When you enter dual-diagnosis treatment for both addiction and mental health challenges, understanding the psychiatric medications that may become part of your treatment plan can ease anxiety and help you make informed decisions about your care. At Destination Hope, we believe that knowledge empowers recovery. This comprehensive guide explains the psychiatric medications commonly used in non-hospital treatment settings—what they do, how they work, and what you can expect.
Since 2006, Destination Hope has been a pioneer in mental health and addiction treatment, and medication management represents just one component of our comprehensive approach to dual-diagnosis care. As many as 70% of patients in addiction treatment have co-occurring mental health disorders, making proper psychiatric medication essential for many people’s recovery journeys.
Why Psychiatric Medications Matter in Dual-Diagnosis Treatment
Before exploring specific medications, it’s important to understand why psychiatric medications play such a crucial role in treating co-occurring disorders.
The Connection Between Mental Health and Substance Use
Mental health disorders and substance use disorders feed into each other in complex ways. Many people with untreated depression, anxiety, bipolar disorder, or trauma turn to alcohol or drugs to self-medicate their symptoms. While substances may provide temporary relief, they ultimately worsen mental health symptoms, creating a destructive cycle.
Conversely, chronic substance use chemically alters the brain in ways that can trigger or exacerbate mental health conditions. The relationship isn’t always linear—sometimes it’s difficult to determine which came first. What we do know is that both conditions must be treated simultaneously for recovery to be sustainable.
Medication as Part of Integrated Treatment
At Destination Hope, we never rely on medication alone. Psychiatric medications work best when combined with evidence-based therapies, lifestyle changes, peer support, and comprehensive treatment addressing all aspects of wellness. Medication helps stabilize brain chemistry so that you can fully engage in therapy, process emotions, develop coping skills, and rebuild your life.
Think of psychiatric medication as creating a foundation of stability upon which the rest of your recovery work can build. Without proper medication management for moderate to severe mental health symptoms, therapy can feel overwhelming and progress can be frustratingly slow.
Antidepressants: Treating Depression and Anxiety Disorders
Antidepressants represent one of the most commonly prescribed classes of psychiatric medication in dual-diagnosis treatment settings. Despite their name, antidepressants treat not only depression but also various anxiety disorders, PTSD, OCD, and certain eating disorders.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are typically the first-line medication for depression and anxiety because they’re generally well-tolerated with fewer side effects than older antidepressants.
How They Work: SSRIs increase the availability of serotonin in the brain. Serotonin is a neurotransmitter that regulates mood, sleep, appetite, and emotional regulation. People with depression often have lower levels of serotonin, and SSRIs help correct this imbalance by blocking the reabsorption (reuptake) of serotonin, making more available to brain cells.
Common SSRIs Include:
Sertraline (Zoloft): One of the most widely prescribed SSRIs, effective for depression, anxiety disorders, panic disorder, PTSD, and OCD. Sertraline tends to be somewhat activating, making it a good choice for people experiencing fatigue with their depression. FDA-approved specifically for PTSD treatment.
Escitalopram (Lexapro): Often chosen for generalized anxiety disorder and depression. It’s generally well-tolerated with fewer drug interactions than some other SSRIs. Many patients report it has a calming effect.
Fluoxetine (Prozac): Has a longer half-life than other SSRIs, meaning it stays in your system longer—which can be beneficial if you occasionally miss doses but may prolong side effects. Effective for depression, panic disorder, OCD, and bulimia. Sometimes used for bipolar depression in combination with mood stabilizers.
Paroxetine (Paxil): FDA-approved for depression, panic disorder, social anxiety disorder, generalized anxiety disorder, PTSD, and OCD. It can be more sedating than other SSRIs, which may be helpful if anxiety is causing insomnia. However, it has more withdrawal symptoms if stopped abruptly, so tapering must be done carefully.
Citalopram (Celexa): Similar to escitalopram (which is actually the more active portion of citalopram). Generally well-tolerated for depression and anxiety, though higher doses can affect heart rhythm, so EKG monitoring may be needed.
