Overview

Brain stimulation therapies can play a role in treating certain mental disorders. Brain stimulation therapies involve activating or inhibiting the brain directly with electricity. The electricity can be given directly by electrodes implanted in the brain, or noninvasively through electrodes placed on the scalp. The electricity can also be induced by using magnetic fields applied to the head. While these types of therapies are less frequently used than medication and psychotherapies, they hold promise for treating certain mental disorders that do not respond to other treatments.

Electroconvulsive therapy is the best studied brain stimulation therapy and has the longest history of use. Other stimulation therapies discussed here are newer, and in some cases still experimental methods. These include:

• vagus nerve stimulation (VNS)
• repetitive transcranial magnetic stimulation (rTMS)
• magnetic seizure therapy (MST)
• deep brain stimulation (DBS)

A treatment plan may also include medication and psychotherapy.Choosing the right treatment plan should be based on a person’s individual needs and medical situation, and under a doctor’s care.

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) uses an electric current to treat serious mental disorders. This type of therapy is usually considered only if a patient’s illness has not improved after other treatments (such as antidepressant medication or psychotherapy) are tried, or in cases where rapid response is needed (as in the case of suicide risk and catatonia, for example).

ECT: Why it’s done

ECT is most often used to treat severe, treatment-resistant depression, but it may also be medically indicated in other mental disorders, such as bipolar disorder or schizophrenia. It also may be used in life-threatening circumstances, such as when a patient is unable to move or respond to the outside world (e.g., catatonia), is suicidal, or is malnourished as a result of severe depression.

ECT can be effective in reducing the chances of relapse when patients undergo follow-up treatments. Two major advantages of ECT over medication are that ECT begins to work quicker, often starting within the first week, and older individuals respond especially quickly.

ECT: How it works

Before ECT is administered, a person is sedated with general anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. An anesthesiologist monitors breathing, heart rate and blood pressure during the entire procedure, which is conducted by a trained medical team, including physicians and nurses. During the procedure:

• Electrodes are placed at precise locations on the head.
• Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute. Because the patient is under anesthesia and has taken a muscle relaxant, it is not painful and the patient cannot feel the electrical impulses.
• Five to ten minutes after the procedure ends, the patient awakens. He or she may feel groggy at first as the anesthesia wears off. But after about an hour, the patient usually is alert and can resume normal activities.

A typical course of ECT is administered about three times a week until the patient’s depression improves (usually within 6 to 12 treatments). After that, maintenance ECT treatment is sometimes needed to reduce the chances that symptoms will return. ECT maintenance treatment varies depending on the needs of the individual, and may range from one session per week to one session every few months. Frequently, a person who undergoes ECT also takes antidepressant medication or a mood stabilizing medication.

ECT Side Effects

The most common side effects associated with ECT include:

• headache
• upset stomach
• muscle aches
• memory loss

Some people may experience memory problems, especially of memories around the time of the treatment. Sometimes the memory problems are more severe, but usually they improve over the days and weeks following the end of an ECT course.

Research has found that memory problems seem to be more associated with the traditional type of ECT called bilateral ECT, in which the electrodes are placed on both sides of the head.

In unilateral ECT, the electrodes are placed on just one side of the head—typically the right side because it is opposite the brain’s learning and memory areas. Unilateral ECT has been found to be less likely to cause memory problems and therefore is preferred by many doctors, patients and families.

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) works through a device implanted under the skin that sends electrical pulses through the left vagus nerve, half of a prominent pair of nerves that run from the brainstem through the neck and down to each side of the chest and abdomen. The vagus nerves carry messages from the brain to the body’s major organs (e.g. heart, lungs and intestines) and to areas of the brain that control mood, sleep, and other functions.

VNS: Why it’s done

VNS was originally developed as a treatment for epilepsy. However, scientists noticed that it also had favorable effects on mood, especially depressive symptoms. Using brain scans, scientists found that the device affected areas of the brain that are involved in mood regulation. The pulses appeared to alter the levels of certain neurotransmitters (brain chemicals) associated with mood, including serotonin, norepinephrine, GABA and glutamate.

In 2005, the U.S. Food and Drug Administration (FDA) approved VNS for use in treating treatment-resistant depression in certain circumstances:

• If the patient is 18 years of age or over; and
• If the illness has lasted two years or more; and
• if it is severe or recurrent; and
• if the depression has not eased after trying at least four other treatments

According to the FDA, it is not intended to be a first-line treatment, even for patients with severe depression. And, despite FDA approval, VNS remains an infrequently used because results of early studies testing its effectiveness for major depression were mixed. But a newer study , which pooled together findings from only controlled clinical trials, found that 32% of depressed people responded to VSN and 14% had a full remission of symptoms after being treated for nearly 2 years.

VNS: How it works

A device called a pulse generator, about the size of a stopwatch, is surgically implanted in the upper left side of the chest. Connected to the pulse generator is an electrical lead wire, which is connected from the generator to the left vagus nerve.

