Psychiatric medication is a common component of treatment for psychiatric disorders, alongside psychotherapy, lifestyle changes, and community support. In this article, we’ll discuss three common psychiatric medications: Haldol, Thorazine, and Depakote.
Medication and Mental Health Treatment
When you or someone you love receives a diagnosis for a mental health disorder, this is probably the first question you have:
What do I do next?
The simplest answer is to follow the advice of the mental health professional who arrived at the diagnosis. If you’re reading this article, we assume that’s where you are in the process. Either you or a loved one – or maybe a friend – received a psychiatric assessment, received a diagnosis, and now you’re in the process of learning about treatment options.
The current best-practice approach to the treatment of mental health disorders is a whole person, integrated approach that follows the total health paradigm established by the World Health Organization (WHO):
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
The WHO goes on to clarify what this means in terms of mental health:
“Mental health is more than the absence of mental disorders. Mental health is an integral part of health; indeed, there is no health without mental health.”
In other words, in the 21st century, we take a whole person, holistic approach to mental health and the treatment of mental health disorders. Common treatment components include:
- Therapy and/or counseling: individual, group, or family
- Medication: antidepressants, mood stabilizers, antipsychotics, stimulants
- Lifestyle changes: healthy eating, exercise and/or staying active
- Community support: self-help groups for people with various conditions or disorders
In addition, many treatment centers use complementary modalities, including:
- Experiential therapies: yoga, mindfulness, meditation
- Expressive therapies: art, writing, music
As we indicate in the introduction above, this article will focus on three medications: Haldol, Thorazine, and Depakote. Before we dive into the details on those medications, we’ll offer a general overview on psychiatric medication.
What Are the Most Common Types of Psychiatric Medication?
According to the National Institutes of Mental Health (NIMH), there are five general types of psychiatric medication, which is also known as psychotropic medication. Please note that terminology around these medications may vary by context, but these categories are the most commonly recognized, although there may be other types of medication that serve specific purposes in mental health treatment. The five types of medication are:
- Antidepressants. Providers prescribe these medications to relieve/reduce the symptoms of major depressive disorder (MDD) and its variants. Providers may also prescribe antidepressants to relieve/reduce symptoms of post-traumatic stress disorder (PTSD).
- Anti-anxiety medications (anxiolytics). Providers prescribe these medications to relieve/reduce the symptoms of anxiety, and anxiety-related disorders, including generalized anxiety disorder (GAD), panic disorder (PD), and others.
- Stimulants. These medications are most often prescribed for attentional disorders such as attention-deficit/hyperactivity disorder. In the past, stimulant medication for attentional disorders was most commonly prescribed to youth and adolescents. However, in recent years, stimulant medication prescriptions for ADHD has become more common among college-age people and young adults.
- Antipsychotics. Providers prescribe these medications to relieve/reduce the symptoms of psychosis and psychotic disorders such as schizophrenia. In some cases, these medications are used for bipolar disorder, severe depression, psychotic depression, and borderline personality disorder.
- Mood stabilizers. Providers prescribe these medications most often to relieve/reduce the symptoms of bipolar disorder (BD I &II), but they may also be prescribed to address the symptoms of depression, schizophrenia, and impulse control disorders.
That list will help you understand the basics of psychiatric medication. It tells you what they are and why they’re prescribed. Now we’ll look at the most commonly prescribed psychiatric medications by prescription data.
Top Ten Psychiatric Medications in 2020: Data on Prescribing Rates
- Sertraline (Zoloft). Antidepressant: 38.22 million prescriptions
- Escitalopram (Lexapro). Antidepressant/anti-anxiety: 30.6 million prescriptions
- Bupropion (Wellbutrin). Antidepressant: 28.9 million prescriptions
- Amphetamine/dextroamphetamine (Adderall). Stimulant: 26.24 million prescriptions
- Trazodone: Antidepressant: 26.21 million prescriptions
- Fluoxetine (Prozac). Anti-anxiety and antidepressant: 23.4 million prescriptions
- Duloxetine (Cymbalta). Antidepressant/anti-anxiety: 22.5 million prescriptions
- Citalopram (Celexa). Antidepressant: 18.55 million prescriptions
- Alprazolam (Xanax). Anti-anxiety: 16.78 million prescriptions
- Methylphenidate (Concerta). Stimulant: 15.45 million prescriptions
You’ll notice the medications that are the focus of this article aren’t on this list: that’s because the disorders they’re used to treat are not as common as the disorders the medications above are used to treat. The disorders above – depression, anxiety, ADHD – are present in roughly 5-30 percent of adults in the U.S. The disorders Haldol, Thorazine, and Depakote are used to treat – schizophrenia, psychosis, and psychotic disorders – are present in roughly 0.5-1.4 percent of adults in the U.S.