What to Expect: SSRIs typically take 4-6 weeks to reach full effectiveness, though some people notice improvement within 2-3 weeks. Common initial side effects include nausea, headache, sleep changes, and increased anxiety (which usually resolves after the first week or two). Sexual side effects—decreased libido or difficulty reaching orgasm—are also common and may persist.
Important Considerations:
- SSRIs must be tapered off gradually rather than stopped suddenly to avoid discontinuation syndrome
- They can interact with alcohol and other substances, making sobriety even more important
- Some people experience “emotional blunting” where they feel less intense emotions, both positive and negative
- Response varies individually—what works well for one person may not work for another
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs affect two neurotransmitters: serotonin and norepinephrine. Norepinephrine plays a role in alertness, energy, and attention. By targeting both neurotransmitters, SNRIs can be particularly helpful for people with depression accompanied by fatigue, low motivation, or chronic pain.
Common SNRIs Include:
Venlafaxine (Effexor): Effective for major depression, generalized anxiety disorder, panic disorder, and social anxiety disorder. At lower doses, it primarily affects serotonin; at higher doses, it also impacts norepinephrine. Can be somewhat activating, so it’s often taken in the morning.
Duloxetine (Cymbalta): FDA-approved for depression, generalized anxiety disorder, fibromyalgia, and chronic pain conditions. The pain-relieving properties make it particularly useful for people whose depression co-occurs with chronic pain.
Desvenlafaxine (Pristiq): The active metabolite of venlafaxine, with similar effects but potentially fewer drug interactions.
What to Expect: Like SSRIs, SNRIs take several weeks to reach full effectiveness. Side effects can include nausea, dry mouth, increased blood pressure (particularly at higher doses), decreased appetite, and insomnia. Sexual side effects occur but may be less common than with SSRIs.
Important Considerations:
- Blood pressure should be monitored, especially at higher doses
- Discontinuation syndrome can be significant if stopped abruptly—always taper
- In people with bipolar disorder, SNRIs carry a slightly higher risk of triggering mania than SSRIs do
Other Antidepressants
Bupropion (Wellbutrin): This medication works differently than SSRIs and SNRIs—it primarily affects dopamine and norepinephrine. Bupropion is unique because it doesn’t cause sexual side effects or weight gain, and it can actually be energizing.
It’s particularly useful for people with depression characterized by low energy, difficulty concentrating, and loss of interest in activities. Bupropion is also FDA-approved for smoking cessation (marketed as Zyban), making it doubly useful for people in recovery who are also trying to quit smoking.
However, bupropion lowers the seizure threshold, meaning it increases seizure risk. This makes it inappropriate for people with eating disorders (who may have electrolyte imbalances increasing seizure risk) or those in alcohol withdrawal.
Mirtazapine (Remeron): This medication works on multiple receptor systems. It’s particularly helpful for people whose depression includes insomnia and poor appetite, as it tends to be sedating and appetite-stimulating. Many treatment centers prescribe mirtazapine at bedtime for this reason.
The downside is potential significant weight gain and daytime drowsiness, though the sedation often decreases at higher doses (paradoxically).
Trazodone: While technically an antidepressant, trazodone is rarely used for depression today due to requiring very high doses. Instead, it’s commonly prescribed at low doses (50-150mg) for insomnia. It’s particularly popular in treatment settings because it’s non-habit-forming, doesn’t impair memory or cognition, and has minimal abuse potential.
Mood Stabilizers: Essential for Bipolar Disorder
Mood stabilizers are the cornerstone of bipolar disorder treatment. Unlike antidepressants, which can potentially trigger mania in people with bipolar disorder, mood stabilizers help prevent both manic/hypomanic episodes and depressive episodes.
Lithium
Lithium is the oldest mood stabilizer, with over 70 years of use. It remains the gold standard for bipolar disorder treatment and is the only psychiatric medication proven to reduce suicide risk.
How It Works: Lithium’s exact mechanism isn’t fully understood, but it appears to stabilize neurotransmitter activity and protect brain cells from damage. It’s effective for acute mania and depression prevention and particularly good at preventing manic episodes.
What to Expect: Lithium requires regular blood monitoring because the therapeutic level is close to toxic levels. Initial side effects often include increased thirst and urination, hand tremor, weight gain, and cognitive dulling. These often improve with time or dose adjustment.
