Mental Illness

People diagnosed with serious mental illness typically need a combination of medication and talk therapy to get better.

Mental illness isn’t the fault of the person diagnosed. It’s a medical problem, just like diabetes or heart disease, and it’s also common in the United States.

For some people, symptoms of poor mental health such as feeling lonely, being overwhelmed or worrying become more serious mental illnesses.

More than 46 million Americans live with mental illness, according to the National Institute of Mental Health. That’s about 1 in 5 Americans, and 1 in 24 has a serious illness.

The good news is that mental illness is highly treatable. For example, more than 80 percent of people with depression get better after treatment. As many as 90 percent of people with panic disorders get better, according to Mental Health America.

These disorders are marked by severe fear or dread associated with certain situations or objects. Patients have physical reactions to these objects and situations, including rapid heartbeat and sweating. They cannot control their responses. With anxiety disorders, these feelings do not go away and can get worse. They can interfere with things like job performance, school and relationships. These disorders include panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder and post-traumatic stress disorder, or PTSD.

Panic Disorder

Panic disorder is an anxiety disorder marked by panic attacks. Symptoms include fast heartbeat, chest pain, trouble breathing and dizziness. Patients with panic disorder often report intense feelings of terror or impending doom associated with attacks. These attacks can happen without warning. Fear of these attacks can control a person’s life, even making it difficult to leave the home.

Phobias

Phobias are irrational fears. For example, acrophobia is fear of heights and agoraphobia is fear of public places. Some people have social phobia or phobias involving tunnels, highway driving, water, animals or flying. Phobias can be treated with medication and therapy.

Post-Traumatic Stress Disorder

This happens to some people who experience or witness a terrifying or traumatic event, such as a war, a bad accident or rape. PTSD is marked by flashbacks, feeling alone, sleep disturbances and angry outbursts. People with PTSD may have uncontrollable thoughts and intrusive memories about the event, and may avoid specific places, objects or events that bring about memories of the trauma. PTSD is treated with medications and psychotherapy. The therapist may pursue various treatment techniques.

These disorders involve changes in mood or disturbances. These typically involve depression or elation, also known as mania. These disorders are highly treatable. They include major depression and bipolar disorder.

Depression

More than 17 million Americans had at least one major depressive episode in 2018, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Symptoms persist and interfere with normal life.

Causes can be genetic, environmental or biochemical. For example, the COVID-19 pandemic increased global rates of anxiety and depression by 25 percent, according to a 2022 World Health Organization study. Treatment options include antidepressant medications and talk therapy.

Bipolar Disorder

Formerly known as manic depression, bipolar disorder causes extreme emotional lows and highs in known as depression and mania. According to an article in JAMA, about 10 million adults and children in the U.S. have this condition.

While depression has symptoms of extreme sadness or worthlessness, mania manifests as extreme elation, jumpiness and overblown feelings of self-esteem.

A person will cycle back and forth between these moods. This cycling affects their ability to perform daily tasks. The length and severity of symptoms determines whether a person has bipolar I, bipolar II or cyclothymia.

People with bipolar I have severe symptoms of mania and depression. Those with bipolar II have more serious bouts of depression, but a lesser form of mania. People with cyclothymia have less severe symptoms of depression and mania, but symptoms are more chronic in nature.

Treating bipolar disorder can be tricky because traditional treatments for depression such as antidepressants can worsen symptoms of mania. The most effective treatment plans include atypical antipsychotics, mood stabilizers and psychotherapy.

Schizophrenia is a mental illness that affects a person’s emotions, behaviors, concentration and perception of reality. This disorder is rarer than depression or anxiety, but it can be crippling.

Symptoms of this disorder fall into three categories: positive, negative and cognitive.

Positive symptoms include movement disorders, hallucinations and delusions, or fixed false beliefs. Negative symptoms include reduced feelings of pleasure in life, reduced speaking and difficulty beginning activities. Cognitive symptoms include trouble paying attention, problems processing information and difficulty understanding information and using it.

The main treatments for schizophrenia are antipsychotics and psychotherapy. Coordinated specialty care combines psychotherapy, medication, case management education, family involvement and employment services to help people live better lives.

People with ADHD, or attention-deficit/hyperactivity disorder, have symptoms of inattention, hyperactivity and impulsivity. ADHD is usually diagnosed in children, but adults can also have the disorder.

Symptoms of ADHD include trouble staying organized, trouble focusing on tasks, restlessness, forgetfulness, excessive talking or difficulty paying attention to instructions and conversations.