Typically, 30-second electrical pulses are sent about every five minutes from the generator to the vagus nerve. The duration and frequency of the pulses may vary depending on how the generator is programmed. The vagus nerve, in turn, delivers those signals to the brain. The pulse generator, which operates continuously, is powered by a battery that lasts around 10 years, after which it must be replaced. Normally, people do not feel pain or any other sensations as the device operates.

The device also can be temporarily deactivated by placing a magnet over the chest where the pulse generator is implanted. A person may want to deactivate it if side effects become intolerable, or before engaging in strenuous activity or exercise because it may interfere with breathing. The device reactivates when the magnet is removed.

VNS treatment is intended to reduce symptoms of depression. It may be several months before the patient notices any benefits and not all patients will respond to VNS. It is important to remember that VNS is intended to be given along with other traditional therapies, such as medications, and patients should not expect to discontinue these other treatments, even with the device in place.

VNS: Side Effects

VNS is not without risk. There may be complications such as infection from the implant surgery, or the device may come loose, move around or malfunction, which may require additional surgery to correct. Some patients have no improvement in symptoms and some actually get worse.

Other potential side effects include:

• Voice changes or hoarseness
• Cough or sore throat
• Neck pain
• Discomfort or tingling in the area where the device is implanted
• Breathing problems, especially during exercise
• Difficulty swallowing

Long-term side effects are unknown.

Repetitive Transcranial Magnetic Stimulation

Repetitive transcranial magnetic stimulation (rTMS) uses a magnet to activate the brain. First developed in 1985, rTMS has been studied as a treatment for depression, psychosis, anxiety, and other disorders.

Unlike ECT, in which electrical stimulation is more generalized, rTMS can be targeted to a specific site in the brain. Scientists believe that focusing on a specific site in the brain reduces the chance for the types of side effects associated with ECT. But opinions vary as to what site is best.

rTMS: Why it’s done

In 2008, rTMS was approved for use by the FDA as a treatment for major depression for patients who do not respond to at least one antidepressant medication in the current episode. It is also used in other countries as a treatment for depression in patients who have not responded to medications and who might otherwise be considered for ECT.

The evidence supporting rTMS for depression was mixed until the first large clinical trial , funded by NIMH, was published in 2010. The trial found that 14% achieved remission with rTMS compared to 5% with an inactive (sham) treatment. After the trial ended, patients could enter a second phase in which everyone, including those who previously received the sham treatment, was given rTMS. Remission rates during the second phase climbed to nearly 30%. A sham treatment is like a placebo, but instead of being an inactive pill, it’s an inactive procedure that mimics real rTMS.

rTMS: How it works

A typical rTMS session lasts 30 to 60 minutes and does not require anesthesia.

During the procedure:

• An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation.
• Then, short electromagnetic pulses are administered through the coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.

Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan. Generally, the person feels a slight knocking or tapping on the head as the pulses are administered.

Not all scientists agree on the best way to position the magnet on the patient’s head or give the electromagnetic pulses. They also do not yet know if rTMS works best when given as a single treatment or combined with medication and/or psychotherapy. More research is underway to determine the safest and most effective uses of rTMS.

rTMS: Side Effects

Sometimes a person may have discomfort at the site on the head where the magnet is placed. The muscles of the scalp, jaw or face may contract or tingle during the procedure. Mild headaches or brief lightheadedness may result. It is also possible that the procedure could cause a seizure, although documented incidences of this are uncommon. Two large-scale studies on the safety of rTMS found that most side effects, such as headaches or scalp discomfort, were mild or moderate, and no seizures occurred. Because the treatment is relatively new, however, long-term side effects are unknown.

Magnetic Seizure Therapy

MST: How it works

Magnetic seizure therapy (MST) borrows certain aspects from both ECT and rTMS. Like rTMS, MST uses magnetic pulses instead of electricity to stimulate a precise target in the brain. However, unlike rTMS, MST aims to induce a seizure like ECT. So the pulses are given at a higher frequency than that used in rTMS. Therefore, like ECT, the patient must be anesthetized and given a muscle relaxant to prevent movement. The goal of MST is to retain the effectiveness of ECT while reducing its cognitive side effects.

MST is in the early stages of testing for mental disorders, but initial results are promising. A recent review article that examined the evidence from eight clinical studies found that MST triggered remission from major depression or bipolar disorder in 30-40% of individuals.

MST: Side Effects

Like ECT, MST carries the risk of side effects that can be caused by anesthesia exposure and the induction of a seizure. Studies in both animals and humans have found that MST produces

• fewer memory side effects
• shorter seizures
• allows for a shorter recovery time than ECT

Deep Brain Stimulation

Deep brain stimulation (DBS) was first developed as a treatment for Parkinson’s disease to reduce tremor, stiffness, walking problems and uncontrollable movements. In DBS, a pair of electrodes is implanted in the brain and controlled by a generator that is implanted in the chest. Stimulation is continuous and its frequency and level are customized to the individual.