Important Considerations:
- Requires blood level monitoring every few months once stabilized, more frequently when starting
- Thyroid and kidney function must be monitored regularly
- Dehydration or sodium imbalance can quickly raise lithium to toxic levels
- Not recommended during pregnancy due to potential birth defects
- Takes 1-2 weeks to start working for acute mania
Anticonvulsants Used as Mood Stabilizers
Several medications originally developed for seizure disorders are effective mood stabilizers.
Valproic Acid/Divalproex (Depakote): Highly effective for acute mania and mixed episodes (when manic and depressive symptoms occur simultaneously). Works faster than lithium for acute episodes. Common side effects include weight gain, hair loss (usually temporary), tremor, and sedation. Requires monitoring of liver function and blood counts. Not safe during pregnancy.
Lamotrigine (Lamictal): Particularly effective for preventing depressive episodes in bipolar disorder. Unlike most mood stabilizers that primarily prevent mania, lamotrigine is better at preventing depression. It doesn’t cause weight gain and has relatively few side effects, making it well-tolerated.
However, lamotrigine requires very slow dose titration (gradual increase) because of the risk of a serious rash called Stevens-Johnson syndrome. If you develop any rash while starting lamotrigine, contact your prescriber immediately.
Carbamazepine (Tegretol): Effective for acute mania and maintenance treatment. Less commonly used than valproate or lamotrigine because it has more drug interactions and requires more frequent blood monitoring. Can be useful when other mood stabilizers haven’t worked.
What to Expect with Mood Stabilizers: Most mood stabilizers take 1-2 weeks to begin working for acute episodes and several weeks to reach full effectiveness for prevention. Patience is essential—many people feel discouraged during this period, but stability does come.
Antipsychotics: For Psychosis, Mania, and Treatment-Resistant Depression
Antipsychotic medications were originally developed to treat schizophrenia, but second-generation (atypical) antipsychotics are now commonly used for bipolar disorder, severe depression with psychotic features, and as augmentation for treatment-resistant depression and anxiety.
Second-Generation (Atypical) Antipsychotics
These medications are called “atypical” because they have a lower risk of the movement side effects (tardive dyskinesia) associated with older antipsychotics.
Quetiapine (Seroquel): FDA-approved for bipolar depression, bipolar mania, and schizophrenia, also commonly used for anxiety and insomnia at lower doses. Quetiapine is unique among antipsychotics for being effective specifically for bipolar depression. It’s often sedating, so typically taken at bedtime. Common side effects include weight gain, increased blood sugar, drowsiness, and dizziness.
Olanzapine (Zyprexa): Highly effective for acute mania and maintenance treatment of bipolar disorder, also used for schizophrenia and treatment-resistant depression (often combined with fluoxetine as Symbyax). Olanzapine is one of the most effective antipsychotics but also has the highest risk of metabolic side effects—significant weight gain, increased blood sugar, and cholesterol changes. Requires regular metabolic monitoring.
Aripiprazole (Abilify): Works differently than most antipsychotics (it’s a “partial agonist”). Approved for bipolar disorder, schizophrenia, and as augmentation for major depression. Has a lower risk of weight gain and metabolic problems than most other atypical antipsychotics. Can be somewhat activating, so usually taken in the morning. Some people experience restlessness (akathisia) as a side effect.
Risperidone (Risperdal): Effective for bipolar mania and schizophrenia. Has less metabolic impact than olanzapine or quetiapine but higher risk of movement side effects and elevated prolactin (which can cause breast tenderness, lactation, or sexual dysfunction). Also available as a long-acting injection for maintenance treatment.
Lurasidone (Latuda): Specifically approved for bipolar depression and schizophrenia. Must be taken with food (at least 350 calories) for proper absorption. Has a better metabolic profile than some other antipsychotics—lower risk of weight gain or blood sugar problems.
What to Expect: Most antipsychotics work relatively quickly for acute symptoms like mania or agitation—often within days to a week. For depression, it takes longer, typically 2-4 weeks. Side effects vary significantly between different medications, but common ones include sedation, weight gain, dizziness, and metabolic changes.
