” is very simple: it is a medication that primarily treats depression. And while that’s true, it’s important to note that they are medications that are primarily used to treat depression and not solely used to treat depression.
Similarly, antipsychotics are medications that are primarily used to treat psychosis: the presence of hallucinations (experiencing things that aren’t real) and/or delusions (strongly-held false beliefs). Antipsychotics were once known as major tranquilizers and are also sometimes known as neuroleptics.
Antidepressants are commonly prescribed for major depressive disorder and antipsychotics are commonly prescribed for schizophrenia. That said, sometimes antidepressants may be prescribed to others with mood symptoms – which some people with schizophrenia have – and antipsychotics may be prescribed to those with treatment-resistant major depressive disorder as some antipsychotics appear to augment the effectiveness in antidepressants in some people.
In other words, while these medications are very different, they can actually be useful in the same disorders for some people.
In addition to schizophrenia and major depressive disorder, some antidepressants are also prescribed for:
• Premenstrual dysphoric disorder (PDD)
• Anxiety disorders obsessive-compulsive disorder (OCD) and panic disorder
• Pain such as in fibromyalgia
• Insomnia
• Eating disorders (like bulimia nervosa)
• Attention-deficit/hyperactivity disorder (ADHD)
• Migraines
• Hot flashes caused by hormonal therapy
• Raynaud Phenomenon
It’s important to note that some of the above uses are not approved by the Food and Drug Administration (FDA) but may still be used in that way if judged useful by the prescribing physician.
In addition to schizophrenia and major depressive disorder, some antipsychotics are also prescribed for:
• Bipolar disorder
• Alcohol dependence
• Insomnia
• Nausea or vomiting as associated with chemotherapy
As with antidepressants, not all uses are FDA approved.
How Antidepressants and Antipsychotics Work
There is some overlap between the uses for antipsychotics and antidepressants, but the way the two medications work are quite different.
While antidepressants have been prescribed for decades, the way the work in the brain is not fully understood. That said, it is thought that antidepressants work by changing the levels of neurotransmitters in the brain. The chemicals in the brain that antidepressants alter are typically serotonin, norepinephrine and dopamine. Antidepressants typically take several weeks to work.
It is not fully understood how antipsychotics work either. It is thought that antipsychotics work by blocking subtypes of dopamine and sometimes serotonin receptors (parts of the brain nerve cells that are acted on by neurotransmitters).
Typically, then, antidepressants increase the levels of chemicals like serotonin in the brain while antipsychotics reduce the levels of chemicals like dopamine in the brain. It is likely, however, that additional effects also play a role in how antidepressants and antipsychotics work.
Antidepressant Types
• Tricyclic antidepressants (TCAs) – This is an older class of antidepressant. While TCAs are effective for some, they are less-commonly prescribed due to an adverse side effect profile. Examples of tricyclic antidepressants include:
o Anafranil (Clomipramine)
o Aventyl (Nortriptyline)
• Monoamine oxidase inhibitors (MAOIs) – This is also an older class of antidepressant. As with TCAs, MAOIs may be effective for some but are less-commonly prescribed due to their side effects and also the likelihood that a special diet will need to be followed while taking the medication. Examples of MAOIs include:
o Emsam (Selegiline)
o Nardil (Phenelzine)
o Parnate (Tranylcypromine)
• Selective serotonin reuptake inhibitors (SSRIs) – This type of antidepressant is one of the most-prescribed due to its effectiveness relative to its side effects. Commonly prescribed SSRIs include:
o Celexa (Citalopram)
o Paxil (Paroxetine)
o Prozac (Fluoxetine)
o Zoloft (Sertraline)
• Serotonin norepinephrine reuptake inhibitors (SNRIs) – This type of antidepressant has shown usefulness but some find withdrawal from it difficult. Available SNRIs include:
o Cymbalta (Duloxetine)
o Effexor (Venlafaxine)
o Pristiq (Desvenlafaxine)
• Atypical antidepressants – There are a few antidepressants that don’t fall into one of the above classes and they are simply known as “atypical.” Atypical antidepressants include:
o Remeron (Mirtazapine )
o Wellbutrin (Bupropion)
Antipsychotic Types
• Typical antipsychotics – Typical antipsychotics are also known as first generation-antipsychotics. These antipsychotics have been around for many decades but are less used today due to side effects (such as movement disorders) that can be difficult to deal with (although typical antipsychotics may be more effective for some). Examples of typical antipsychotics include:
o Haldol (Haloperidol)
o Thorazine (Chlorpromazine)
• Atypical antipsychotics – Atypical antipsychotics are also known as second-generation antipsychotics and are thought to treat more symptoms of schizophrenia with an improved side effect profile. Several are also approved for use in bipolar disorder. Examples of antipsychotics include:
o Abilify (Aripiprazole)
o Clozaril (Clozapine)
o Fanapt(Iloperidone)
o Geodon (Ziprasidone)
o Invega (Paliperidone)
o Latuda (Lurasidone)
o Risperdal (Risperidone)
o Seroquel (Quetiapine)
o Zyprexa (Olanzapine)
Side Effects of Antidepressants vs Antipsychotics
There is quite a bit of crossover between antipsychotic and antidepressants side effects. That said, side effects vary depending on the specific antipsychotic or antidepressant and also tend to vary between type of antipsychotic or antidepressant. For this reason, it’s always critical to talk to your doctor about your specific medication’s possible side effects.
