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Mental Health

National Institute of Mental Health

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES UÊÊ >̈œ˜>Ê˜Ã̈ÌÕÌiÃʜvÊi>Ì Contents Mental Health Medications ...... 1 What are psychiatric medications? ...... 1 How are medications used to treat mental disorders? ...... 1 What medications are used to treat ? ...... 2 What are the side effects? ...... 2 How are taken and how do people respond to them? ...... 3 How do antipsychotics interact with other medications? ...... 3 What medications are used to treat depression? ...... 4 What are the side effects? ...... 4 How should be taken? ...... 5 Are herbal used to treat depression? ...... 5 FDA warning on antidepressants...... 6 What medications are used to treat ? ...... 7 Mood stabilizers ...... 7 Atypical antipsychotics ...... 7 Antidepressants ...... 7 What are the side effects? ...... 8 How should medications for bipolar disorder be taken?...... 9 What medications are used to treat disorders? ...... 10 Antidepressants ...... 10 (anti-anxiety medications)...... 10 Beta-blockers...... 10 What are the side effects? ...... 11 How should medications for anxiety disorders be taken?...... 11 What medications are used to treat ADHD? ...... 12 What are the side effects? ...... 12 How are ADHD medications taken? ...... 12 Are ADHD medications safe? ...... 12 FDA warning on possible rare side effects ...... 13 Which groups have special needs when taking psychiatric medications?...... 14 Children and adolescents...... 14 Older adults ...... 14 Women who are pregnant or may become pregnant ...... 15 What should I ask my doctor if I am prescribed a psychiatric ? ...... 16 Alphabetical List of Medications...... 17 Citations ...... 25 For More Information on Medications ...... 26 Mental Health Medications

edications are used to treat the people with mental disorders live fulfilling lives symptoms of mental disorders such with the help of these medications. Without them, Mas schizophrenia, depression, bipolar people with mental disorders might suffer serious disorder (sometimes called manic-depressive and disabling symptoms. illness), anxiety disorders, and attention deficit- hyperactivity disorder (ADHD). Sometimes How are medications used to medications are used with other treatments such as treat mental disorders? . This guide describes: Medications treat the symptoms of mental s Types of medications used to treat mental disorders. They cannot cure the disorder, but they disorders make people feel better so they can function. s Side effects of medications s Directions for taking medications Medications work differently for different people. s Warnings about medications from the U.S. Some people get great results from medications Food and Drug Administration (FDA). and only need them for a short time. For example, a person with depression may feel much better This booklet does not provide information about after taking a medication for a few months, and diagnosing mental disorders. Choosing the right may never need it again. People with disorders like medication, medication dose, and treatment plan schizophrenia or bipolar disorder, or people who should be based on a person’s individual needs and have long-term or severe depression or anxiety may medical situation, and under a doctor’s care. need to take medication for a much longer time. Information about medications is frequently updated. Some people get side effects from medications Check the FDA Web site (http://www.fda.gov) and other people don’t. Doses can be small or for the latest information on warnings, patient large, depending on the medication and the person. medication guides, or newly approved medications. Factors that can affect how medications work in Throughout this document you will see two people include: names for medications —the generic name and s Type of , such as depression, in parenthesis, the trade name. An example is anxiety, bipolar disorder, and schizophrenia fluoxetine (Prozac). See the end of this document s Age, sex, and body size for a complete alphabetical listing of medications. s Physical illnesses s Habits like smoking and drinking What are psychiatric s and kidney function medications? s Genetics Psychiatric medications treat mental disorders. s Other medications and herbal/ Sometimes called psychotropic or psychothera- supplements peutic medications, they have changed the lives of s Diet people with mental disorders for the better. Many s Whether medications are taken as prescribed.

Mental Health Medications 1 What medications are used to treat schizophrenia?

ntipsychotic medications are used to treat s (Geodon) schizophrenia and schizophrenia-related s (Abilify) Adisorders. Some of these medications have s (Invega). been available since the mid-1950’s. They are also called conventional “typical” antipsychotics. Some The antipsychotics listed here are some of the of the more commonly used medications include: medications used to treat symptoms of schizo- s (Thorazine) phrenia. Additional antipsychotics and other s (Haldol) medications used for schizophrenia are listed in s (generic only) the chart at the end. s (generic only). Note: The FDA issued a Public Health Advisory for atypical In the 1990’s, new medications antipsychotic medications. The FDA determined that death were developed. These new medications are called rates are higher for elderly people with when second generation, or “atypical” antipsychotics. taking this medication. A review of data has found a risk with conventional antipsychotics as well. Antipsychotic medications One of these medications was (Clozaril). are not FDA-approved for the treatment of behavioral disorders It is a very effective medication that treats in patients with dementia. psychotic symptoms, hallucinations, and breaks What are the side effects? with reality, such as when a person believes he or she is the president. But clozapine can sometimes Some people have side effects when they start cause a serious problem called agranulocytosis, taking these medications. Most side effects go which is a loss of the white cells that help a away after a few days and often can be managed person fight . Therefore, people who take successfully. People who are taking antipsychotics clozapine must get their white blood cell counts should not drive until they adjust to their new checked every week or two. This problem and the medication. Side effects of many antipsychotics cost of blood tests make treatment with clozapine include: difficult for many people. Still, clozapine is s Drowsiness potentially helpful for people who do not respond s Dizziness when changing positions to other antipsychotic medications. s Blurred vision s Rapid heartbeat Other atypical antipsychotics were developed. s Sensitivity to the sun All of them are effective, and none cause s Skin rashes agranulocytosis. These include: s Menstrual problems for women. s (Risperdal) s (Zyprexa) medications can cause s (Seroquel) major weight gain and changes in a person’s . This may increase a person’s risk of

2 National Institute of Mental Health getting diabetes and high cholesterol.1 A person’s a person needs to try several medications before weight, glucose levels, and lipid levels should be finding the right one. Doctors and patients can monitored regularly by a doctor while taking an work together to find the best medication or atypical antipsychotic medication. medication combination, and dose. medications can cause side Some people may have a —their symptoms effects related to physical movement, such as: come back or get worse. Usually, happen s Rigidity when people stop taking their medication, or when s Persistent muscle spasms they only take it sometimes. Some people stop s Tremors taking the medication because they feel better or s Restlessness. they may feel they don’t need it anymore. But Long-term use of typical antipsychotic medications no one should stop taking an antipsychotic may lead to a condition called tardive dyskinesia medication without talking to his or her doctor. When a doctor says it is okay to stop taking a (TD). TD causes muscle movements a person can’t medication, it should be gradually tapered off, control. The movements commonly happen around never stopped suddenly. the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. How do antipsychotics interact with Sometimes people with TD recover partially or other medications? fully after they stop taking the medication. Antipsychotics can produce unpleasant or dangerous Every year, an estimated 5 percent of people taking side effects when taken with certain medications. typical antipsychotics get TD. The condition For this reason, all doctors treating a patient need happens to fewer people who take the new, atypical to be aware of all the medications that person is antipsychotics, but some people may still get TD. taking. Doctors need to know about prescription and People who think that they might have TD should over-the-counter , , minerals, and check with their doctor before stopping their herbal supplements. People also need to discuss any medication. or other drug use with their doctor.