DBS has been studied as a treatment for depression or obsessive compulsive disorder (OCD). Currently, there is a Humanitarian Device Exemption for the use of DBS to treat OCD, but its use in depression remains only on an experimental basis. A review of all 22 published studies testing DBS for depression found that only three of them were of high quality because they not only had a treatment group but also a control group which did not receive DBS. The review found that across the studies, 40-50% of people showed receiving DBS greater than 50% improvement.

DBS: How it works

DBS requires brain surgery. The head is shaved and then attached with screws to a sturdy frame that prevents the head from moving during the surgery. Scans of the head and brain using MRI are taken. The surgeon uses these images as guides during the surgery. Patients are awake during the procedure to provide the surgeon with feedback, but they feel no pain because the head is numbed with a local anesthetic and the brain itself does not register pain.

Once ready for surgery, two holes are drilled into the head. From there, the surgeon threads a slender tube down into the brain to place electrodes on each side of a specific area of the brain. In the case of depression, the first area of the brain targeted by DBS is called Area 25, or the subgenual cingulate cortex. This area has been found to be overactive in depression and other mood disorders. But later research targeted several other areas of the brain affected by depression. So DBS is now targeting several areas of the brain for treating depression. In the case of OCD, the electrodes are placed in an area of the brain (the ventral capsule/ventral striatum) believed to be associated with the disorder.

After the electrodes are implanted and the patient provides feedback about their placement, the patient is put under general anesthesia. The electrodes are then attached to wires that are run inside the body from the head down to the chest, where a pair of battery-operated generators are implanted. From here, electrical pulses are continuously delivered over the wires to the electrodes in the brain. Although it is unclear exactly how the device works to reduce depression or OCD, scientists believe that the pulses help to “reset” the area of the brain that is malfunctioning so that it works normally again.

DBS Side Effects

DBS carries risks associated with any type of brain surgery. For example, the procedure may lead to:

• Bleeding in the brain or stroke
• Infection
• Disorientation or confusion
• Unwanted mood changes
• Movement disorders
• Lightheadedness
• Trouble sleeping

Because the procedure is still being studied, other side effects not yet identified may be possible. Long-term benefits and side effects are unknown.

Overview

Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called “talk therapy”) and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person’s individual needs and medical situation, and under a mental health professional’s care.

The National Institute of Mental Health (NIMH), a Federal research agency, does not provide medical advice or referrals. Resources that may help you find treatment services in your area are listed on ourHelp for Mental Illnesses web page.

NIMH also does not endorse or recommend any particular drug, herb, or supplement. Results from NIMH-supported clinical research trials (What are Clinical Research Trials?) that examine the effectiveness of treatments, including medications, are reported in the medical literature. This health topic webpage is intended to provide basic information about mental health medications. It is not a complete source for all medications available and should not be used as a guide for making medical decisions.

Information about medications changes frequently. Check the U.S. Food and Drug Administration (FDA) website  for the latest warnings, patient medication guides, or newly approved medications. Brand names are not referenced on this page, but you can search by brand name on MedlinePlus Drugs, Herbs and Supplements Drugs website. The MedlinePlus website also provides additional information about each medication, including side effects and FDA warnings.

Understanding Your Medications

If you are prescribed a medication, be sure that you:

• Tell the doctor about all medications and vitamin supplements you are already taking.
• Remind your doctor about any allergies and any problems you have had with medicines.
• Understand how to take the medicine before you start using it and take your medicine as instructed.
• Don’t take medicines prescribed for another person or give yours to someone else.
• Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.
• Report serious side effects to the FDA MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch ] or by phone [1-800-332-1088]. You or your doctor may send a report.

Antidepressants

What are antidepressants?

Antidepressants are medications commonly used to treat depression. Antidepressants are also used for other health conditions, such as anxiety, pain and insomnia. Although antidepressants are not FDA-approved specifically to treat ADHD, antidepressants are sometimes used to treat ADHD in adults.

The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:

• Fluoxetine 
• Citalopram 
• Sertraline 
• Paroxetine 
• Escitalopram 

Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and includevenlafaxine  and duloxetine. 

Another antidepressant that is commonly used is bupropion.Bupropion  is a third type of antidepressant which works differently than either SSRIs or SNRIs.  Bupropion is also used to treat seasonal affective disorder and to help people stop smoking.

SSRIs, SNRIs, and bupropion are popular because they do not cause as many side effects as older classes of antidepressants, and seem to help a broader group of depressive and anxiety disorders. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

How do people respond to antidepressants?

According to a research review by the Agency for Healthcare Research and Quality , all antidepressant medications work about as well as each other to improve symptoms of depression and to keep depression symptoms from coming back. For reasons not yet well understood, some people respond better to some antidepressant medications than to others.

Therefore, it is important to know that some people may not feel better with the first medicine they try and may need to try several medicines to find the one that works for them. Others may find that a medicine helped for a while, but their symptoms came back. It is important to carefully follow your doctor’s directions for taking your medicine at an adequate dose and over an extended period of time (often 4 to 6 weeks) for it to work.

