Mental health is finally getting the recognition it deserves as a serious condition that needs quality treatment options. However, the brain continues to surprise and mystify researchers. Ongoing research is determined to do away with many of the brain’s mysteries and uncover ways in which mental health conditions can be properly addressed with as few side effects as possible.
There are over 160 medicines in development, all aimed to address various mental health conditions. While there are plenty of new mental health drugs in 2023, research is ongoing, and the jury is out as to whether they will prove to be an effective replacement for existing mental health drugs. These current drugs are often not the best way to improve mental health and create unwanted side effects of their own.
Current Treatment Options for Mental Illness
There are a variety of treatment options available for individuals with mental health conditions, both holistic (i.e., focused on the whole person rather than just their symptoms) and pharmaceutical. Unfortunately, when a person goes to a doctor seeking treatment for a mental health condition, many providers tend to reach for the prescription pad first. This can mean equally or more effective therapies for mental health disorders go unused in favor of a few select classes of psychotropic medications: antidepressants, antipsychotics, mood stabilizers, and in some cases, tranquilizers.
While these psychotropic medications are designed to interact with the brain and affect mood, the ways in which they do so can vary. Many are intended to interact with chemical messengers and receptors in the brain known as neurotransmitters, artificially influencing chemical levels in an attempt to modulate mood, pleasure, and more. Among the most common psychotropic medications are the SSRIs intended to address depression.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are lab-created drugs designed to block the reabsorption (reuptake) of serotonin, a natural neurotransmitter. Despite the repeating mantra of serotonin as a “brain chemical”, 95% of the body’s serotonin is found in the gut. Psychiatric drugs can, however, artificially increase serotonin levels in the brain by blocking its normal reuptake. Serotonin is a neurotransmitter that carries signals between the nerve cells and the brain, acting as a powerful modulator of the entire nervous system, and is thought to have a significant influence on mood, emotion, and sleep.13
In this way, SSRIs are postulated to help the brain access more serotonin and improve mood. However, this increase is only temporary and can cause a range of unintended side effects. For example, these drugs can prevent natural hormones from being recycled for reuse, interrupting normal hormone recycling.
There are many other potential long-term effects of using SSRIs, including a deficiency of natural neurotransmitter hormones. This often coincides with an individual developing a tolerance to the SSRI, forcing them to require more medication to achieve the same effects. Eventually, when neither the SSRI nor the brain can sufficiently increase serotonin levels, depression, anxiety, and other mental health symptoms can reappear more intensely than before.
SSRI medications have withdrawal risks that can vary among individual medications. This is why so many holistic practitioners recommend medication-free treatment options to address mental health.
Celexa is a commonly prescribed SSRI used to treat depression. There are a wide variety of potential negative long-term effects when taking this drug, which can start to impact a person’s health within weeks. Unfortunately, Celexa is often used by individuals for years at a time, and research is still underway regarding the risks of remaining on SSRIs for such a long period..
Lexapro is a widely-used SSRI that was FDA-approved to treat major depressive disorder and generalized anxiety disorder. This medication can also be prescribed for conditions such as OCD, PTSD, panic attacks, and other mental health conditions. Like other SSRIs, Lexapro must build up within the brain to start providing any resemblance of results. Over time, though, results become harder to achieve, which can lead providers to increase patient dosages.
Some of the most significant impacts of long-term use include:
Prozac is an SSRI often prescribed to combat a wide variety of mental health conditions such as depression, OCD, panic disorders, and bulimia. The active ingredient in Prozac has a controversial history. Fluoxetine was originally designed to treat high blood pressure but wasn’t able to show viable success in human trials. In time, researchers turned to treating depression and saw some success in a small trial run. Backed by a strong marketing campaign, this drug soon soared in popularity as an off-label option for treating a wide range of issues.
Like its other SSRI counterparts, this medication can cause negative long-term effects. Those unique to Prozac can include:
Luvox is an SSRI used to treat symptoms associated with obsessive-compulsive disorder (OCD) and social anxiety disorders. This medication has come under heavy scrutiny recently due to its extreme side effects. Teenagers and children using this medication were found to be at a significantly increased risk of suicidal thoughts and behaviors. It was removed from the US market in 2002 and later reintroduced with a black box warning to alert patients of the suicidality risk. Currently, research groups are using novel methods, including social media reporting, to track the adverse effects of medications like Luvox, particularly suicidal thoughts. 1
Paroxetine HCI (Paxil)
Paxil has been on the market since 1992 and is available in extended-release and immediate-release forms. This drug is intended to work as an antidepressant but can also be prescribed for OCD, panic disorders, and social anxiety disorders due to its ability to induce a sedative-like calm. Creators intended for Paxil to target serotonin, but long-term use has also been shown to impact other neurotransmitters such as dopamine, GABA, histamine, and acetylcholine.