When looking at side effects, it’s important to note that an individual may experience several side effects from a medication or an individual may experience one or even none. Side effects also vary widely in severity. Some side effects may make a person discontinue a medication while others are minor annoyances and worth living with given the positive effects of the medication. Additionally, side effects do generally appear with zapmedication treatment before the positive effects of the medication but they also tend to decrease with time.
If a side effect concerns you, make sure you talk to your doctor about it as soon as possible.
Side effects common to both antidepressants and antipsychotics include:
• Drowsiness / sedation
• Weight gain (more in antipsychotics)
• Sexual dysfunction
• Changes in appetite (more in antipsychotics)
• Dizziness
• Blurred vision
• Dry mouth
• Constipation
• Diarrhea
• Sleeplessness
Side effects more common just for antipsychotics:
• Tremors
• Inner restlessness
• Muscle spasms
• Diabetes
• Lipid disorders
• Tardive dyskinesia (a disorder that causes repetitive, involuntary, purposeless movements)
• Neuroleptic malignant syndrome (a rare but very dangerous complication that includes fever, muscle stiffness and delirium)
Side effects more common just for antidepressants:
• Greater withdrawal symptoms including brain zaps (the feeling of an electrical shock usually in the head)
• Nausea and vomiting
It’s important to note that in rare cases, those on antidepressants can experiencing a worsening of depression or anxiety symptoms and they may experience suicidality. If this happens, contact your doctor immediately as that is likely not the right medication for you.
Additionally, experiencing new or worsening irritability, acting on dangerous impulses, experiencing an extreme increase of activity or talking or acting aggressively, being angry or violent should also be reported to your doctor immediately as they can be signs of mania. Other side effects that can indicate a dangerous situation include hallucinations, high fever and high blood pressure. These may indicate a rare side effect known as serotonin syndrome.
Taking an Antidepressant or Antipsychotic Safely
It’s critical to follow your doctor’s instructions when taking an antidepressant, antipsychotic or any other medication. For example, it’s typical to start at a lower dose and the work up to a higher dose over time. If your doctor has set up a schedule like that with you, make sure you follow it exactly. That schedule is there so you don’t face an unnecessary side effects. You may also have to take your medication at a specific time of day or with food – sometimes these instructions are for your comfort (for example, to avoid stomach upset) and other times are critical in making the medication work as intended. Make sure you follow these instructions so the medication has the best chance to work for you. If you don’t know why you have to take your medication(s) in a certain way, be sure to ask your doctor.
When you are taking medications, make sure you keep up on any lab tests ordered by your doctor and keep track of anything that may be of concern such as your weight or blood pressure. If something like your lipid levels or weight starts to creep in the wrong way, talk to your doctor immediately. It’s much easier to deal with these issues early on and not waiting until an emergency occurs.
On the other hand, if taking the medication the way it has been prescribed is causing too many side effects that you can’t withstand, be sure to talk to your doctor about it as soon as possible. Fixing the problem can be as simple as changing the medication dose, schedule or other variables but you should only ever do that upon the advice of your doctor. Do not ever suddenly stop taking your medication unless told to do so by your doctor. When it comes to antipsychotics and antidepressants, antidepressants often have more withdrawal effects, but this varies person to person.
Remember, while antidepressants and antipsychotics are relatively safe medications, it is taking them as directed that keeps you safe.
References
1. Tung, A, BSc, Procyshyn, R, PharmD, PhD, “How Antidepressant and Antipsychotic Medications Work.” Visions Journal. 2007.
2. Unknown, “Antipsychotic Medications.” Center for Addiction and Mental Health. Accessed April 22, 2019.
3. Unknown, Fluoxetine. Medscape. Accessed April 22, 2019.
4. Unknown, “Mental Health Medications.” National Institute of Mental Health. October 2016.
5. Unknown, “Monoamine Oxidase Inhibitors (MAOIs).” Mayo Clinic. June 8, 2016.
6. Unknown, Olanzapine. Medscape. Accessed April 22, 2019.
7. Unknown, Quetiapine. Medscape. Accessed April 22, 2019.
8. Unknown, “Tricyclic Antidepressants and Tetracyclic Antidepressants.” Mayo Clinic. June 28, 2016.