Once a person begins taking antidepressants, it is important to not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It’s important to give the body time to adjust to the change. People don’t get addicted (or “hooked”) on these medications, but stopping them abruptly may also cause withdrawal symptoms

What are the possible side effects of antidepressants?

Some antidepressants may cause more side effects than others. You may need to try several different antidepressant medications before finding the one that improves your symptoms and that causes side effects that you can manage.

The most common side effects listed by the FDA include:

• Nausea and vomiting
• Weight gain
• Diarrhea
• Sleepiness
• Sexual problems

Call your doctor right away if you have any of the following symptoms, especially if they are new, worsening, or worry you(U.S. Food and Drug Administration, 2011):

• Thoughts about suicide or dying
• Attempts to commit suicide
• New or worsening depression
• New or worsening anxiety
• Feeling very agitated or restless
• Panic attacks
• Trouble sleeping (insomnia)
• New or worsening irritability
• Acting aggressively, being angry, or violent
• Acting on dangerous impulses
• An extreme increase in activity and talking (mania)
• Other unusual changes in behavior or mood

Combining the newer SSRI or SNRI antidepressants with one of the commonly-used “triptan” medications used to treat migraine headaches could cause a life-threatening illness called “serotonin syndrome.” A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications. For more information, please see the FDA Medication Guide on Antidepressant Medicines 

Antidepressants may cause other side effects that were not included in this list. To report any serious adverse effects associated with the use of antidepressant medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA .

Anti-Anxiety Medications

What are anti-anxiety medications?

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind SSRIs or other antidepressants.

Benzodiazepines used to treat anxiety disorders include:

• Clonazepam 
• Alprazolam 
• Lorazepam 

Short half-life (or short-acting) benzodiazepines (such as Lorazepam ) and beta-blockers are used to treat the short-term symptoms of anxiety. Beta-blockers help manage physical symptoms of anxiety, such as trembling, rapid heartbeat, and sweating that people with phobias (an overwhelming and unreasonable fear of an object or situation, such as public speaking) experience in difficult situations. Taking these medications for a short period of time can help the person keep physical symptoms under control and can be used “as needed” to reduce acute anxiety.Buspirone  (which is unrelated to the benzodiazepines) is sometimes used for the long-term treatment of chronic anxiety. In contrast to the benzodiazepines, buspirone must be taken every day for a few weeks to reach its full effect. It is not useful on an “as-needed” basis.

How do people respond to anti-anxiety medications?

Anti-anxiety medications such as benzodiazepines are effective in relieving anxiety and take effect more quickly than the antidepressant medications (or buspirone) often prescribed for anxiety. However, people can build up a tolerance to benzodiazepines if they are taken over a long period of time and may need higher and higher doses to get the same effect. Some people may even become dependent on them. To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults (read the NIMH article: Despite Risks, Benzodiazepine Use Highest in Older People), people who have substance abuse problems and people who become dependent on medication easily. If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly.

What are the possible side effects of anti-anxiety medications?

Like other medications, anti-anxiety medications may cause side effects. Some of these side effects and risks are serious. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include:

• Nausea
• Blurred vision
• Headache
• Confusion
• Tiredness
• Nightmares

Tell your doctor if any of these symptoms are severe or do not go away:

• Drowsiness
• Dizziness
• Unsteadiness
• Problems with coordination
• Difficulty thinking or remembering
• Increased saliva
• Muscle or joint pain
• Frequent urination
• Blurred vision
• Changes in sex drive or ability (The American Society of Health-System Pharmacists, Inc, 2010)

If you experience any of the symptoms below, call your doctor immediately:

• Rash
• Hives
• Swelling of the eyes, face, lips, tongue, or throat
• Difficulty breathing or swallowing
• Hoarseness
• Seizures
• Yellowing of the skin or eyes
• Depression
• Difficulty speaking
• Yellowing of the skin or eyes
• Thoughts of suicide or harming yourself
• Difficulty breathing

Common side effects of beta-blockers include:

• Fatigue
• Cold hands
• Dizziness or light-headedness
• Weakness

Beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms related to both.

Possible side effects from buspirone include:

• Dizziness
• Headaches
• Nausea
• Nervousness
• Lightheadedness
• Excitement
• Trouble sleeping

Anti-anxiety medications may cause other side effects that are not included in the lists above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please see Drugs@FDA. 

Stimulants

What are Stimulants?

As the name suggests, stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration (National Institute on Drug Abuse, 2014). Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.

Stimulants used to treat ADHD include:

• Methylphenidate 
• Amphetamine 
• Dextroamphetamine 
• Lisdexamfetamine Dimesylate 

Note: In 2002, the FDA approved the non-stimulant medication atomoxetine for use as a treatment for ADHD. Two other non-stimulant antihypertensive medications, clonidine  and guanfacine , are also approved for treatment of ADHD in children and adolescents. One of these non-stimulant medications is often tried first in a young person with ADHD, and if response is insufficient, then a stimulant is prescribed.