How are antipsychotics taken and To find out more about how antipsychotics work, how do people respond to them? the National Institute of Mental Health (NIMH) funded a study called CATIE (Clinical Antipsychotic Antipsychotics are usually pills that people swallow, Trials of Intervention Effectiveness). This study or liquid they can drink. Some antipsychotics are compared the effectiveness and side effects of shots that are given once or twice a month. five antipsychotics used to treat people with Symptoms of schizophrenia, such as feeling schizophrenia. In general, the study found that the agitated and having hallucinations, usually go away older medication perphenazine worked as well as within days. Symptoms like usually go the newer, atypical medications. But because people away within a few weeks. After about six weeks, respond differently to different medications, it is many people will see a lot of improvement. important that treatments be designed carefully However, people respond in different ways to for each person. You can find more information on antipsychotic medications, and no one can tell CATIE here. beforehand how a person will respond. Sometimes

Mental Health Medications 3 What medications are used to treat depression?

epression is commonly treated What are the side effects? with medications. Antidepressants may cause mild side effects that DAntidepressants work to balance some usually do not last long. Any unusual reactions of the natural chemicals in our . These or side effects should be reported to a doctor chemicals are called neurotransmitters, and immediately. they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as The most common side effects associated with , , and . SSRIs and SNRIs include: s Headache, which usually goes away within a The most popular types of antidepressants are few days. called selective serotonin reuptake inhibitors s Nausea (feeling sick to your stomach), which (SSRIs). These include: usually goes away within a few days. s (Prozac) s Sleeplessness or drowsiness, which may s (Celexa) happen during the first few weeks but then s (Zoloft) goes away. Sometimes the medication dose s (Paxil) needs to be reduced or the time of day it is s (Lexapro). taken needs to be adjusted to help lessen Other types of antidepressants are serotonin and these side effects. norepinephrine reuptake inhibitors (SNRIs). SNRIs s Agitation (feeling jittery). are similar to SSRIs and include s Sexual problems, which can affect both men (Effexor) and (Cymbalta). Another and women and may include reduced sex antidepressant that is commonly used is drive, and problems having and enjoying sex. (Wellbutrin). Bupropion, which works on the antidepressants can cause side effects, neurotransmitter dopamine, is unique in that it does including: not fit into any specific drug type. s Dry mouth. SSRIs and SNRIs are popular because they do s Constipation. not cause as many side effects as older classes of s Bladder problems. It may be hard to empty antidepressants. Older antidepressant medications the bladder, or the urine stream may not be include , tetracyclics, and monoamine as strong as usual. Older men with enlarged oxidase inhibitors (MAOIs). For some people, prostate conditions may be more affected. tricyclics, tetracyclics, or MAOIs may be the best s Sexual problems, which can affect both men medications. and women and may include reduced sex drive, and problems having and enjoying sex.

4 National Institute of Mental Health s Blurred vision, which usually goes away decrease the dose. It’s important to give the body quickly. time to adjust to the change. People don’t get s Drowsiness. Usually, antidepressants that addicted, or “hooked,” on the medications, but make you drowsy are taken at bedtime. stopping them abruptly can cause withdrawal symptoms. People taking MAOIs need to be careful about the foods they eat and the medicines they take. If a medication does not work, it is helpful to Foods and medicines that contain high levels of a be open to trying another one. A study funded chemical called are dangerous for people by NIMH found that if a person with difficult- taking MAOIs. Tyramine is found in some cheeses, to-treat depression did not get better with a first wines, and pickles. The chemical is also in some medication, chances of getting better increased medications, including and over-the- when the person tried a new one or added a second counter . medication to his or her treatment. The study was called STAR*D (Sequenced Treatment Alternatives Mixing MAOIs and tyramine can cause a sharp to Relieve Depression).2,3 increase in blood pressure, which can lead to stroke. People taking MAOIs should ask their Are herbal medicines used to treat doctors for a complete list of foods, medicines, and depression? other substances to avoid. An MAOI skin patch has recently been developed and may help reduce some The herbal medicine St. John’s wort has been used of these risks. A doctor can help a person figure out for centuries in many folk and herbal remedies. if a patch or a pill will work for him or her. Today in Europe, it is used widely to treat mild-to- moderate depression. In the United States, it is one How should antidepressants be of the top-selling botanical products. taken? The National Institutes of Health conducted a People taking antidepressants need to follow their to determine the effectiveness of doctors’ directions. The medication should be taken treating adults who have major depression with in the right dose for the right amount of time. It can St. Johns wort. The study included 340 people take three or four weeks until the medicine takes diagnosed with major depression. One-third of effect. Some people take the medications for a short the people took the herbal medicine, one-third time, and some people take them for much longer took an SSRI, and one-third took a , or periods. People with long-term or severe depression “sugar pill.” The people did not know what they may need to take medication for a long time. were taking. The study found that St. John’s wort was no more effective than the placebo in treating Once a person is taking antidepressants, it is major depression.4 A study currently in progress is important not to stop taking them without the looking at the effectiveness of St. John’s wort for help of a doctor. Sometimes people taking treating mild or minor depression. antidepressants feel better and stop taking the medication too soon, and the depression may Other research has shown that St. John’s wort return. When it is time to stop the medication, can dangerously interact with other medications, the doctor will help the person slowly and safely including those used to control HIV. On February