For this reason, taking this drug with other medications or alcohol can be dangerous and cause unpredictable side effects. Serotonin syndrome, caused by too much serotonin in the brain, can cause vomiting, agitation, elevated heart rate, disorientation, reduced coordination, and other symptoms, including death. Other long-term effects of Paxil may include:
Sertraline is an SSRI used to treat a variety of mental health concerns, such as OCD, depression, and anxiety. It is believed that this medication works by triggering the central nervous system to accumulate serotonin. However, it is not without its negative effects, which are elevated when taken with other medications or alcohol. This medication also poses a risk of dependency and serious withdrawal symptoms.
The long-term effects associated with taking Zoloft include:
New Advancements in Mental Health Illness Treatment
Treating mental health illnesses is a vital undertaking that seriously impacts the health and well-being of the nation. Mental health conditions can impact a person’s quality of life and increase their risk of turning to drugs or alcohol in a desire to self-medicate. As a result, researchers continue to pursue new ways that mental health issues can be successfully treated, either in conjunction with or without the use of SSRIs and other psychotropic medications.
Technology
Technology has opened numerous doors when it comes to mental health care and vital data collection. Smartphones and tablets can be utilized by both healthcare providers and their patients to better monitor conditions, medications, dosages, and side effects. New apps can help individuals improve their ability to self-monitor their symptoms, improve thinking skills, increase accessibility for support, and aid in data and research developments.2
Telehealth
More mental health providers are now offering telehealth options for their patients, a practice that gained serious momentum due to the Covid-19 pandemic. Telehealth allows individuals to meet with a mental professional virtually via a tablet, smartphone, laptop, or other device within the comfort of their own homes. This provides better accessibility for individuals in rural areas, individuals with disabilities, those who don’t have schedules that work with a traditional office setting, and other people who wouldn’t have otherwise reached out for mental health services. Telehealth has the potential to significantly reduce the current strain on the mental health system.3
Pharmacogenomics
The concept of pharmacogenomics is a newly emerging tool designed to explore a person’s genes to accurately discover what medication might work best for them. A current issue with prescription medication is the prescriber’s ultimate inability to determine with any certainty how the body and mind will react to a given medication. This can be especially difficult with medications like SSRIs, which need to build up in the system over time to demonstrate any positive or negative reactions. Current trials indicate that this approach may prove beneficial for people with mood disorders.4
Psychedelics
Researchers are currently exploring the potential benefits of incorporating micro-doses of psychedelics like ketamine and psilocybin to address various mental health conditions, particularly PTSD and severe depression. Emerging evidence shows promise that, when added to traditional treatment options like therapy, psychedelics may provide lasting support. How psychedelics help is yet to be fully realized, but there may be a correlation between the presentation of these substances and a shift in how a person relates to their memories. When administered in a clinical setting, these substances may provide substantial relief for individuals with PTSD. 5
Transcranial Magnetic Stimulation (TMS)
This non-invasive therapy is a targeted form of brain stimulation using a magnet. A magnetic coil is placed on a patient’s head, creating an electrical current across the scalp and bone and into the surface of the brain. This allows providers to target specific areas of the brain that are responsible for mental health conditions such as depression. This treatment can be completed quickly with minimal risk of side effects. In a controlled study featuring a specific TMS methodology known as Stanford Neuromodulation Therapy, almost 80% of participants found the treatment effective.6
One of the most significant issues facing the safe use of SSRIs and other psychotropic drugs to treat depression, anxiety, and other mental health conditions is the inability to completely understand how these drugs work. Researchers have a general idea of the mechanisms that should be in place, yet there is no concrete understanding of the reactions that may occur in each individual person. This presents researchers and prescribing doctors with a serious problem – the inability to determine whether the drugs will help at all, whether they will produce short- or long-term effects, and whether those effects will truly be worth the minimal improvement that may occur.
While newer drugs are created frequently in an effort to correct these issues, there is still room for development and improvement. Here are a few that have been recently marketed.7
Caplyta (Lumateperone)
Odds are you’ve seen commercials for this antipsychotic medication. This is a once-daily pill intended to treat schizophrenia in adults.8. It is believed to work by artificially manipulating transporters and receptors of chemicals in the brain including serotonin, dopamine, norepinephrine, muscarine, and histamine. Like other current psychotropic drugs on the market, the exact way that Caplyta works is still not fully understood. Caplyta can cause serious side effects such as dizziness, stroke, uncontrollable movements, decreased blood pressure, and more.8
IGALMI (Dexmedetomidine)
Although the generic medication has been around since 1999, IGALMI was approved in 2022 for agitation associated with schizophrenia and bipolar I or II disorder in adults. No studies on human subjects went beyond 24 hours after the first dose. The drug is given via a sublingual film that allows absorption within 15 minutes. As with other antipsychotic medications, IGALMI artificially modulates neurotransmitters in the brain, namely norepinephrine, which is thought to be a primary hormone involved with agitation. Common side effects can include dizziness, drowsiness, or feeling faint. As a powerful CNS depressant, it should not be given to elderly patients, or those compromised with heart conditions.9
Ruoxinlin
Ruoxinlin is China’s first class 1 antidepressant for treating major depressive disorder. This specific condition can be difficult to regulate with the medications currently on the market. As a triple reuptake inhibitor capable of interacting with serotonin, norepinephrine, and dopamine, Ruoxinlin may be among what are considered next-generation antidepressants. Ruoxinlin is another hopeful drug in the decades-long quest for an antidepressant drug that actually works. Long-term trials have not occurred, and the majority of short-term trials were unpublished or undisclosed. And so, the efficacy of this new drug remains largely unknown.10
Drug Development FAQs
Drug development is a complex process that only results in a handful of drugs actually reaching the market each year out of thousands of candidates. Here are some commonly-asked drug development questions.
