What medications are used to treat mental health conditions like depression, anxiety, and bipolar disorder?

Medications for Depression, Anxiety, and Bipolar Disorder

For mental health conditions like depression, anxiety, and bipolar disorder, the most effective medications include SSRIs (such as sertraline and fluoxetine) for depression and anxiety, while mood stabilizers (lithium, lamotrigine) and atypical antipsychotics (aripiprazole) are first-line treatments for bipolar disorder. 1

Depression Treatment

First-line Medications

• SSRIs (Selective Serotonin Reuptake Inhibitors)
  • Sertraline: Effective for major depression, panic disorder, PTSD, social anxiety disorder, and premenstrual dysphoric disorder 2
  • Fluoxetine: Effective for depression with short-term weight loss and weight neutrality with long-term use 3
  • Escitalopram: Recommended as first-line for social anxiety disorder 3
  • Paroxetine: Effective but associated with greater risk for weight gain compared to other SSRIs 3

Second-line Medications

• SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
  • Venlafaxine: Effective for social anxiety disorder 3
• Other Antidepressants
  • Bupropion: The only antidepressant consistently shown to promote weight loss; useful for depression without comorbid anxiety 3

Anxiety Treatment

First-line Medications

• SSRIs
  • Sertraline and escitalopram: Recommended as first-line for social anxiety disorder 3
  • Fluvoxamine: Effective for anxiety disorders 3

Second-line Medications

• SNRIs
  • Venlafaxine: Effective for social anxiety disorder 3
• Benzodiazepines
  • Alprazolam, bromazepam, and clonazepam: Second-line options for anxiety disorders 3
  • Caution: Risk of dependence and withdrawal; not recommended for long-term use

Other Options

• Antiepileptics
  • Pregabalin: First-line option for some anxiety disorders 3
  • Gabapentin: Second-line option for anxiety 3

Bipolar Disorder Treatment

First-line Medications

• Mood Stabilizers
  • Lithium: Effective for bipolar disorder with strong evidence for reducing suicide risk 1
  • Lamotrigine: Preferred for bipolar II depression with metabolically neutral profile 1
  • Valproate: Effective for acute mania 1

Atypical Antipsychotics

• First-line Options
  • Aripiprazole: Preferred due to efficacy and lower risk of weight gain 1, 4
  • Quetiapine: Effective for both bipolar depression and mania 5
• Weight-Neutral Options
  • Lurasidone and ziprasidone: Most weight-neutral in the class 3

Important Considerations

• Traditional antidepressants are not recommended as monotherapy for bipolar depression as they can induce switching to mania 6
• Combination therapy (mood stabilizer + antipsychotic) is often more effective for bipolar disorder 1

Medication Selection Considerations

Comorbidities

• Weight concerns: Consider bupropion, fluoxetine, or sertraline for depression; aripiprazole, lurasidone, or ziprasidone for bipolar disorder 3
• Anxiety with bipolar disorder: Residual anxiety may predict depressive relapse in bipolar II disorder 7
• Sleep disturbances: Consider CBT-I as first-line; if medication needed, use mood stabilizers with sedating properties 1

Side Effect Profiles

• Weight gain risk: Highest with olanzapine, clozapine, quetiapine, and risperidone 3
• Metabolic concerns: Monitor weight, BMI, blood pressure, fasting glucose, and lipid panel regularly 1
• Bleeding risk: SSRIs may increase bleeding risk, especially when combined with NSAIDs, aspirin, or warfarin 2, 8

Monitoring and Follow-up

• Regular monitoring for:
  • Mood changes
  • Weight and BMI
  • Blood pressure
  • Fasting glucose and lipid panel
  • Liver and renal function
  • Movement disorders (with antipsychotics)
  • Suicidal thoughts, especially early in treatment or with dose changes 2, 8

Common Pitfalls to Avoid

1. Misdiagnosing bipolar depression as unipolar depression, leading to inappropriate antidepressant monotherapy 6
2. Failing to screen for bipolar disorder in patients with depression, anxiety, or substance use disorders 9
3. Inadequate monitoring for metabolic side effects with mood stabilizers and antipsychotics
4. Abrupt discontinuation of medications, which can lead to withdrawal symptoms and relapse 1

Remember that medication treatment should be accompanied by appropriate psychotherapy for optimal outcomes, particularly cognitive-behavioral therapy for both depression and anxiety disorders 3, 1.