People with ADHD may also have co-occurring disorders such as anxiety, depression or autism spectrum disorder.

For younger children, the first line of therapy should be behavior therapy, according to the American Academy of Pediatrics. This therapy teaches children how to control symptoms by changing behaviors. It focuses on positive reinforcement of “good” behaviors and improves social skills. Other types of therapy for ADHD are cognitive behavior therapy and parental skills training.

The typical medications for ADHD are called stimulants. These include drugs such as Adderall (amphetamine) and Ritalin (methylphenidate). But these should be used with caution because they are controlled substances and can be habit-forming.

Major mental illness rarely appears without warning. In the early stages before a disorder is recognized, friends and family members may start to notice small changes. They may feel something is not right about their loved one’s thinking, feelings or behavior.

If a person displays several of these symptoms at once, and if the symptoms are interfering with the person’s life, he or she should visit a mental health professional.

A person’s character flaws are not causes of mental illness, and being “weak” or “lazy” has nothing to do with them, according to the U.S. National Library of Medicine. Researchers don’t know exactly what causes mental illness, but they think it is a combination of factors.

Can Medication Cause Mental Illness?

While medications don’t typically cause mental illness, some drugs may cause psychiatric symptoms. This is especially true if a person suddenly develops psychiatric symptoms without a prior history.

Always tell your health care provider about all prescription, over-the-counter and illicit drugs you are taking.

Most mental illness can be treated in an effective way, especially with early diagnosis. Treatment options include psychotherapy, medication and learning skills to manage symptoms.

With effective treatment, people with mental illness can live better, productive lives. Treatment plans are tailored to the individual patient, because people react to therapy and medication differently.

Psychotherapy

Also called talk therapy, psychotherapy is the best option for some patients. There are a number of psychotherapy techniques to help patients identify and modify thoughts, behavior and emotions with the help of a trained and licensed professional.

The two most popular forms of psychotherapy are psychodynamic therapy and cognitive behavioral therapy, according to Harvard Medical School.

Psychodynamic Therapy

Psychodynamic therapy focuses on how current and past relationships, life events and desires affect the choices you make and how you feel. The theory is that people create thought patterns and behaviors to protect themselves from traumatic experiences or external threats. A therapist can help people identify these thought patterns and behaviors and help develop strategies to cope with and overcome them.

For example, someone with overbearing parents may have difficulty developing intimate relationships because they are afraid of being controlled.

This type of therapy can also help improve social interaction. A type of psychodynamic therapy called interpersonal therapy blends psychodynamic and cognitive behavior therapy to help people deal with relationships and teach better ways to communicate with others.

Cognitive Behavior Therapy (CBT)

In contrast to psychodynamic therapy, cognitive behavior therapy (CBT) focuses less on feelings. Instead, it teaches people how to recognize behavior and thought patterns that are causing problems. Then, it teaches techniques to change these patterns. The theory is that people can change feelings by changing thoughts and actions.

People have used CBT to treat smoking, phobias, procrastination and help symptoms of depression and anxiety.

For example, people may have distorted thinking patterns such as always thinking the worst, excessive guilt or self-criticism or thinking people view them negatively. CBT therapists help people recognize these patterns and change them.

CBT helps people develop more positive and productive responses to distress such as breathing deeply to relax instead of hyperventilating during stressful situations.

Prescription Drugs

There are a number of prescription drugs to treat mental illness. According to a 2017 research letter published in the journal JAMA Internal Medicine, one in six Americans took a psychiatric medicine in 2013.

Often, health care providers will use medication as the first line of therapy for mental illness. But people should ask their health care providers if psychotherapy might be effective enough without medication.

Depending on the type of mental illness, health care providers may prescribe a specific type of drug. Because people respond to medications differently, finding the proper medication and dosage is often a trial-and-error process. Sometimes a health care provider may prescribe more than one medication.

It’s important for people to be patient and communicate their feelings and if they have experience side effects to their health care provider. Each drug has its own side effects and the patient and health care provider need to weight the risks and benefits of each medication.

Some medications for mental illness can be habit-forming. These include stimulants and benzodiazepines. Benzodiazepines are considered problematic for long-term use and are no longer recommended as the first line of treatment for anxiety.

Medications for Depression and Anxiety

Medications for anxiety and depression are similar. These drugs are designed to balance some of the natural chemicals in the brain. Classes of antidepressants include selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, atypical antidepressants and tricyclic antidepressants. SSRIs are the most popular type. They work by increasing the level of serotonin in the brain. Serotonin plays a role in mood.