Stimulants are also prescribed to treat other health conditions, including narcolepsy, and occasionally depression (especially in older or chronically medically ill people and in those who have not responded to other treatments).

How do people respond to stimulants?

Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. Stimulant medications are safe when given under a doctor’s supervision. Some children taking them may feel slightly different or “funny.”

Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this when they are used properly as prescribed. Additionally, research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.

What are the possible side effects of stimulants?

Stimulants may cause side effects. Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:

• Difficulty falling asleep or staying asleep
• Loss of appetite
• Stomach pain
• Headache

Less common side effects include:

• Motor tics or verbal tics (sudden, repetitive movements or sounds)
• Personality changes, such as appearing “flat” or without emotion

Call your doctor right away if you have any of these symptoms, especially if they are new, become worse, or worry you.

Stimulants may cause other side effects that are not included in the list above. To report any serious adverse effects associated with the use of stimulants, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each medication, please seeDrugs@FDA. 

Antipsychotics

What are antipsychotics?

Antipsychotic medicines are primarily used to manage psychosis. The word “psychosis” is used to describe conditions that affect the mind, and in which there has been some loss of contact with reality, often including delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as schizophrenia, bipolar disorder, or very severe depression (also known as “psychotic depression”).

Antipsychotic medications are often used in combination with other medications to treat delirium, dementia, and mental health conditions, including:

• Attention-Deficit Hyperactivity Disorder (ADHD)
• Severe Depression
• Eating Disorders
• Post-traumatic Stress Disorder (PTSD)
• Obsessive Compulsive Disorder (OCD)
• Generalized Anxiety Disorder

Antipsychotic medicines do not cure these conditions. They are used to help relieve symptoms and improve quality of life.

Older or first-generation antipsychotic medications are also called conventional “typical” antipsychotics or “neuroleptics”. Some of the common typical antipsychotics include:

• Chlorpromazine 
• Haloperidol 
• Perphenazine 
• Fluphenazine 

Newer or second generation medications are also called “atypical” antipsychotics. Some of the common atypical antipsychotics include:

• Risperidone 
• Olanzapine 
• Quetiapine 
• Ziprasidone 
• Aripiprazole 
• Paliperidone 
• Lurasidone 

According to a 2013 research review by the Agency for Healthcare Research and Quality , typical and atypical antipsychotics both work to treat symptoms of schizophrenia and the manic phase of bipolar disorder.

Several atypical antipsychotics have a “broader spectrum” of action than the older medications, and are used for treating bipolar depression or depression that has not responded to an antidepressant medication alone.

To find additional antipsychotics and other medications used to manage psychoses and current warnings and advisories, please visit the FDA website .

How do people respond to antipsychotics?

Certain symptoms, such as feeling agitated and having hallucinations, usually go away within days of starting an antipsychotic medication. Symptoms like delusions usually go away within a few weeks, but the full effects of the medication may not be seen for up to six weeks. Every patient responds differently, so it may take several trials of different antipsychotic medications to find the one that works best.

Some people may have a relapse—meaning their symptoms come back or get worse. Usually relapses happen when people stop taking their medication, or when they only take it sometimes. Some people stop taking the medication because they feel better or they may feel that they don’t need it anymore, but no one should stop taking an antipsychotic medication without talking to his or her doctor.When a doctor says it is okay to stop taking a medication, it should be gradually tapered off— never stopped suddenly. Many people must stay on an antipsychotic continuously for months or years in order to stay well; treatment should be personalized for each individual.

What are the possible side effects of antipsychotics?

Antipsychotics have many side effects (or adverse events) and risks. The FDA lists the following side effects of antipsychotic medicines:

• Drowsiness
• Dizziness
• Restlessness
• Weight gain (the risk is higher with some atypical antipsychotic medicines)
• Dry mouth
• Constipation
• Nausea
• Vomiting
• Blurred vision
• Low blood pressure
• Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
• Seizures
• A low number of white blood cells, which fight infections

A person taking an atypical antipsychotic medication should have his or her weight, glucose levels, and lipid levels monitored regularly by a doctor.

Typical antipsychotic medications can also cause additional side effects related to physical movement, such as:

• Rigidity
• Persistent muscle spasms
• Tremors
• Restlessness

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements, commonly around the mouth, that a person can’t control. TD can range from mild to severe, and in some people, the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking typical antipsychotic medication. People who think that they might have TD should check with their doctor before stopping their medication. TD rarely occurs while taking atypical antipsychotics.

Antipsychotics may cause other side effects that are not included in this list above. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program . For more information about the risks and side effects for antipsychotic medications, please visit Drugs@FDA .

Mood Stabilizers

What are mood stabilizers?

Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression.Lithium , which is aneffective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. A number of cohort studies describe anti-suicide benefits of lithium for individuals on long-term maintenance. Mood stabilizers work by decreasing abnormal activity in the brain and are also sometimes used to treat:

• Depression (usually along with an antidepressant)
• Schizoaffective Disorder
• Disorders of impulse control
• Certain mental illnesses in children

Anticonvulsant medications are also used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid  (also called divalproex sodium). For some people, especially those with “mixed” symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than lithium. Other anticonvulsants used as mood stabilizers include:

• Carbamazepine 
• Lamotrigine 
• Oxcarbazepine 

What are the possible side effects of mood stabilizers?

Mood stabilizers can cause several side effects, and some of them may become serious, especially at excessively high blood levels. These side effects include:

• Itching, rash
• Excessive thirst
• Frequent urination
• Tremor (shakiness) of the hands
• Nausea and vomiting
• Slurred speech
• Fast, slow, irregular, or pounding heartbeat
• Blackouts
• Changes in vision
• Seizures
• Hallucinations (seeing things or hearing voices that do not exist)
• Loss of coordination
• Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her blood, and make sure the kidneys and the thyroid are working normally.

Lithium is eliminated from the body through the kidney, so the dose may need to be lowered in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to rise, requiring a temporary lowering of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range.

Mood stabilizers may cause other side effects that are not included in this list. To report any serious adverse effects associated with the use of these medicines, please contact the FDA MedWatch program using the contact information at the bottom of this page. For more information about the risks and side effects for each individual medication, please see Drugs@FDA .

For more information on the side effects of Carbamazepine ,Lamotrigine , and Oxcarbazepine , please visit MedlinePlus Drugs, Herbs and Supplements .

Some possible side effects linked anticonvulsants (such as valproic acid) include:

• Drowsiness
• Dizziness
• Headache
• Diarrhea
• Constipation
• Changes in appetite
• Weight changes
• Back pain
• Agitation
• Mood swings
• Abnormal thinking
• Uncontrollable shaking of a part of the body
• Loss of coordination
• Uncontrollable movements of the eyes
• Blurred or double vision
• Ringing in the ears
• Hair loss

These medications may also:

• Cause damage to the liver or pancreas, so people taking it should see their doctors regularly
• Increase testosterone (a male hormone) levels in teenage girls and lead to a condition called polycystic ovarian syndrome (a disease that can affect fertility and make the menstrual cycle become irregular)

Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact badly with anticonvulsants. In this case, a doctor can offer other medication options.

For more information about the risks and side effects for each medication, please see Drugs@FDA .

Special Groups: Children, Older Adults, Pregnant Women

All types of people take psychiatric medications, but some groups have special needs, including:

• Children and adolescents
• Older adults
• Women who are pregnant or who may become pregnant

Children and Adolescents

Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents.

Still, a doctor can give a young person an FDA-approved medication on an “off-label” basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age. Remember:

• It is important to watch children and adolescents who take these medications on an “off-label: basis.
• Children may have different reactions and side effects than adults.
• Some medications have current FDA warnings about potentially dangerous side effects for younger patients.

In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. Read more about child and adolescent mental health research.

Older Adults

People over 65 have to be careful when taking medications, especially when they’re taking many different drugs. Older adults have a higher risk for experiencing bad drug interactions, missing doses, or overdosing.

Older adults also tend to be more sensitive to medications. Even healthy older people react to medications differently than younger people because older people’s bodies process and eliminate medications more slowly. Therefore, lower or less frequent doses may be needed for older adults. Before starting a medication, older people and their family members should talk carefully with a physician about whether a medication can affect alertness, memory, or coordination, and how to help ensure that prescribed medications do not increase the risk of falls.

Sometimes memory problems affect older people who take medications for mental disorders. An older adult may forget his or her regular dose and take too much or not enough. A good way to keep track of medicine is to use a seven-day pill box, which can be bought at any pharmacy. At the beginning of each week, older adults and their caregivers fill the box so that it is easy to remember what medicine to take. Many pharmacies also have pill boxes with sections for medications that must be taken more than once a day.

For more information and practical tips to help older people take their medicines safely, please see National Institute on Aging’s Safe Use of Medicines booklet and Taking Medicines  on NIHSeniorHealth.gov.

Women who are pregnant or who may become pregnant

The research on the use of psychiatric medications during pregnancy is limited. The risks are different depending on which medication is taken, and at what point during the pregnancy the medication is taken. Decisions on treatments for all conditions during pregnancy should be based on each woman’s needs and circumstances, and based on a careful weighing of the likely benefits and risks of all available options, including psychotherapy (or “watchful waiting” during part or all of the pregnancy), medication, or a combination of the two. While no medication is considered perfectly safe for all women at all stages of pregnancy, this must be balanced for each woman against the fact that untreated serious mental disorders themselves can pose a risk to a pregnant woman and her developing fetus. Medications should be selected based on available scientific research, and they should be taken at the lowest possible dose. Pregnant women should have a medical professional who will watch them closely throughout their pregnancy and after delivery.