Let’s look at the details of those medications now, including their prescription rates, most common uses, effectiveness, side effects, and how they differ from one another.
Haldol, Thorazine, and Depakote: Facts and Figures
First, the prescription rates:
- Haldol (Halperidol): 1,051,630 prescriptions in 2020
- Thorazine: (data unavailable)
- Depakote: 6,000,123 prescriptions in 2020
Now let’s look at their uses, effectiveness, major differences, and side effects.
Haldol
Haldol is a conventional antipsychotic.
Uses
Haloperido lis prescribed for:
- Psychotic disorders, such as schizophrenia
- Tourette’s syndrome
- Severe behavior problems in children
Effectiveness
Research shows haloperidol is highly effective in treating symptoms of schizophrenia. Symptoms it can improve include:
- Visual hallucinations
- Auditory hallucinations
- Delusional thoughts and/or beliefs
- Disorganized thinking
Side-effects
Haldol is very effective in reducing the disruptive symptoms of psychotic disorders. However, research and patient input indicates the side-effect profile is problematic. Side-effects of haldol include:
Common:
- Problems speaking or swallowing
- Loss of balance
- Frozen/mask like face
- Neck and back spasms
- Extreme restlessness
- Shuffling gait
- Stiffness in arms/legs
- Shaking hands
- Arm/leg weakness
Less common:
- Dry mouth
- Dizziness
- Hallucinations
- Skin rash
- Uncontrolled movement in arms and legs
Rare:
- Mental confusion/delirium
- Seizures
- Irregular breathing
- Increased or irregular heart rate
- Fever
Because of this extensive list of potentially significant side-effects, patients collaborate with providers to perform a risk/benefit analysis of the use of this medication. Despite the risk of these side effect, many patients choose this medication because of its ability to reduce the presence and severity of the most disruptive symptoms of schizophrenia.
Differences
Haldol is similar to Thorazine in that they’re both antipsychotics used to treat the symptoms of psychotic disorders such as schizophrenia and behavior disorders in children. However, unlike Thorazine, Haldol is indicated for disorders such as Tourette’s syndrome. It differs from Depakote in that it is not used to treat mania associated with bipolar disorder.
Thorazine
Thorazine, and its more common generic equivalent, chlorpromazine, is a first-generation antipsychotic. It’s also the first antipsychotic medication to be developed and used in the U.S. and around the world.
Uses
Thorazine (chlorpromazine) is prescribed for:
- Psychotic disorders, such as schizophrenia
- Manic components of bipolar disorder
- Explosive and aggressive behavior in children under age 12
- Nausea/vomiting
- Hiccups that last longer than a month
- Tetanus
Effectiveness
Research shows Thorazine (chlorpromazine) is highly effective in treating symptoms of schizophrenia. Symptoms it can improve include:
- Visual hallucinations
- Auditory hallucinations
- Delusional thoughts and/or beliefs
- Disorganized thinking
It’s important to note that Thorazine (chlorpromazine) was the first medication effective in treating patients with schizophrenia. In fact, it’s considered the beginning of the era in which people with schizophrenia were treated with an expectation of success.
