Dopamine, Serotonin, and Stigma: Rethinking Mental Health Meds

Introduction 

Mental health is a crucial issue in today's age, affecting around 20% of adults and 17% of children (NAMI, 2023). Despite these statistics, the percentage of those seeking treatment is lower. While there are many types of treatment for different mental health disorders, the most notable ones are Cognitive Behavioral Therapy (CBT) and psychiatric medication. Approximately 15.4% of American adults take psychiatric medication (CDC, 2021), including 17% of college students (Macroni et al., 2023). Although the percentage of individuals prescribed psychiatric medication has increased, there is still a very prevalent stigma surrounding its use. 

Stigma behind psychiatric medication is a substantial issue, and it has been shown to reduce individual adherence to psychiatric medications. Stigma is also shown to be internalized in those taking psychiatric medication and reduce therapeutic response (Abdisa et al., 2020). 

Science Behind Psychotropic Medications 

The most stigmatized psychiatric medications are stimulants, antidepressants, antipsychotics, and benzodiazepines. Almost every aspect of these medications are constantly up for debate, which influences varying perspectives on these medications.

One of the most stigmatized psychiatric medications are stimulants. Stimulants are primarily used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). A primary factor for the stigma associated with stimulants is the comparison to methamphetamine. Methamphetamine is a potent psychostimulant that primarily increases dopamine and norepinephrine in the brain. A commonly prescribed medication for ADHD, known as Adderall, contains mixed amphetamine salts. In comparison to methamphetamines, Adderall is considerably less potent and crosses the blood brain barrier significantly slower (Kirkpatrick et. al, 2012). The basis behind giving stimulants to individuals with ADHD lies in the fact that ADHD is a neurodevelopmental disorder characterized by patterns of inattentiveness and hyperactivity due to a dopamine deficit in the prefrontal cortex (Blum et al., 2008). Individuals with ADHD typically retain brain structure abnormalities. However, it has recently been shown that stimulants can normalize the structure of these regions, highlighting the importance of these medications (Wu et al., 2024). 

Another highly stigmatized class of psychiatric medications include antidepressants. There are many different types of antidepressants, most notable being Selective Serotonin Reuptake Inhibitors (SSRIs). The main driving force for stigma behind antidepressants lies in the fact that they do not address the underlying issue and simply reduce symptoms. Another driving force is the idea that individuals are “weak” for taking an antidepressant. While antidepressants may not address the underlying issue for depression, these medications have been shown to reduce depressive symptoms and improve quality of life. Antidepressants are prescribed for a variety of different conditions, most notably being Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and Obsessive-Compulsive Disorder (OCD). It is important to realize the debilitating nature of these diseases and how they can affect quality of life when discussing antidepressants. Antidepressants have been shown to decrease the risk of suicide along with many other outcomes of many different disorders (Søndergård et al., 2006). It is important to realize that no one is “weak” for taking an antidepressant, as psychiatric medications may be as important for heart medication for some. 

A third stigmatized class of psychiatric medications are antipsychotics. Antipsychotics are a class of psychiatric medication which generally function by blocking dopamine and serotonin receptors. These medications are most commonly prescribed for Bipolar Disorder and Schizophrenia. Bipolar Disorder is an illness classified by periods of manic or hypomanic and depressive episodes. Schizophrenia is an illness classified by a combination of symptoms, most commonly psychotic, that significantly impair a person's cognition. Antipsychotic medications have been shown to significantly reduce symptoms of bipolar disorder and schizophrenia (Johnsen & Kroken, 2012). 

Lastly, one of the most stigmatized psychiatric medication classes remains benzodiazepines. Benzodiazepines are a class of psychiatric medication commonly prescribed for anxiety and sleep disorders. They agonize the GABA receptor, leading to significant anxiolytic and sedative symptoms. The stigma behind this class lies in its highly addictive potential. However, benzodiazepines have been shown to be rapidly effective and safe when prescribed correctly, highlighting their critical role in treating anxiety and sleep disorders (Soumerai et al., 2024). 

How to stop the Stigma 

There are many ways individuals can help stop the stigma around these medications. The following strategies will help reduce the stigma and are a way you can make a difference:

• Educate yourself and counter misinformation. 
• Share accurate information. 
• Encourage openness about mental health treatment. 
• Treat mental health like physical health. 
• Use empathetic language when discussing mental health. 

Conclusion  

In conclusion, the stigma behind psychiatric medication is unjust and harmful. As previously stated, psychiatric medication can be as critical as medication for physical health issues. Although there are risks to psychiatric medication, for many, the benefits outweigh these risks. Psychiatric medication can improve quality of life significantly, even reducing suicide rates in many cases. Using the strategies above to reduce this stigma can be very helpful in reducing the stigma behind psychiatric medications and promoting more positive outcomes for mental health patients. 

References 

National Alliance on Mental Illness. (2023, April). Mental health by the numbers. https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/\ Terlizzi, E. P., & Norris, T. (2021, October). Mental health treatment among adults: United States, 2020 (NCHS Data Brief No. 419). National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db419.htm Marconi, A. M., Hodson, S., Slawek, K., & Levin, M. E. (2023). Psychiatric medication prescriptions increasing for college students. Psychiatric Services, 74(6), 599-601. https://doi.org/10.1176/appi.ps.202200913 PMID: 37925588 Abdisa, E., Fekadu, G., Girma, S., Shibiru, T., Tilahun, T., Mohamed, H., Wakgari, A., Takele, A., Abebe, M., & Tsegaye, R. (2020). Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. International journal of mental health systems, 14, 56. https://doi.org/10.1186/s13033-020-00391-6 Kirkpatrick, M. G., Gunderson, E. W., Johanson, C. E., Levin, F. R., Foltin, R. W., & Hart, C. L. (2012). Comparison of intranasal methamphetamine and d-amphetamine self-administration by humans. Addiction (Abingdon, England), 107(4), 783–791. https://doi.org/10.1111/j.1360-0443.2011.03706.x Blum, K., Chen, A. L., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., Blum, S. H., Downs, B. W., Waite, R. L., Notaro, A., Lubar, J., Williams, L., Prihoda, T. J., Palomo, T., & Oscar-Berman, M. (2008). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric disease and treatment, 4(5), 893–918. https://doi.org/10.2147/ndt.s2627 Wu, F., Zhang, W., Ji, W., Zhang, Y., Jiang, F., Li, G., Hu, Y., Wei, X., Wang, H., Wang, S. A., Manza, P., Tomasi, D., Volkow, N. D., Gao, X., Wang, G. J., & Zhang, Y. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. 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Addiction (Abingdon, England), 107(4), 783–791. https://doi.org/10.1111/j.1360-0443.2011.03706.x Blum, K., Chen, A. L., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., Blum, S. H., Downs, B. W., Waite, R. L., Notaro, A., Lubar, J., Williams, L., Prihoda, T. J., Palomo, T., & Oscar-Berman, M. (2008). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric disease and treatment, 4(5), 893–918. https://doi.org/10.2147/ndt.s2627 Wu, F., Zhang, W., Ji, W., Zhang, Y., Jiang, F., Li, G., Hu, Y., Wei, X., Wang, H., Wang, S. A., Manza, P., Tomasi, D., Volkow, N. D., Gao, X., Wang, G. J., & Zhang, Y. (2024). Stimulant medications in children with ADHD normalize the structure of brain regions associated with attention and reward. Neuropsychopharmacology : of icial publication of the American College of Neuropsychopharmacology, 49(8), 1330–1340. https://doi.org/10.1038/s41386-024-01831-4 Søndergård, L., Kvist, K., Andersen, P. K., & Kessing, L. V. 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