Most women should avoid certain medications during pregnancy. For example:

• Mood stabilizers are known to cause birth defects. Benzodiazepines and lithium have been shown to cause “floppy baby syndrome,” in which a baby is drowsy and limp, and cannot breathe or feed well. Benzodiazepines may cause birth defects or other infant problems, especially if taken during the first trimester.
• According to research, taking antipsychotic medications during pregnancy can lead to birth defects, especially if they are taken during the first trimester and in combination with other drugs, but the risks vary widely and depend on the type of antipsychotic taken. The conventional antipsychotic haloperidol has been studied more than others, and has been found not to cause birth defects. Research on the newer atypical antipsychotics is ongoing.

Antidepressants, especially SSRIs, are considered to be safe during pregnancy. However, antidepressant medications do cross the placental barrier and may reach the fetus. Birth defects or other problems are possible, but they are very rare. The effects of antidepressants on childhood development remain under study.

Studies have also found that fetuses exposed to SSRIs during the third trimester may be born with “withdrawal” symptoms such as breathing problems, jitteriness, irritability, trouble feeding, or hypoglycemia (low blood sugar). Most studies have found that these symptoms in babies are generally mild and short-lived, and no deaths have been reported. Risks from the use of antidepressants need to be balanced with the risks of stopping medication; if a mother is too depressed to care for herself and her child, both may be at risk for problems.

In 2004, the FDA issued a warning against the use of certain antidepressants in the late third trimester. The warning said that doctors may want to gradually taper pregnant women off antidepressants in the third trimester so that the baby is not affected. After a woman delivers, she should consult with her doctor to decide whether to return to a full dose during the period when she is most vulnerable to postpartum depression.

After the baby is born, women and their doctors should watch for postpartum depression, especially if a mother stopped taking her medication during pregnancy. In addition, women who nurse while taking psychiatric medications should know that a small amount of the medication passes into the breast milk. However, the medication may or may not affect the baby depending s on the medication and when it is taken. Women taking psychiatric medications and who intend to breastfeed should discuss the potential risks and benefits with their doctors.

Contact FDA MedWatch

About the FDA

The FDA is responsible for protecting the public health by ensuring the safety, efficacy and security of drugs (medications), biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

FDA is also responsible for advancing public health by helping to speed innovations that make medicines more effective, safer, and more affordable and by helping the public get accurate science-based information they need to use medicines and foods to maintain and improve their health.

Reporting Serious Problems to the FDA

Visit FDA’s MedWatch  to voluntarily report a serious adverse effect, product quality problem, product use error or product failure that you suspect is associated with the use of an FDA-regulated drug, biologic, medical device, dietary supplement or cosmetic. You can also report suspected counterfeit medical products to the FDA through MedWatch . You can also use the contact information provided below:

1-800-332-1088

1-800-FDA-0178 Fax

Report a Serious Problem: MedWatch Online 

Regular Mail: Use postage-paid FDA Form 3500 

Mail to: MedWatch, 5600 Fishers Lane, Rockville, MD 20857

Subscribe to MedWatch Safety Alerts

FDAs MedWatch program offers several ways to help you stay informed about the medical products are prescribed, administered, or dispensed every day. Get safety alerts delivered to your inbox. To subscribe, join the MedWatch email list . Learn more about the MedWatch E-list . You can also follow MedWatch on Twitter by following @FDAMedWatch .

Additional Resources

• Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder: A Review of the Research for Adults and Caregivers : This summary talks about one type of medicine—antipsychotics— used to treat schizophrenia and bipolar disorder. It tells you what research says about how older and newer antipsychotics compare for treating schizophrenia and bipolar disorder in adults.
• Antipsychotic Medicines for Children and Teens: A Review of the Research for Parents and Caregivers : This summary discusses using antipsychotic medicines to treat psychiatric conditions in children. It explains what medical research says about the benefits and possible side effects of these medicines when taken by children.
• DailyMed:  DailyMed provides trustworthy information about marketed drugs. DailyMed is the official provider of FDA label information (package inserts). This Web site provides a standard, comprehensive, up-to-date, look-up and download resource of medication content and labeling found in medication package inserts.
• MedlinePlus Drugs, Herbs and Supplements:  MedlinePlus is the National Institutes of Health’s Web site for patients and their families and friends. Produced by the National Library of Medicine, the world’s largest medical library, it brings you information about diseases, conditions, and wellness.
• Medicines for Treating Mental Health Conditions:  This summary tells you about research on how well some antipsychotic medicines work for conditions other than psychosis and bipolar disorder. It also tells you about research on the risks of side effects for these medicines.
• Medicines for Treating Depression: A Review of the Research for Adults:  This summary tells you what research has found about the possible benefits and side effects of antidepressants. You can use this information to talk with your doctor about which medicine may be best for you.
• Second-Generation Antidepressants for Treating Adult Depression: An Update : This summary is an update to a 2007 report, which was a systematic review of 248 clinical studies published between January 1980 and January 2011 examining the comparative effectiveness, benefits, and adverse effects of newer (“second-generation”) antidepressants for adults with depression.
• Treatment Options for ADHD in Children and Teens: A Review of Research for Parents and Caregivers : This summary discusses the different types of treatments for ADHD. It explains what research says about how each treatment improves symptoms and the risks involved with each treatment. It can help you talk with the doctor about ADHD and your child.