Medications for Bipolar Disorder and Schizophrenia

Medications for bipolar and schizophrenia are called antipsychotics. Antipsychotics are used to treat conditions that involve psychosis. Psychosis involves a disconnection with reality. These drugs relieve symptoms but are not cures.

Older antipsychotics are referred to as typical antipsychotics or neuroleptics. Newer antipsychotics are called atypical antipsychotics.

Both types of antipsychotics work to treat symptoms of schizophrenia and mania. Long-term use of older antipsychotics may cause a potentially incurable nerve condition called tardive dyskinesia. This condition involves uncontrolled muscle movements, often around the mouth.

Drugs called mood stabilizers are used to treat bipolar disorders and mood swings. Lithium is a well-known mood stabilizer. The U.S. Food and Drug Administration has approved it for treatment of mania and bipolar disorder. Mood stabilizers work by decreasing abnormal activity in the brain.

Safely Using Psychiatric Medications

Experts advise that doctors should prescribe these medications at the lowest effective dose. They should continue to monitor their patients to determine whether the drugs are still needed. Researchers have found many patients are given long-term prescriptions for drugs that are recommended only for short-term use. Doctors and patients should work together on safely discontinuing drugs. Suddenly halting a psychiatric drug can be dangerous.

Patients should also discuss possible interactions with other medications and supplements, as well as food. They should avoid mixing prescription drugs with alcohol and other substances.

Sometimes, a doctor may prescribe a medication for a use other than what is approved by the FDA. This is known as off-label prescribing. Patients should inquire if their drugs are being given for approved uses. If not, the doctor and patient should be clear about the limits of the research supporting the prescription in the patient’s circumstances.

Also, when patients take generic medications, they should realize they are not exactly the same as the name-brand drug. They may have different inactive ingredients, such as fillers and binders. However, generic drugs are required to have the same active ingredient, strength, route of administration and dosage form as name-brand drugs, and must be manufactured under the same strict standards.

Side Effects from Drugs to Treat Mental Illness

Medications used to treat mental illness are linked to a number of unpleasant side effects. They can make it difficult for patients to maintain employment or stay in school. Expected side effects vary depending on the class of medication used.

In addition to prescription drugs, patients have the option of exploring other kinds of treatments. These include brain stimulation and complementary or alternative medicine.

Examples of complementary treatments suggested by the National Alliance on Mental Illness include herbs and supplements and exercise, including yoga. These treatments may be helpful, but NAMI stresses that the FDA does not review or approve many of these treatments.

The government agency that oversees these therapies is the National Center for Complementary and Integrative Health. People can visit this website to see what the current science says about the effectiveness for a particular complementary therapy.

Brain Stimulation

Brain stimulation involves using electricity to directly activate or inhibit brain activity. This can involve electrodes implanted in the brain or placed on the scalp. Magnetic fields can also be applied to the head.

These therapies can be helpful for patients who have mental disorders that don’t respond to other kinds of treatment. The most commonly used of these is electroconvulsive therapy or ECT — once called electroshock therapy. ECT is used to treat severe depression that has not responded to other therapy. It also may be useful in cases of bipolar disorder or schizophrenia. ECT involves the use of electrodes placed on the head of a patient under anesthesia. They pass electric current through the brain.

Research has found that ECT shows results more quickly than other forms of treatment.

Herbs and Supplements

Various herbs and supplements are used to treat different mental health conditions. For example, omega-3 fatty acids may help decrease the risk of developing chronic schizophrenia in young people who have had a psychotic episode. Folic acid or vitamin B9 may be useful in the treatment of depression and schizophrenia.

Exercise, Yoga and Meditation

Mind and body treatment options include yoga, exercise, meditation and Tai chi. These activities can improve mood and relieve anxiety and other symptoms of mental illness.

Exercise can also reduce side effects of many conventional psychiatric medicines, such as weight gain and fatigue. Research has found evidence that these activities may reduce symptoms of depression and anxiety.

Experts theorize that yoga, for example, may affect brain chemicals called neurotransmitters, boosting levels of chemicals like serotonin that make people feel good. The exercise may also reduce inflammation and have a positive effect on lipids in the body.

Meditation involves sitting in a quiet place, focusing on breathing or a specially chosen word, and letting distractions come and go without judgment. According to the National Center for Complementary and Integrative Medicine, some research suggests that meditation may reduce symptoms of anxiety, depression and insomnia.