Selecting Medications

Psychiatric medications treat mental disorders like anxiety, depression, bipolar, or schizophrenia. With the help of medication, people with mental illness are able to avoid symptoms that interfere with daily life.

Medications treat the symptoms of mental illness but are not a cure. Medications do more than help people feel better. They also prevent symptoms from coming back and reduce the chances of having to go the hospital. Some people may need to take these medications for their entire lives. Most medications can be taken safely for long periods of time.

Be honest and open when discussing concerns with your doctor. Choosing the right medication and dose should be based on each individual’s needs. Your doctor will choose a medication based on:

• Symptoms you currently have
• Age
• Sex or gender identity
• Allergies or problems you had with medications
• Other health conditions you have
• Other medications you take
• Medications you have tried and how these worked for you
• If anyone in your family is or has been on any medication that has helped symptoms you have
• How regularly you take your medication(s)
• Cost of medications and insurance
• If you are pregnant or plan to become pregnant

Side effects are unwanted reactions to a medication. These are unique to each medication and can change depending on how long you take a medication. Not everyone will experience side effects to medications and some individuals may experience different side effects that are not as common.

• Some side effects can be mild and temporary. For example, stomach upset is common when starting antidepressants, like citalopram. This is usually limited to the first few days and disappears with continued treatment. If side effects are likely to disappear or improve, the medication can be safely continued.
• Some health conditions can make individuals more likely to experience side effects with certain medications. In these situations, the doctor may avoid a specific medication altogether. For example, haloperidol should not be used for people with Parkinson’s disease because it can make movement symptoms worse.^{1, 2, 3}

• Drug interactions happen when two or more medications are taken together, and one of the medications changes the effects of the other medication(s). Interactions can happen between medications prescribed by your doctor, street drugs, lifestyle drugs (such as caffeine, alcohol, or tobacco), herbal supplements (natural products), or medications bought over-the-counter such as pain relievers.
• For this reason, let your doctor and pharmacist know about all of the medications you are currently taking. It may be useful to carry a medication list in your wallet or purse for convenience.
• Example: If you are taking fluoxetine and aripiprazole, the fluoxetine may increase the level and effects of aripiprazole in your body.⁴ This may lead to unwanted side effects like severe restlessness. In this situation, the doctor may prefer a different antidepressant over fluoxetine.

• Medication history refers to the list of medications a person has taken in the past or may be currently taking.
• Past medication use may help health care providers pick a medication.
  • If the medication was successful in the past, it may be chosen again.
• If a medication worked well for a family member, there is a better chance the medication may work well for you, too.
• Example: If you have symptoms of anxiety disorder, your doctor may consider what medications have worked for other family members treated for anxiety.^4,5 For instance, if your mother did well on escitalopram, this medication would be a good option to start for you.

• Metabolism refers to the body breaking down a medication to either be used by the body or removed from the body.
• Older people may process drugs slower. This may determine which medication is picked and what dose is started.
• Certain medical conditions may influence how medication is absorbed, or taken into, your body. If you have certain stomach conditions or have had weight loss surgeries, some medications may not get into your body as well. Be sure to tell your doctor this information.
• If you have problems swallowing pills, certain medications come in forms that do not need to be swallowed. Examples include patches, injections, or tablets that can dissolve in your mouth or under your tongue.
• A lot of medications are broken down by the liver. Others may be removed by the kidneys. If a person has liver or kidney damage, this might be a reason to not use certain medications.
• Some medications may just need a change in dose if a person has certain liver or kidney damage.
• Example: Lithium can be used to treat bipolar disorder. If a person has kidney problems, the dose of lithium will likely need to be changed.⁷ In some cases, the person may need to be switched to a new medication.

• Goals of therapy refers to what a person living with mental illness wishes or expects to get out of their therapy.
• Before beginning therapy, the doctor and individual should talk about goals of therapy.
• Your doctor will think about these goals when picking a medication to make sure that it helps you reach the goals.
• Example: An example goal is to stop having panic attacks. The doctor may pick a medication that helps keep panic attacks from happening, like sertraline. The doctor may not pick a medication that only stops panic attacks after they already start, like alprazolam.⁵

Provided by

(January 2023)

Megan Vaden, PharmD, February 2019 

To view the references for this resource, please visit https://aapp.org/resource/patients/factors.

©2022 The American Association of Psychiatric Pharmacists (AAPP). AAPP makes this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.​

This information is being provided as a community outreach effort of the American Association of Psychiatric Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the topic. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The American Association of Psychiatric Pharmacists disclaims any and all liability alleged as a result of the information provided herein.