Side-effects
Like Haldol, Thorazine (chlorpromazine) is considered highly effective in reducing the disruptive symptoms of schizophrenia. However, like Thorazine (chlorpromazine), the side-effect profile is significant. Known side-effects include:
- Dizziness
- Feeling unsteady
- Problems with balance
- Frozen/mask-like face
- Shuffling gait
- Restlessness
- Agitation
- Nervousness
- Difficulty falling asleep or staying asleep
- Increased appetite
- Weight gain
- Breast milk production
- Breast enlargement
- Missed menstrual periods
- Decreased sexual ability
Like Haldol, the extensive list of potentially significant side-effects associated with Thorazine (chlorpromazine) creates a catch-22. It can work very well, but at a cost. And like Haldol, the decision to initiate treatment with Thorazine (chlorpromazine) requires a serious conversation between patient and provider about the relative benefits and risks of this medication.
Differences
Thorazine (chlorpromazine) is similar to Haldol in that they’re both antipsychotics used to treat the symptoms of psychotic disorders such as schizophrenia and severe behavior disorders in children. Unlike Haldol, Thorazine (chlorpromazine) is used to treat the manic phases of bipolar disorder, nausea, vomiting, chronic hiccups, and tetanus. Like the next medication we’ll discuss, Depakote, Thorazine (chlorpromazine) is used to treat mania associated with bipolar disorder.
Depakote
Depakote is an anticonvulsant medication.
Uses
Depakote (valproic acid) is prescribed for:
- Seizure prevention
- Manic episodes associated with bipolar disorder
- Prevention of migraine headaches
Effectiveness
Research shows Depakote (valproic acid) is effective in treating the symptoms of the manic phases of bipolar disorder and the symptoms of ADHD in children Symptoms it can improve include:
- Over-excitement and mania
- Aggression in children with ADHD
In addition, evidence shows this medication is effective in preventing migraine headaches, but ineffective in treating migraines after they begin.
Side-effects
Several serious Black Box Warnings accompany Depakote (valproic acid). A black box warning alerts patients to rare but serious side effects of a medication. The black box warnings for Depakote (valproic acid) include:
- Life-threatening liver damage
- Birth defects (warning for pregnant women)
- Life-threatening pancreatic damage
It’s critical to share any and all health information with a provider before considering treatment with Depakote (valproic acid). In addition to these serious side-effects, additional side-effects may include:
- Headaches
- Dizziness
- Tremors
- Muscle weakness
- Drowsiness
- Nausea
- Vomiting
- Insomnia
- Hair loss
- Weight gain
- Diarrhea or abdominal pain
Like Haldol and Thorazine (chlorpromazine), this medication carries risk of serious side-effects. Therefore – like with Haldol and Thorazine (chlorpromazine) – it’s essential to have a serious conversation with your provider before beginning treatment with Depakote (valproic acid).
Differences
There are two primary differences between Depakote (valproic acid) and the other two medications we discuss in this article, Haldol and Thorazine (chlorpromazine):
- It’s an anticonvulsant, rather than an antipsychotic.
- Clinicians use it to mania in bipolar disorder, and aggression in children, but rarely use it to treat the psychotic symptoms associated with schizophrenia.
That’s the end of our discussion of the uses, effectiveness, side-effects, and differences between these three medications. There’s a significant amount of information to process – but we can help you do that.
Psychiatric Medications Like Haldol, Thorazine, and Depakote: How Do I Decide?
When we read over the list of side-effects of these medications, we realize they may be scary, intimidating, or both. However, it’s important to understand that all medications have side-effects. Even common medications such as ibuprofen and acetaminophen have serious side-effects in some cases, but millions of people use them every day without adverse effects. The same is true for these psychiatric medications. In some cases, the side-effects are serious. However, for people with complex and disruptive mental health disorders – especially those with psychotic features – the potential symptom relief they offer outweighs the potential negative side-effects.
Therefore, the most important thing to do if you or someone you love is diagnosed with a mental health disorder such as bipolar disorder or schizophrenia – or another disorder with psychotic features – is to have an open and honest discussion with your provider. They’re in the best position to offer you advice, because they know the details of your situation, or a friend’s or loved one’s situation. This article can help give you the basic facts, but your provider knows best. They’ll help you, a friend, or a loved one consider the risks, the benefits, and arrive at the best possible decision.
How to Find Treatment
If you are not in crisis or emergency, you can use the therapist locator maintained by the American Psychological Association (APA) to find support near you. Finally, both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness (NAMI) provide and high-quality online resources – including treatment locators – that are available 24/7/365.