Mental Health Medications 5 10, 2000, the FDA issued a Public Health Advisory The warning also says that patients of all ages letter stating that the herb appears to interfere with taking antidepressants should be watched closely, certain medications used to treat heart disease, especially during the first few weeks of treatment. depression, seizures, certain cancers, and organ Possible side effects to look for are depression transplant rejection. Also, St. Johns wort may that gets worse, suicidal thinking or behavior, interfere with oral contraceptives. or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from Because St. John’s wort may not mix well with normal social situations. Families and caregivers other medications, people should always talk should report any changes to the doctor. The with their doctors before taking it or any herbal latest information from the FDA can be found supplement. at http://www.fda.gov. FDA warning on antidepressants Results of a comprehensive review of pediatric Antidepressants are safe and popular, but some trials conducted between 1988 and 2006 suggested studies have suggested that they may have that the benefits of antidepressant medications unintentional effects, especially in young people. likely outweigh their risks to children and In 2004, the FDA looked at published and adolescents with major depression and anxiety 5 unpublished data on trials of antidepressants that disorders. The study was funded in part by NIMH. involved nearly 4,400 children and adolescents. Finally, the FDA has warned that combining the They found that 4 percent of those taking newer SSRI or SNRI antidepressants with one of antidepressants thought about or tried suicide the commonly-used “” medications used (although no suicides occurred), compared to to treat migraine headaches could cause a life- 2 percent of those receiving (sugar pill). threatening illness called “serotonin syndrome.” In 2005, the FDA decided to adopt a “black box” A person with serotonin syndrome may be agitated, warning label—the most serious type of warning— have hallucinations (see or hear things that are not on all antidepressant medications. The warning real), have a high temperature, or have unusual says there is an increased risk of suicidal thinking blood pressure changes. Serotonin syndrome is or attempts in children and adolescents taking usually associated with the older antidepressants antidepressants. In 2007, the FDA proposed that called MAOIs, but it can happen with the newer makers of all antidepressant medications extend the antidepressants as well, if they are mixed with the warning to include young adults up through age 24. wrong medications.

6 National Institute of Mental Health What medications are used to treat bipolar disorder?

ipolar disorder, also called manic- Antipsychotics used to treat people with bipolar depressive illness, is commonly treated disorder include: Bwith mood stabilizers. Sometimes, s Olanzapine (Zyprexa), which helps people antipsychotics and antidepressants are used along with severe or psychotic depression, which with a . often is accompanied by a break with reality, hallucinations, or delusions7 Mood stabilizers s Aripiprazole (Abilify), which can be taken as People with bipolar disorder usually try mood a pill or as a shot stabilizers first. In general, people continue s Risperidone (Risperdal) treatment with mood stabilizers for years. s Ziprasidone (Geodon) is a very effective mood stabilizer. It was the first s Clozapine (Clorazil), which is often used mood stabilizer approved by the FDA in the 1970’s for people who do not respond to lithium or 8 for treating both manic and depressive episodes. .

Anticonvulsant medications also are used as mood Antidepressants stabilizers. They were originally developed to Antidepressants are sometimes used to treat treat seizures, but they were found to help control symptoms of depression in bipolar disorder. moods as well. One commonly Fluoxetine (Prozac), paroxetine (Paxil), or used as a mood stabilizer is valproic acid, also sertraline (Zoloft) are a few that are used. However, called divalproex sodium (Depakote). For some people with bipolar disorder should not take an people, it may work better than lithium.6 Other antidepressant on its own. Doing so can cause the anticonvulsants used as mood stabilizers are person to rapidly switch from depression to , (Tegretol), (Lamictal) which can be dangerous.9 To prevent this problem, and (Trileptal). doctors give patients a mood stabilizer or an antipsychotic along with an antidepressant. Atypical antipsychotics Atypical antipsychotic medications are sometimes Research on whether antidepressants help people used to treat symptoms of bipolar disorder. with bipolar depression is mixed. An NIMH- Often, antipsychotics are used along with other funded study found that antidepressants were medications. no more effective than a placebo to help treat depression in people with bipolar disorder. The people were taking mood stabilizers along with

Mental Health Medications 7 the antidepressants. You can find out more about Some possible side effects linked with valproic this study, called STEP-BD (Systematic Treatment acid/divalproex sodium include: Enhancement Program for Bipolar Disorder), s Changes in weight here.10 s Nausea s Stomach pain What are the side effects? s Vomiting Treatments for bipolar disorder have improved over s Anorexia the last 10 years. But everyone responds differently s Loss of appetite. to medications. If you have any side effects, tell Valproic acid may cause damage to the liver or your doctor right away. He or she may change the pancreas, so people taking it should see their dose or prescribe a different medication. doctors regularly. Different medications for treating bipolar disorder Valproic acid may affect young girls and women may cause different side effects. Some medications in unique ways. Sometimes, valproic acid may used for treating bipolar disorder have been increase testosterone (a male hormone) levels linked to unique and serious symptoms, which are in teenage girls and lead to a condition called described below. polycystic ovarian syndrome (PCOS).11,12 PCOS Lithium can cause several side effects, and some of is a disease that can affect fertility and make the them may become serious. They include: menstrual cycle become irregular, but symptoms 13 s Loss of coordination tend to go away after valproic acid is stopped. s Excessive thirst It also may cause birth defects in women who are s Frequent urination pregnant. s Blackouts Lamotrigine can cause a rare but serious skin rash s Seizures that needs to be treated in a hospital. In some cases, s Slurred speech this rash can cause permanent disability or be life- s Fast, slow, irregular, or pounding heartbeat threatening. s Hallucinations (seeing things or hearing In addition, valproic acid, lamotrigine, voices that do not exist) carbamazepine, oxcarbazepine and other s Changes in vision anticonvulsant medications (listed in the chart at s Itching, rash the end of this document) have an FDA warning. s Swelling of the eyes, face, lips, tongue, The warning states that their use may increase the throat, hands, feet, ankles, or lower legs. risk of suicidal thoughts and behaviors. People If a person with bipolar disorder is being treated taking anticonvulsant medications for bipolar or with lithium, he or she should visit the doctor other illnesses should be closely monitored for new regularly to check the levels of lithium in the blood, or worsening symptoms of depression, suicidal and make sure the kidneys and the thyroid are thoughts or behavior, or any unusual changes in working normally. mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

8 National Institute of Mental Health Other medications for bipolar disorder may also There is no cure for bipolar disorder, but treatment be linked with rare but serious side effects. Always works for many people. Treatment works best when talk with the doctor or pharmacist about any it is continuous, rather than on and off. However, potential side effects before taking the medication. mood changes can happen even when there are no breaks in treatment. Patients should be open with For information on side effects of antipsychotics, their doctors about treatment. Talking about how see the section on medications for treating treatment is working can help it be more effective. schizophrenia. It may be helpful for people or their family For information on side effects and FDA warnings members to keep a daily chart of mood symptoms, of antidepressants, see the section on medications treatments, sleep patterns, and life events. This for treating depression. chart can help patients and doctors track the illness. Doctors can use the chart to treat the illness most How should medications for bipolar disorder be taken? effectively. Medications should be taken as directed by a Because medications for bipolar disorder can have doctor. Sometimes a person’s treatment plan needs serious side effects, it is important for anyone to be changed. When changes in medicine are taking them to see the doctor regularly to check for needed, the doctor will guide the change. A person possibly dangerous changes in the body. should never stop taking a medication without asking a doctor for help.