Important Considerations:
- Require regular monitoring of weight, blood sugar, and cholesterol (metabolic monitoring)
- Can cause significant weight gain in some people
- Movement side effects (restlessness, stiffness) can occur
- Not all are safe during pregnancy
Anti-Anxiety Medications: Short-Term Relief
Benzodiazepines
Benzodiazepines (benzos) are powerful anti-anxiety medications that work quickly—often within 30 minutes. However, they’re problematic for people in addiction treatment because they carry significant abuse and dependence potential.
Common benzodiazepines include:
- Alprazolam (Xanax) – short-acting
- Lorazepam (Ativan) – intermediate-acting
- Clonazepam (Klonopin) – long-acting
- Diazepam (Valium) – long-acting
The Problem with Benzos in Recovery: Benzodiazepines activate the same reward pathways as alcohol and can lead to addiction, especially in people with a history of substance use disorders. They’re also dangerous when combined with opioids or alcohol, significantly increasing overdose risk. Additionally, benzodiazepine withdrawal can be medically dangerous, even life-threatening.
When Benzos Might Be Used: In dual-diagnosis treatment settings, benzodiazepines are generally avoided except for specific situations like alcohol or benzodiazepine detox, acute panic attacks, or severe short-term anxiety while waiting for other medications to take effect. When used, it’s typically for the shortest possible duration with careful monitoring.
Safer Alternatives:
- Buspirone (BuSpar): Non-addictive anxiety medication that takes several weeks to work but has no abuse potential
- Hydroxyzine (Vistaril): Antihistamine with anti-anxiety properties, non-addictive
- Gabapentin: Originally an anticonvulsant, increasingly used for anxiety
- Propranolol: Beta-blocker that helps with physical anxiety symptoms (racing heart, trembling)
Medications for PTSD: Addressing Trauma
Post-traumatic stress disorder (PTSD) frequently co-occurs with substance use disorders. Treating trauma is essential for sustained recovery.
First-Line Medications for PTSD
Sertraline (Zoloft) and Paroxetine (Paxil): These two SSRIs are the only FDA-approved medications specifically for PTSD. They help reduce intrusive thoughts, nightmares, hypervigilance, and avoidance behaviors. Effects typically become noticeable within 4-8 weeks.
Medications for Specific PTSD Symptoms
Prazosin: This blood pressure medication is often prescribed off-label specifically for PTSD-related nightmares. It blocks adrenaline receptors in the brain, reducing the intensity and frequency of nightmares. Usually taken at bedtime, with dose gradually increased. Can cause low blood pressure or dizziness, especially when standing up quickly.
Mirtazapine: In addition to its antidepressant effects, mirtazapine can help with PTSD symptoms, particularly when sleep disturbance is prominent.
Medications to Avoid in PTSD
Research shows that benzodiazepines are not effective for PTSD and may actually worsen outcomes by interfering with the processing of traumatic memories that occurs in trauma-focused therapy. Beta-blockers besides prazosin generally aren’t helpful for chronic PTSD symptoms, though they can reduce physical anxiety in specific situations.
Medication Management in Dual-Diagnosis Treatment
Understanding the medications themselves is important, but equally crucial is understanding how medication management works in treatment settings.
The Assessment Process
At Destination Hope, psychiatric medication decisions begin with a comprehensive assessment. This includes:
- Detailed psychiatric history: What mental health symptoms have you experienced? When did they start? What’s worked or hasn’t worked in the past?
- Medical history: Physical health conditions, current medications, allergies, family history of mental illness
- Substance use history: What substances, how much, how long, when did you last use?
- Current symptoms: Detailed evaluation of mood, anxiety, sleep, appetite, energy, concentration, and any psychotic symptoms
A board-certified psychiatrist reviews all this information before making medication recommendations. The goal is to identify the right medication at the right dose with the fewest side effects.
Starting Medications
Most psychiatric medications are started at low doses and gradually increased. This approach, called “start low, go slow,” minimizes side effects and allows your body to adjust. You’ll have regular check-ins with the psychiatric team to assess how you’re responding, manage any side effects, and adjust doses as needed.