Definition

Disruptive mood dysregulation disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. DMDD symptoms go beyond a being a “moody” child—children with DMDD experience severe impairment that requires clinical attention. DMDD is a fairly new diagnosis, appearing for the first time in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013 .

Signs and Symptoms

DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. A child with DMDD experiences:

• Irritable or angry mood most of the day, nearly every day
• Severe temper outbursts (verbal or behavioral) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level
• Trouble functioning due to irritability in more than one place (e.g., home, school, with peers)

To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months.

Risk Factors

It is not clear how widespread DMDD is in the general population, but it is common among children who visit pediatric mental health clinics. Researchers are exploring risk factors and brain mechanisms of this disorder.

Treatment and Therapies

DMDD is a new diagnosis. Therefore, treatment is often based on what has been helpful for other disorders that share the symptoms of irritability and temper tantrums . These disorders include attention deficit hyperactivity disorder (ADHD), anxiety disorders, oppositional defiant disorder, and major depressive disorder.

If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.

While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:

• Medication
• Psychological treatments
  • Psychotherapy
  • Parent training
  • Computer based training

Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.

It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.

Medication

Many medications used to treat children and adolescents with mental illness are effective in relieving symptoms. However, some of these medications have not been studied in depth and/or do not have U.S. Food and Drug Administration (FDA)  approval for use with children or adolescents. All medications have side effects and the need for continuing them should be reviewed frequently with your child’s doctor.

For basic information about these and other mental health medications, you can visit the NIMH Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the FDA website .

Stimulants

Stimulants are medications that are commonly used to treat ADHD. There is evidence that, in children with irritability and ADHD, stimulant medications also decrease irritability.

Stimulants should not be used in individuals with serious heart problems. According to the FDA , people on stimulant medications should be periodically monitored for change in heart rate and blood pressure.

Antidepressants

Antidepressant medication is sometimes used to treat the irritability and mood problems associated with DMDD. Ongoing studies are testing whether these medicines are effective for this problem. It is important to note that, although antidepressants are safe and effective for many people, they carry a risk of suicidal thoughts and behavior in children and teens. A “black box” warning—the most serious type of warning that a prescription can carry—has been added to the labels of these medications to alert parents and patients to this risk. For this reason, a child taking an antidepressant should be monitored closely, especially when they first start taking the medication.

Atypical Antipsychotic

An atypical antipsychotic medication may be prescribed for children with very severe temper outbursts that involve physical aggression toward people or property. Risperidone  and aripiprazole  are FDA-approved for the treatment of irritability associated with autism and are sometimes used to treat DMDD. Atypical antipsychotic medications are associated with many significant side-effects, including suicidal ideation/behaviors, weight gain, metabolic abnormalities, sedation, movement disorders, hormone changes, and others.

Psychological treatments

Psychotherapy

Cognitive-behavioral therapy, a type of psychotherapy, is commonly used to teach children and teens how to deal with thoughts and feelings that contribute to their feeling depressed or anxious. Clinicians can use similar techniques to teach children to more effectively regulate their mood and to increase their tolerance for frustration. The therapy also teaches coping skills for regulating anger and ways to identify and re-label the distorted perceptions that contribute to outbursts. Other research psychotherapies are being explored at the NIMH.

Parent Training

Parent training aims to help parents interact with a child in a way that will reduce aggression and irritable behavior and improve the parent-child relationship. Multiple studies show that such interventions can be effective. Specifically, parent training teaches parents more effective ways to respond to irritable behavior, such as anticipating events that might lead a child to have a temper outburst and working ahead to avert the outburst. Training also focuses on the importance of predictability, being consistent with children, and rewarding positive behavior.

Computer-based training

Evidence suggests that irritable youth with DMDD may be prone tomisperceiving ambiguous facial expressions as angry. There is preliminary evidence that computer-based training designed to correct this problem may help youth with DMDD or severe irritability .

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. During clinical trials, treatments might be new drugs or combinations of drugs, new psychotherapies or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Clinical Trials at NIMH/NIH

Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics, epidemiology, and psychiatry. The studies take place at the NIH Clinical Center in Bethesda, Maryland and usually require regular visits. After an initial phone interview to see if any of the clinical trials recruiting subjects are a good match for you, you will come to an appointment at the clinic and meet with a clinician. Visit the NIMH Clinical Trials — Participants or Join a Study: Disruptive Mood Dysregulation Disorder for more information.

How Do I Find a Clinical Trial Near Me?

To find a clinical trial near you, you can visit ClinicalTrials.gov . This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from your health provider.