Mental Health Medications 9 What medications are used to treat anxiety disorders?

ntidepressants, anti-anxiety medications, MAOIs are also used for anxiety disorders. and beta-blockers are the most common Doctors sometimes prescribe (Nardil), Amedications used for anxiety disorders. (Parnate), and (Marplan). People who take MAOIs must avoid Anxiety disorders include: certain food and medicines that can interact with s Obsessive compulsive disorder (OCD) their medicine and cause dangerous increases in s Post-traumatic stress disorder (PTSD) blood pressure. For more information, see the s Generalized (GAD) section on medications used to treat depression. s Panic disorder s Social phobia. Benzodiazepines (anti-anxiety medications) Antidepressants The anti-anxiety medications called Antidepressants were developed to treat depression, benzodiazepines can start working more quickly but they also help people with anxiety disorders. than antidepressants. The ones used to treat anxiety SSRIs such as fluoxetine (Prozac), sertraline disorders include: (Zoloft), escitalopram (Lexapro), paroxetine s (Klonopin), which is used for (Paxil), and citalopram (Celexa) are commonly social phobia and GAD prescribed for panic disorder, OCD, PTSD, and s (Ativan), which is used for panic social phobia. The SNRI venlafaxine (Effexor) is disorder commonly used to treat GAD. The antidepressant s (Xanax), which is used for panic bupropion (Wellbutrin) is also sometimes used. disorder and GAD. When treating anxiety disorders, antidepressants generally are started at low doses and increased (Buspar) is an anti-anxiety medication over time. used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone Some tricyclic antidepressants work well for to begin working. anxiety. For example, (Tofranil) is prescribed for panic disorder and GAD. Clonazepam, listed above, is an anticonvulsant (Anafranil) is used to treat OCD. medication. See FDA warning on anticonvulsants Tricyclics are also started at low doses and under the bipolar disorder section. increased over time.

10 National Institute of Mental Health Beta-blockers In addition, beta-blockers generally are not Beta-blockers control some of the physical recommended for people with asthma or diabetes symptoms of anxiety, such as trembling and because they may worsen symptoms. sweating. (Inderal) is a beta-blocker usually used to treat heart conditions and high How should medications for anxiety blood pressure. The medicine also helps people disorders be taken? who have physical problems related to anxiety. For People can build a tolerance to benzodiazepines if example, when a person with social phobia must they are taken over a long period of time and may face a stressful situation, such as giving a speech, need higher and higher doses to get the same effect. or attending an important meeting, a doctor may Some people may become dependent on them. To prescribe a beta-blocker. Taking the medicine for avoid these problems, doctors usually prescribe a short period of time can help the person keep the medication for short periods, a practice that is physical symptoms under control. especially helpful for people who have substance What are the side effects? abuse problems or who become dependent on medication easily. If people suddenly stop taking See the section on antidepressants for a discussion benzodiazepines, they may get withdrawal on side effects. symptoms, or their anxiety may return. Therefore, The most common side effects for benzodiazepines they should be tapered off slowly. are drowsiness and dizziness. Other possible side Buspirone and beta-blockers are similar. They effects include: are usually taken on a short-term basis for s Upset stomach s Blurred vision anxiety. Both should be tapered off slowly. Talk s Headache to the doctor before stopping any anti-anxiety s Confusion medication. s Grogginess s Nightmares. Possible side effects from buspirone (BuSpar) include: s Dizziness s Headaches s Nausea s Nervousness s Lightheadedness s Excitement s Trouble sleeping. Common side effects from beta-blockers include: s Fatigue s Cold hands s Dizziness s Weakness.

Mental Health Medications 11 What medications are used to treat ADHD?

ttention deficit/hyperactivity disorder s Stomachaches and headaches. (ADHD) occurs in both children and s Less common side effects. A few children adults. ADHD is commonly treated with A develop sudden, repetitive movements , such as: or sounds called tics. These tics may or s (Ritalin, Metadate, may not be noticeable. Changing the Concerta, Daytrana) medication dosage may make tics go away. s () Some children also may appear to have a s (Dexedrine, Dextrostat). personality change, such as appearing “flat” In 2002, the FDA approved the nonstimulant or without emotion. Talk with your child’s medication (Strattera) for use as a doctor if you see any of these side effects. treatment for ADHD. In February 2007, the FDA approved the use of the How are ADHD medications taken? dimesylate (Vyvanse) for the treatment of ADHD Stimulant medications can be short-acting or long- in children ages 6 to 12 years. acting, and can be taken in different forms such as a pill, patch, or powder. Long-acting, sustained What are the side effects? and extended release forms allow children to take Most side effects are minor and disappear when the medication just once a day before school. dosage levels are lowered. The most common side Parents and doctors should decide together which effects include: medication is best for the child and whether the s Decreased appetite. Children seem to be less child needs medication only for school hours or for hungry during the middle of the day, but evenings and weekends too. they are often hungry by dinnertime as the ADHD medications help many children and medication wears off. adults who are hyperactive and impulsive. s Sleep problems. If a child cannot fall asleep, They help people focus, work, and learn. the doctor may prescribe a lower dose. The Stimulant medication also may improve physical doctor might also suggest that parents give coordination. However, different people respond the medication to their child earlier in the differently to medications, so children taking day, or stop the afternoon or evening dose. ADHD medications should be watched closely. To help ease sleeping problems, a doctor may add a prescription for a low dose of Are ADHD medications safe? an antidepressant or a medication called . Stimulant medications are safe when given under a doctor’s supervision. Some children taking them may feel slightly different or “funny.”