It’s crucial to understand that finding the right medication often requires patience and sometimes trial and error. The first medication tried may not be the one you ultimately stay on. This doesn’t mean treatment isn’t working—it’s a normal part of the process.
What Happens if Side Effects Occur?
All medications have potential side effects, but most are manageable. When side effects occur, your psychiatric team has several options:
- Adjust the dose: Sometimes lowering the dose eliminates side effects while maintaining benefits
- Change the timing: Taking medication at different times of day can reduce certain side effects
- Add another medication: Some medications can counteract side effects of others
- Switch medications: If side effects are intolerable or the medication isn’t effective, switching to a different option is common
The key is open communication. Never suffer in silence with side effects—your treatment team needs to know what you’re experiencing to help you effectively.
Medication and Therapy: Working Together
Medication creates neurochemical stability, but therapy teaches you skills, processes trauma, and addresses the behavioral and psychological aspects of both mental health disorders and addiction. They work synergistically.
At Destination Hope’s treatment programs, you’ll participate in individual therapy, group counseling, and evidence-based treatments like Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and trauma-focused therapies. Medications make you more available for this therapeutic work by reducing symptoms that might otherwise be overwhelming.
Special Considerations in Dual-Diagnosis Treatment
Treating co-occurring mental health and substance use disorders requires careful attention to several factors that don’t apply in single-diagnosis treatment.
Medication Interactions with Substances
Active substance use can interact dangerously with psychiatric medications. This is one of many reasons why sobriety is essential for successful dual-diagnosis treatment:
- Alcohol and benzodiazepines together can cause fatal respiratory depression
- Stimulants can interfere with antidepressants and mood stabilizers
- Marijuana can worsen psychiatric symptoms despite temporary perceived relief
- Opioids combined with certain antidepressants or sedating medications increase overdose risk
Addressing Medication Concerns About Dependence
Many people entering treatment worry that psychiatric medication is “just replacing one drug with another.” This concern is understandable but based on a misunderstanding of addiction.
Addiction involves compulsive use despite negative consequences, loss of control, and activation of reward pathways. Properly prescribed psychiatric medications:
- Don’t produce euphoria or a “high”
- Aren’t taken to escape feelings but to achieve stability
- Are carefully monitored and adjusted
- Treat underlying brain chemistry imbalances rather than masking symptoms
That said, certain psychiatric medications (like benzodiazepines) do have addiction potential, which is why they’re used cautiously in people with substance use history.
How Long Will I Need to Take Medications?
This varies tremendously based on your specific diagnoses, symptom severity, treatment response, and personal history. Some general guidelines:
Chronic conditions like bipolar disorder or schizophrenia typically require lifelong medication to prevent relapse, though specific medications and doses may change over time.
Major depression recommendations vary. First-time depression that responds well to medication is often treated for 6-12 months after symptoms resolve. Multiple depressive episodes may warrant longer-term treatment. Many people stay on antidepressants indefinitely because symptoms return when they discontinue.
Anxiety disorders similarly vary. Some people use medication for a defined period while learning coping skills in therapy, then gradually discontinue. Others find long-term medication necessary for symptom management.
The decision about medication duration should be made collaboratively between you and your psychiatrist, revisited periodically, and never based on pressure from others or stigma about taking medication.
Common Questions About Psychiatric Medications in Recovery
“Will medications change my personality?”
Properly prescribed psychiatric medications treat symptoms of illness—they don’t change who you are fundamentally. You may notice that you feel more like “yourself” once symptoms are under control. However, if you feel emotionally blunted, flat, or not like yourself, this is important feedback for your prescriber. Adjustments can often resolve this.
“What if I forget to take my medication?”
This depends on the medication. Some can be taken as soon as you remember; others should be skipped until the next scheduled dose. Your pharmacist and treatment team will provide specific guidance for each medication. Using phone alarms, pill organizers, or medication reminder apps can help prevent missed doses.
“Can I stop taking medication once I feel better?”