What Is the Oldest Psych Drug?
The first approved drug used as a chemical-based treatment for the control of extreme psychiatric conditions was the antipsychotic chlorpromazine, more commonly known as Thorazine. This drug received FDA approval in 1954. Thorazine was voluntarily discontinued for undisclosed reasons, but there are still generic versions on the market.11
What Is the Top Prescribed Medication for Mental Health?
Selective serotonin reuptake inhibitors are the most popular prescribed medications for mental health. Within this category falls a variety of medications, including Prozac, Zoloft, Paxil, Lexapro, and more. These medications are designed to interact with the brain to aid in the retention of serotonin, but their exact mechanisms of action have never been determined .12
What Are Three of the Newest Treatments for Mental Disorders?
The three newest treatments for mental health disorders include pharmacogenomics, telehealth/app implementation, and transcranial magnetic stimulation (TMS). While these treatments are still new and require further exploration and trials, all have shown promise in addressing a variety of mental health conditions.
Try Alternatives to Medication
Currently, medications are among the first avenues many physicians will try when faced with a mental health issue. Unfortunately, the precise ways these medications work are theoretical in nature, and there are no guarantees they will address the many symptoms of mental health disorders. Many medications cause severe side effects, cumulative toxicity, and long-term issues that can serve to make mental health symptoms worse.
At Alternative to Meds Center, we are excited to see that many of the latest advancements are stepping back from reliance on prescription drugs. There are many alternatives to medication that individuals can consider to tackle the root cause of mental health issues instead of just the symptoms themselves.
References:
1. Lee, J. Y., Lee, Y. S., Kim, D. H., Lee, H. S., Yang, B. R., & Kim, M. G. (2021). The use of social media in detecting drug safety–related new black box warnings, labeling changes, or withdrawals: scoping review. JMIR public health and surveillance, 7(6), e30137. https://doi.org/10.2196/30137
3. Moreno, C., Wykes, T., Galderisi, S., Nordentoft, M., Crossley, N., Jones, N., … & Arango, C. (2020). How mental health care should change as a consequence of the COVID-19 pandemic. The lancet psychiatry, 7(9), 813-824. https://doi.org/10.1016/S2215-0366(20)30307-2
4. Amare, A. T., Schubert, K. O., & Baune, B. T. (2017). Pharmacogenomics in the treatment of mood disorders: strategies and opportunities for personalized psychiatry. EPMA Journal, 8, 211-227. Retrieved June 27, 2023, from https://link.springer.com/article/10.1007/s13167-017-0112-8
5. De Gregorio, D., Aguilar-Valles, A., Preller, K. H., Heifets, B. D., Hibicke, M., Mitchell, J., & Gobbi, G. (2021). Hallucinogens in Mental Health: Preclinical and Clinical Studies on LSD, Psilocybin, MDMA, and Ketamine. The Journal of neuroscience : the official journal of the Society for Neuroscience, 41(5), 891–900. https://doi.org/10.1523/JNEUROSCI.1659-20.2020
6. Cole, E. J., Phillips, A. L., Bentzley, B. S., Stimpson, K. H., Nejad, R., Barmak, F., … & Williams, N. R. (2022). Stanford neuromodulation therapy (SNT): a double-blind randomized controlled trial. American Journal of Psychiatry, 179(2), 132-141. https://doi.org/10.1176/appi.ajp.2021.20101429
8. FDA Label Catypla (lumateperone)capsules [approval 2019]
9. FDA Label IGALMI (dexmedetomidine) sublingual film, for siblingual or buccal use) (initial approval 1999)
10. Vasiliu O, Efficacy, Tolerability, and Safety of Toludesvenlafaxine for the Treatment of Major Depressive Disorder [published in the Journal of Pharmaceuticals (Basel)][2023 March 8]
11. Field R. I. (2010). Antipsychotic medications are spelling legal trouble for drugmakers. P & T : a peer-reviewed journal for formulary management, 35(11), 621–622.
12. Taylor, C., Fricker, A. D., Devi, L. A., & Gomes, I. (2005). Mechanisms of action of antidepressants: from neurotransmitter systems to signaling pathways. Cellular signalling, 17(5), 549–557. https://doi.org/10.1016/j.cellsig.2004.12.007
13. Terry, N., & Margolis, K. G. (2017). Serotonergic Mechanisms Regulating the GI Tract: Experimental Evidence and Therapeutic Relevance. Handbook of experimental pharmacology, 239, 319–342. https://doi.org/10.1007/164_2016_103
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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