12 National Institute of Mental Health Some parents worry that stimulant medications ADHD who take atomoxetine are more likely to may lead to drug abuse or dependence, but there is have suicidal thoughts than children and teenagers little evidence of this. Research shows that teens with ADHD who do not take atomoxetine. If with ADHD who took stimulant medications were your child is taking atomoxetine, watch his or her less likely to abuse drugs than those who did not behavior carefully. A child may develop serious take stimulant medications.14 symptoms suddenly, so it is important to pay attention to your child’s behavior every day. Ask FDA warning on possible rare side other people who spend a lot of time with your effects child, such as brothers, sisters, and teachers, to tell In 2007, the FDA required that all makers of you if they notice changes in your child’s behavior. ADHD medications develop Patient Medication Call a doctor right away if your child shows any of Guides. The guides must alert patients to the following symptoms: possible heart and psychiatric problems related to s Acting more subdued or withdrawn than usual ADHD medicine. The FDA required the Patient s Feeling helpless, hopeless, or worthless Medication Guides because a review of data found s New or worsening depression that ADHD patients with heart conditions had a s Thinking or talking about hurting himself or slightly higher risk of strokes, heart attacks, and herself sudden death when taking the medications. The s Extreme worry review also found a slightly higher risk (about 1 in s Agitation 1,000) for medication-related psychiatric problems, s Panic attacks such as hearing voices, having hallucinations, s Trouble sleeping becoming suspicious for no reason, or becoming s Irritability manic. This happened to patients who had no s Aggressive or violent behavior history of psychiatric problems. s Acting without thinking s Extreme increase in activity or talking The FDA recommends that any treatment plan for s Frenzied, abnormal excitement ADHD include an initial health and family history s Any sudden or unusual changes in behavior. examination. This exam should look for existing heart and psychiatric problems. While taking atomoxetine, your child should see a doctor often, especially at the beginning The non-stimulant ADHD medication called of treatment. Be sure that your child keeps all atomoxetine (Strattera) carries another warning. appointments with his or her doctor. Studies show that children and teenagers with

Mental Health Medications 13 Which groups have special needs when taking psychiatric medications?

sychiatric medications are taken by all types (3 to 5 years old) diagnosed with ADHD. The of people, but some groups have special study found that low doses of the stimulant Pneeds, including: methylphenidate are safe and effective for s Children and adolescents preschoolers. However, children of this age are s Older adults more sensitive to the side effects of the medication, s Women who are pregnant or may become including slower growth rates. Children taking pregnant. methylphenidate should be watched closely.15,16,17 In addition to medications, other treatments Children and adolescents for young people with mental disorders should Most medications used to treat young people with be considered. Psychotherapy, family therapy, mental illness are safe and effective. However, educational courses, and behavior management many medications have not been studied or techniques can help everyone involved cope with approved for use with children. Researchers are the disorder. Click here for more information on not sure how these medications affect a child’s child and adolescent mental health research. growing body. Still, a doctor can give a young person an FDA-approved medication on an “off- Older adults label” basis. This means that the doctor prescribes Because older people often have more medical the medication to help the patient even though the problems than other groups, they tend to medicine is not approved for the specific mental take more medications than younger people, disorder or age. including prescribed, over-the-counter, and herbal For these reasons, it is important to watch young medications. As a result, older people have a people who take these medications. Young people higher risk for experiencing bad drug interactions, may have different reactions and side effects missing doses, or overdosing. than adults. Also, some medications, including Older people also tend to be more sensitive to antidepressants and ADHD medications, carry medications. Even healthy older people react to FDA warnings about potentially dangerous side medications differently than younger people because effects for young people. See the sections on their bodies process it more slowly. Therefore, lower antidepressants and ADHD medications for more or less frequent doses may be needed. information about these warnings. Sometimes memory problems affect older people More research is needed on how these medications who take medications for mental disorders. An affect children and adolescents. NIMH has older adult may forget his or her regular dose funded studies on this topic. For example, NIMH and take too much or not enough. A good way to funded the Preschoolers with ADHD Treatment keep track of medicine is to use a seven-day pill Study (PATS), which involved 300 preschoolers

14 National Institute of Mental Health box, which can be bought at any pharmacy. At consult with her doctor to decide whether to return the beginning of each week, older adults and their to a full dose during the period when she is most caregivers fill the box so that it is easy to remember vulnerable to postpartum depression. what medicine to take. Many pharmacies also have Some medications should not be taken during pillboxes with sections for medications that must pregnancy. Benzodiazepines may cause birth be taken more than once a day. defects or other infant problems, especially if taken during the first trimester. Mood stabilizers Women who are pregnant or may are known to cause birth defects. Benzodiazepines become pregnant and lithium have been shown to cause “floppy baby The research on the use of psychiatric medications syndrome,” which is when a baby is drowsy and during pregnancy is limited. The risks are different limp, and cannot breathe or feed well. depending on what medication is taken, and at what Research suggests that taking antipsychotic point during the pregnancy the medication is taken. medications during pregnancy can lead to birth Research has shown that antidepressants, especially defects, especially if they are taken during the SSRIs, are safe during pregnancy. Birth defects first trimester. But results vary widely depending or other problems are possible, but they are very on the type of antipsychotic. The conventional rare.18,19 antipsychotic haloperidol has been studied more However, antidepressant medications do cross than others, and has been found not to cause birth 23,24 the placental barrier and may the fetus. defects. Some research suggests the use of SSRIs during After the baby is born, women and their doctors pregnancy is associated with miscarriage or birth should watch for postpartum depression, especially defects, but other studies do not support this.20 if they stopped taking their medication during Studies have also found that fetuses exposed to pregnancy. In addition, women who nurse while SSRIs during the third trimester may be born taking psychiatric medications should know that with “withdrawal” symptoms such as breathing a small amount of the medication passes into the problems, jitteriness, irritability, trouble feeding, or breast milk. However, the medication may or may hypoglycemia (low blood sugar). not affect the baby. It depends on the medication Most studies have found that these symptoms in and when it is taken. Women taking psychiatric babies are generally mild and short-lived, and no medications and who intend to breastfeed should deaths have been reported. On the flip side, women discuss the potential risks and benefits with their who stop taking their antidepressant medication doctors. during pregnancy may get depression again and Decisions on medication should be based on each may put both themselves and their infant at risk.20,21 woman’s needs and circumstances. Medications In 2004, the FDA issued a warning against the use should be selected based on available scientific of certain antidepressants in the late third trimester. research, and they should be taken at the lowest The warning said that doctors may want to possible dose. Pregnant women should be watched gradually taper pregnant women off antidepressants closely throughout their pregnancy and after in the third trimester so that the baby is not delivery. affected.22 After a woman delivers, she should

