Thu. Oct 22nd, 2020

The Role of Antipsychotics in Depression

When traditional antidepressants no longer work alone for depression, there is the possibility of using antipsychotics with the usual SSRI drugs to help. In fact, this works for many patients and is now becoming a standard black box use of the drugs.

What are Antipsychotics?

Usually, these drugs are used in higher doses to treat schizophrenia and mania in bipolar disorder but in lower doses, they can be used in conjunction with antidepressant drugs to manage depression much more effectively than either drug alone.

In higher doses, these drugs are used to mitigate psychotic states in individuals who are prone to them. That would be delusional thinking, hallucinations, paranoia, and unreasonable levels of anxiety. Just because a doctor prescribes these medications does not mean you are psychotic.


The Benefits

Many people who take antidepressant drugs find that they either do not work completely or they only work sporadically. Others think they work just fine but they still experience anxiety and panic which tends to accompany depression.

In these cases, the antipsychotic drugs calm the person down and help the antidepressant drugs to work better. They calm anxiety and panic, relieve anxiety, and produce a calmer and better mood.

The Risks

Despite the fact that antipsychotic drugs can be very helpful in treating depression that is resistant to treatment, there are some drawbacks. First of all, not everybody responds to them in the right way. They may make depression worse or induce suicidal thinking and behavior as well.

Antipsychotic drugs can cause weight gain in many to most patients who receive them. With some of the drugs, the weight gain is minor and just a few pounds while with others it is extreme and the person can gain ten to fifteen pounds or more.

These drugs also carry a risk for causing type 2 diabetes in certain people. This risk is significant enough to mention in in the black box warning on the literature but doctors do not usually mention it to the patients. If you are taking these drugs, you really should monitor your blood sugar regularly regardless.


Movement Disorders

The scariest and worst potential side effect of antipsychotic medication is that they can cause a person to develop movement disorders that are similar to Parkinson’s disease. Since these drugs block receptors for dopamine in the brain (Parkinson’s is a dopamine deficiency), they can cause Parkinson’s symptoms.

Other movement disorder problems called dyskinesia can also develop. These are involuntary movements of the muscles that show up as twitching, shaking, and writhing of the muscles in the limbs and the jaw.

The most serious of the types of dyskinesia is tardive dyskinesia and that is an involuntary chewing motion of the mouth coupled with smacking of the lips and uncontrollable movement of the tongue.

These types of dyskinesia are usually permanent but they may subside when the drug is withdrawn. Despite this, many people who are on these medications who do develop these problems still decide to stay on the drugs. The best course of action to avoid this is to never use the drugs at all.