This is one of the most common reasons for relapse. Feeling better often means the medication is working, not that you no longer need it. Stopping psychiatric medications abruptly can cause:
- Return of symptoms, often more severe than before
- Withdrawal symptoms
- Discontinuation syndrome
Always discuss any desire to discontinue medication with your prescriber. If discontinuation is appropriate, they’ll develop a gradual tapering plan to minimize withdrawal and monitor for symptom return.
“What about natural alternatives or supplements?”
Some supplements have evidence supporting their use for mental health:
- Omega-3 fatty acids: May help with depression
- SAMe: Some evidence for depression, but can trigger mania in bipolar disorder
- St. John’s Wort: Effective for mild depression but interacts with many medications
Always discuss supplements with your prescriber. “Natural” doesn’t mean safe or without interactions. Some supplements can interfere with psychiatric medications or worsen certain conditions.
“Will I gain weight on psychiatric medications?”
Weight gain is a potential side effect of many psychiatric medications, particularly certain mood stabilizers and antipsychotics. However:
- Not everyone gains weight on these medications
- The amount varies tremendously
- Some medications have lower weight gain risk than others
- Diet, exercise, and medication choices can all minimize this concern
If weight gain is a significant concern, discuss this with your prescriber. They may choose medications with lower weight gain profiles or provide strategies to manage this side effect.
The Role of Medication in Long-Term Recovery
As you transition from acute treatment to long-term recovery, medication management continues playing an important role.
Continuing Care and Medication
Our extended care program includes ongoing psychiatric follow-up. Medication needs often change over time as:
- Symptoms improve or worsen
- Life stressors change
- You develop better coping skills
- Side effects become more or less tolerable
Regular psychiatric appointments—typically monthly initially, then less frequently as stability is achieved—ensure your medication regimen remains optimal.
Integration with Primary Care
Eventually, some people transition medication management from a psychiatrist to a primary care physician, especially for straightforward cases like stable depression or anxiety. However, complex diagnoses like bipolar disorder or treatment-resistant conditions typically warrant ongoing psychiatric care.
Medication and Relapse Prevention
For many people with co-occurring disorders, consistent medication adherence is a crucial relapse prevention strategy. When psychiatric symptoms destabilize—whether due to skipped medications or other factors—substance use risk increases dramatically.
Building medication adherence into your relapse prevention plan, identifying barriers to consistent medication taking, and having strategies to overcome those barriers protects your recovery.
Making Peace with Medication in Recovery
If you’ve struggled with shame about taking psychiatric medication, know that you’re not alone. Stigma around mental health medication persists despite growing understanding of mental illness as brain-based medical conditions.
Consider this: You wouldn’t feel ashamed of taking insulin for diabetes or blood pressure medication for hypertension. Mental health conditions are medical conditions involving neurochemical imbalances and brain circuit dysfunction. Medication that corrects these imbalances is legitimate medical treatment.
Your recovery is too important to let stigma prevent you from using all available tools. Medication, therapy, support, lifestyle changes—all of these together create the foundation for lasting wellness.
Moving Forward: Your Treatment Journey
Understanding psychiatric medications empowers you to be an active participant in your treatment rather than a passive recipient. Ask questions, voice concerns, report side effects, and work collaboratively with your treatment team.
At Destination Hope, medication management is always part of a comprehensive approach that addresses all aspects of dual-diagnosis. Our board-certified psychiatrists work alongside therapists, counselors, case managers, and support staff to ensure you receive truly integrated care.
If you or someone you love is struggling with co-occurring mental health and substance use disorders, comprehensive help is available. The right treatment—including appropriate medications when needed—can transform your life.
Call Destination Hope today at 800-338-5770 or visit our facility at 6460 NW 5th Way, Fort Lauderdale, FL 33309 to speak with our admissions specialists about our dual-diagnosis treatment programs.
Recovery is possible. With proper diagnosis, evidence-based treatment, and comprehensive support, you can overcome both addiction and mental illness to build the fulfilling life you deserve.
Destination Hope is a Joint Commission-accredited dual-diagnosis treatment center offering comprehensive care for substance use disorders and mental health conditions. Since 2006, we’ve been pioneering integrated treatment that addresses both addiction and psychiatric disorders simultaneously. For more information about our programs, call 800-338-5770.