Mental Health Medications 15 What should I ask my doctor if I am prescribed a ?

ou and your family can help your s Will it interact with other medications I take? doctor find the right medications for s Do I need to avoid any types of food or drink Yyou. The doctor needs to know your while taking the medication? What should I medical history; family history; information about avoid? allergies; other medications, supplements or herbal s Should it be taken with or without food? remedies you take; and other details about your s Is it safe to drink alcohol while taking this overall health. You or a family member should medication? ask the following questions when a medication is s What are the side effects? What should I do prescribed: if I experience them? s What is the name of the medication? s Is the Patient Package Insert for the s What is the medication supposed to do? medication available? s How and when should I take it? After taking the medication for a short time, tell s How much should I take? your doctor how you feel, if you are having side s What should I do if I miss a dose? effects, and any concerns you have about the s When and how should I stop taking it? medicine.

16 National Institute of Mental Health Alphabetical List of Medications

his section identifies antipsychotic publication. The first chart lists the medications by medications, antidepressant medications, trade name; the second chart lists the medications Tmood stabilizers, anticonvulsant by generic name. If your medication does not appear medications, anti-anxiety medications, and ADHD in this section, refer to the FDA Web site. Also, ask medications. Some medications are marketed under your doctor or pharmacist for more information trade names, not all of which can be listed in this about any medication. Medications Organized by Trade Name

Trade Name Generic Name FDA Approved Age Combination Antipsychotic and Antidepressant Medication Symbyax (Prozac & Zyprexa) fluoxetine & olanzapine 18 and older Antipsychotic Medications Abilify aripiprazole 13 to 17 for schizophrenia and bipolar; 18 and older for schizophrenia, bipolar mania, and depression Clozaril clozapine 18 and older Fanapt 18 and older fluphenazine (generic only) fluphenazine 18 and older Geodon ziprasidone 18 and older Haldol haloperidol 3 and older Invega paliperidone 18 and older Loxitane 18 and older Moban 18 and older Navane thiothixene 18 and older Orap (for Tourette’s syndrome) 12 and older perphenazine (generic only) perphenazine 18 and older Risperdal risperidone 13 and older for schizophrenia; 10 and older for bipolar mania and mixed episodes; 5 to 16 for irritability associated with autism Seroquel quetiapine 18 and older for schizophrenia and bipolar disorder Stelazine trifluoperazine 18 and older (generic only) thioridazine 2 and older Thorazine chlorpromazine 18 and older Zyprexa olanzapine 18 and older Mental Health Medications 17 Trade Name Generic Name FDA Approved Age Antidepressant Medications (also used for anxiety disorders) Anafranil (tricyclic) clomipramine 10 and older (for OCD only) Asendin 18 and older Aventyl (tricyclic) 18 and older Celexa (SSRI) citalopram 18 and older Cymbalta (SNRI) duloxetine 18 and older Desyrel 18 and older Effexor (SNRI) venlafaxine 18 and older Elavil (tricyclic) 18 and older Emsam 18 and older Lexapro (SSRI) escitalopram 18 and older; 12-17 (for major depressive disorder) Ludiomil (tricyclic) 18 and older Luvox (SSRI) fluvoxamine 8 and older (for OCD only) Marplan (MAOI) isocarboxazid 18 and older Nardil (MAOI) phenelzine 18 and older Norpramin (tricyclic) 18 and older Pamelor (tricyclic) nortriptyline 18 and older Parnate (MAOI) tranylcypromine 18 and older Paxil (SSRI) paroxetine 18 and older Pexeva (SSRI) paroxetine-mesylate 18 and older Prozac (SSRI) fluoxetine 8 and older Remeron 18 and older Sarafem (SSRI) fluoxetine 18 and older for premenstrual dysphoric disorder (PMDD) Sinequan (tricyclic) 12 and older Surmontil (tricyclic) 18 and older Tofranil (tricyclic) imipramine 6 and older (for bedwetting) Tofranil-PM (tricyclic) imipramine pamoate 18 and older Vivactil (tricyclic) 18 and older Wellbutrin bupropion 18 and older Zoloft (SSRI) sertraline 6 and older (for OCD only)

18 National Institute of Mental Health Trade Name Generic Name FDA Approved Age Mood Stabilizing and Anticonvulsant Medications Depakote divalproex sodium (valproic acid) 2 and older (for seizures) Eskalith 12 and older Lamictal lamotrigine 18 and older (generic only) lithium citrate 12 and older Lithobid lithium carbonate 12 and older Neurontin gabapentin 18 and older Tegretol carbamazepine any age (for seizures) Topamax topiramate 18 and older Trileptal oxcarbazepine 4 and older

Anti-anxiety Medications (All of these anti-anxiety medications are benzodiazepines, except BuSpar)

Ativan lorazepam 18 and older BuSpar buspirone 18 and older Klonopin clonazepam 18 and older Librium 18 and older oxazepam (generic only) oxazepam 18 and older Tranxene clorazepate 18 and older Valium 18 and older Xanax alprazolam 18 and older

Mental Health Medications 19 Trade Name Generic Name FDA Approved Age

ADHD Medications (All of these ADHD medications are stimulants, except Strattera.)

Adderall amphetamine 3 and older Adderall XR amphetamine (extended release) 6 and older Concerta methylphenidate (long acting) 6 and older Daytrana methylphenidate patch 6 and older Desoxyn 6 and older Dexedrine dextroamphetamine 3 and older Dextrostat dextroamphetamine 3 and older Focalin 6 and older Focalin XR dexmethylphenidate (extended release) 6 and older Metadate ER methylphenidate (extended release) 6 and older Metadate CD methylphenidate (extended release) 6 and older Methylin methylphenidate (oral solution and 6 and older chewable tablets) Ritalin methylphenidate 6 and older Ritalin SR methylphenidate (extended release) 6 and older Ritalin LA methylphenidate (long-acting) 6 and older Strattera atomoxetine 6 and older Vyvanse lisdexamfetamine dimesylate 6 and older

20 National Institute of Mental Health Medications Organized by Generic Name

Generic Name Trade Name FDA Approved Age Combination Antipsychotic and Antidepressant Medication fluoxetine & olanzapine Symbyax (Prozac & Zyprexa) 18 and older

Antipsychotic Medications aripiprazole Abilify 13 to 17 for schizophrenia and bipolar; 18 and older for schizophrenia, bipolar mania, and depression chlorpromazine Thorazine 18 and older clozapine Clozaril 18 and older fluphenazine (generic only) fluphenazine 18 and older haloperidol Haldol 3 and older iloperidone Fanapt 18 and older loxapine Loxitane 18 and older molindone Moban 18 and older olanzapine Zyprexa 18 and older paliperidone Invega 18 and older perphenazine (generic only) perphenazine 18 and older pimozide (for Tourette’s Orap 12 and older syndrome) quetiapine Seroquel 18 and older for schizophrenia and bipolar disorder risperidone Risperdal 13 and older for schizophrenia; 10 and older for bipolar mania and mixed episodes; 5 to 16 for irritability associated with autism thioridazine (generic only) thioridazine 2 and older thiothixene Navane 18 and older trifluoperazine Stelazine 18 and older

Mental Health Medications 21 Generic Name Trade Name FDA Approved Age

Antidepressant Medications (also used for anxiety disorders) amitriptyline (tricyclic) Elavil 18 and older amoxapine Asendin 18 and older bupropion Wellbutrin 18 and older citalopram (SSRI) Celexa 18 and older clomipramine (tricyclic) Anafranil 10 and older (for OCD only) desipramine (tricyclic) Norpramin 18 and older doxepin (tricyclic) Sinequan 12 and older duloxetine (SNRI) Cymbalta 18 and older escitalopram (SSRI) Lexapro 18 and older; 12-17 (for major depressive disorder) fluoxetine (SSRI) Prozac 8 and older fluoxetine (SSRI) Sarafem 18 and older for premenstrual dysphoric disorder (PMDD) fluvoxamine (SSRI) Luvox 8 and older (for OCD only) imipramine (tricyclic) Tofranil 6 and older (for bedwetting) imipramine pamoate (tricyclic) Tofranil-PM 18 and older isocarboxazid (MAOI) Marplan 18 and older maprotiline (tricyclic) Ludiomil 18 and older mirtazapine Remeron 18 and older nortriptyline (tricyclic) Aventyl, Pamelor 18 and older paroxetine (SSRI) Paxil 18 and older paroxetine mesylate (SSRI) Pexeva 18 and older phenelzine (MAOI) Nardil 18 and older protriptyline (tricyclic) Vivactil 18 and older selegiline Emsam 18 and older sertraline (SSRI) Zoloft 6 and older (for OCD only) tranylcypromine (MAOI) Parnate 18 and older trazodone Desyrel 18 and older trimipramine (tricyclic) Surmontil 18 and older venlafaxine (SNRI) Effexor 18 and older

22 National Institute of Mental Health Generic Name Trade Name FDA Approved Age

Mood Stabilizing and Anticonvulsant Medications carbamazepine Tegretol any age (for seizures) divalproex sodium (valproic acid) Depakote 2 and older (for seizures) gabapentin Neurontin 18 and older lamotrigine Lamictal 18 and older lithium carbonate Eskalith, Lithobid 12 and older lithium citrate (generic only) lithium citrate 12 and older oxcarbazepine Trileptal 4 and older topiramate Topamax 18 and older Anti-anxiety Medications (All of these anti-anxiety medications are benzodiazepines, except buspirone.)

alprazolam Xanax 18 and older buspirone BuSpar 18 and older chlordiazepoxide Librium 18 and older clonazepam Klonopin 18 and older clorazepate Tranxene 18 and older diazepam Valium 18 and older lorazepam Ativan 18 and older oxazepam (generic only) oxazepam 18 and older

Mental Health Medications 23 Generic Name Trade Name FDA Approved Age

ADHD Medications (All of these ADHD medications are stimulants, except atomoxetine)

amphetamine Adderall 3 and older amphetamine (extended release) Adderall XR 6 and older atomoxetine Strattera 6 and older dexmethylphenidate Focalin 6 and older dexmethylphenidate (extended Focalin XR 6 and older release) dextroamphetamine Dexedrine, Dextrostat 3 and older lisdexamfetamine dimesylate Vyvanse 6 and older methamphetamine Desoxyn 6 and older methylphenidate Ritalin 6 and older methylphenidate (extended Metadate CD, Metadate ER, 6 and older release) Ritalin SR methylphenidate (long-acting) Ritalin LA, Concerta 6 and older methylphenidate patch Daytrana 6 and older methylphenidate (oral solution Methylin 6 and older and chewable tablets)

24 National Institute of Mental Health Citations 1. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, 9. Thase ME, Sachs GS. Bipolar depression: Rosenheck RA, Perkins DO, Keefe RS, Davis SM, pharmacotherapy and related therapeutic strategies. Davis CE, Lebowitz BD, Severe J, Hsiao JK; Clinical Biological . 2000 Sep 15;48(6):558-572. Antipsychotic Trials of Intervention Effectiveness 10. Sachs G, Nierenberg AA, Calabrese JR, Marangell LB, (CATIE). Effectiveness of antipsychotic drugs in patients Wisniewski SR, Gyulai L, Friedman ES, Bowden CL, with chronic schizophrenia. New England Journal of Fossey MD, Ostacher MJ, Ketter TA, Patel J, Hauser P, Medicine. 2005 Sep 22;353(12):1209-1223. Rapport D, Martinez JM, Allen MH, Miklowitz DJ, Otto 2. Rush JA, Trivedi MH, Wisniewski SR, Stewart JW, MW, Dennehy EB, Thase ME. Effectiveness of adjunctive Nierenberg AA, Thase ME, Ritz L, Biggs MM, Warden antidepressant treatment for bipolar depression: a double- D, Luther JF, Shores-Wilson K, Niederehe G, Fava blind placebo-controlled study. New England Journal of M. Bupropion-SR, sertraline, or venlafaxine-XR after Medicine. Epub 28 Mar 2007; 356(17): 1771-1773. failure of SSRIs for depression. New England Journal of 11. Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Medicine. 2006 Mar 23; 354(12):1231-1242. Pakarinen AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi 3. Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin JI. -induced hyperandrogenism during pubertal F, Warden D, Ritz L, Nierenberg AA, Lebowitz BD, Biggs maturation in girls with epilepsy. Annals of Neurology. MM, Luther JF, Shores-Wilson K, Rush JA. Medication 1999 Apr;45(4):444-450. augmentation after the failure of SSRIs for depression. 12. Joffe H, Cohen LS, Suppes T, McLaughlin WL, Lavori New England Journal of Medicine. 2006 Mar 23; 354(12): P, Adams JM, Hwang CH, Hall JE, Sachs GS. Valproate 1243-1252. is associated with new-onset oligoamenorrhea with 4. Hypericum Depression Trial Study Group. Effect hyperandrogenism in women with bipolar disorder. of (St. John’s wort) in major Biological Psychiatry. 2006 Jun 1;59(11):1078-1086. depressive disorder: a randomized controlled trial. Journal 13. Joffe H, Cohen LS, Suppes T, Hwang CH, Molay F, of the American Medical Association. 2002; 287(14): Adams JM, Sachs GS, Hall JE. Longitudinal follow-up 1807-1814. of reproductive and metabolic features of valproate- 5. Bridge JA, Iyengar S, Salary CB, Barbe RP, Birmaher associated polycystic ovarian syndrome features: A B, Pincus HA, Ren L, Brent DA. Clinical response and preliminary report. Biological Psychiatry. 2006 Dec risk for reported suicidal ideation and suicide attempts 15;60(12):1378-1381. in pediatric antidepressant treatment, a meta-analysis of 14. Wilens TC, Faraone, SV, Biederman J, Gunawardene S. randomized controlled trials. Journal of the American Does stimulant therapy of attention-deficit/hyperactivity Medical Association. 2007; 297(15): 1683-1696. disorder beget later substance abuse? A meta-analytic 6. Bowden CL, Calabrese JR, McElroy SL, Gyulai L, Wassef review of the literature. Pediatrics. 2003; 111(1):179-185. A, Petty F, Pope HG, Jr., Chou JC, Keck PE, Jr., Rhodes 15. Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, LJ, Swann AC, Hirschfeld RM, Wozniak PJ, Group DMS. Davies M, Chuang S, Vitiello B, Skroballa A, Posner K, A randomized, placebo-controlled 12-month trial of Abikoff H, Oatis M, McCracken J, McGough J, Riddle M, divalproex and lithium in treatment of outpatients with Ghouman J, Cunningham C, Wigal S. Stimulant-related . Archives of General Psychiatry. reductions in growth rates in the PATS. Journal of the 2000 May; 57(5):481-489. Academy of Child and Adolescent Psychiatry. 2006 Nov; 7. Rothschild AJ, Bates KS, Boehringer KL, Syed A. 45(11): 1304-1313. Olanzapine response in psychotic depression. Journal of 16. Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle Clinical Psychiatry. 1999 Feb; 60(2):116-118. M, Swanson J, McGough J, Wigal S, Wigal T, Vitiello B, 8. Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Skroballa A, Posner K, Ghuman J, Cunningham C, Davies Rush AJ. Clinical outcome in a randomized 1-year M, Chuang S, Cooper T. and safety of immediate- trial of clozapine versus treatment as usual for patients release methylphenidate treatment for preschoolers with with treatment-resistant illness and a history of mania. attention-deficit/hyperactivity disorder. Journal of the American Journal of Psychiatry. 1999 Aug;156(8): Academy of Child and Adolescent Psychiatry. 2006 Nov; 1164-1169. 45(11):1284-1293.

Mental Health Medications 25 17. Wigal T, Greenhill L, Chuang S, McGough J, Vitiello For More Information on B, Skrobala A, Swanson J, Wigal S, Abikoff H, Kollins Medications: S, McCracken J, Riddle M, Posner K, Ghuman J, Davies M, Thorp B, Stehli A. Safety and tolerability of Visit the National Library of Medicine’s methylphenidate in preschool children with attention- MedlinePlus deficit/hyperactivity disorder. Journal of the Academy of Child and Adolescent Psychiatry. 2006 Nov; 45(11): http://www.nlm.nih.gov/medlineplus 1294-1303. En Español 18. Alwan S, Reefhuis J, Rasmussen S, Olney R, Friedman http://medlineplus.gov/spanish J for the National Birth Defects Prevention Study. Use of selective serotonin-reuptake inhibitors in pregnancy For information on Clinical Trials and the risk of birth defects. New England Journal of http://www.nimh.nih.gov/health/trials/index.shtml Medicine. 2007 Jun 28; 356(26):2684-2692. National Library of Medicine Clinical Trials 19. Louik C, Lin An, Werler M, Hernandez S, Mitchell A. First-trimester use of selective serotonin-reuptake Database inhibitors and the risk of birth defects. New England http://www.clinicaltrials.gov Journal of Medicine. 2007 Jun 28; 356(26):2675-2683. Information from NIMH is available in multiple 20. Austin M. To treat or not to treat: maternal depression, formats. You can browse online, download SSRI use in pregnancy and adverse neonatal effects. documents in PDF, and order paper brochures Psychological Medicine. 2006 Jul 25; 1-8. through the mail. If you would like to have NIMH 21. Cohen L, Altshuler L, Harlow B, Nonacs R, Newport DJ, Viguera A, Suri R, Burt V, Hendrick AM, Loughead publications, you can order them online at A, Vitonis AF, Stowe Z. Relapse of major depression http://www.nimh.nih.gov. If you do not have during pregnancy in women who maintain or discontinue Internet access and wish to have information that antidepressant treatment. Journal of the American Medical supplements this publication, please contact the Association. 2006 Feb 1; 295(5): 499-507. NIMH Information Center at the numbers listed 22. U.S. Food and Drug Administration (FDA). FDA below. Medwatch drug alert on Effexor and SSRIs, 2004 Jun 3. Available at www.fda.gov/medwatch/safety/2004/ National Institute of Mental Health safety04.htm#effexor. Science Writing, Press & Dissemination Branch 23. Jain AE, Lacy T. Psychotropic drugs in pregnancy and 6001 Executive Boulevard lactation. Journal of Psychiatric Practice. 2005 May; Room 8184, MSC 9663 11(3): 177-191. Bethesda, MD 20892-9663 24. Ward RK, Zamorski MA. Benefits and risks of psychiatric Phone: 301-443-4513 or medications during pregnancy. American Family Physician. 15 Aug. 2002; 66(4): 629-636. 1-866-615-NIMH (6464) toll-free TTY: 301-443-8431 TTY: 866-415-8051 FAX: 301-443-4279 E-mail: [email protected] Web site: http://www.nimh.nih.gov

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