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Top 25 Psychiatric Medications for 2018

Psychiatric medications are an important part of treatment for many people with mental disorders, such as depression, bipolar disorder, ADHD, schizophrenia, anxiety, and others. They play an important role in helping to alleviate the most serious symptoms, allowing people to better focus on their lives and on other treatment types, such as psychotherapy. Psychiatric medications are an important part of many people’s treatment plans for obtaining the most effective treatment for a mental health concern or mental illness.

It’s good to know what drugs are being prescribed most often for mental disorders in the U.S. These are the top 25 psychiatric medications by number of U.S. prescriptions dispensed in 2018, according to IQVIA, a global information and technology services company.

Maintaining its lead since we last did this review in 2016, Zoloft — a common, older selective serotonin reuptake inhibitor (SSRI) prescribed to help alleviate the symptoms of depression — remains the most prescribed psychiatric medication in the United States. Zoloft was prescribed nearly 49 million times in 2018, at a cost of $179 million. This makes it an affordable and easy-to-tolerate antidepressant choice.

It continues to be outprescribed over other antidepressants, as well as Xanax, a commonly-prescribed anti-anxiety medication found in our number two spot. Lexapro — another antidepressant used to treat clinical depression — holds on to its number three spot, with nearly 38 million prescriptions in 2018.

By far, the most common mental disorder that psychiatric medications are prescribed for is clinical depression. Although it is not the most prevalent mental disorder, it appears to the one that most psychiatric prescriptions are written for.

In 2016, more than 338 million prescriptions were written for anti-depressant medications. In 2018 that number decreased to 318 million — suggesting a slight decline in prescriptions for antidepressants.

A total of 611,780,251 prescriptions were made for psychiatric medications in the U.S. in 2018, at a cost of over $29 billion. That’s up only 2.42% from 2016, when 597,326,489 psychiatric prescriptions were made.

The most expensive medications on the list that make the most money for their manufacturers are:

Vyvanse (for ADHD) – $3.594 billion
Concerta (for ADHD) – $2.176 billion
Adderall (for ADHD) – $1.914 billion
Abilify (for bipolar disorder, depression and schizophrenia) – $1.704 billion
Wellbutrin (for depression) – $1.024 billion

It’s no wonder that so many people believe we are over-medicating kids and teenagers who might suffer from attention deficit hyperactivity disorder (ADHD) — they make up three of the top five profitable medications in this list. In short, ADHD make up the cost of over a third of the prescriptions in 2018. Only antipsychotic medications — prescribed for various disorders including schizophrenia and bipolar disorder — cost more as a category.

Most Prescribed Psychiatric Drugs for 2018

1. Zoloft (sertaline) – Depression (48,999,022 prescriptions – $179 million)
2. Xanax (alprazolam) – Anxiety (39,916,469 prescriptions – $105 million)
3. Lexapro (escitalopram) – Depression (37,927,061 prescriptions – $174 million)
4. Desyrel (trazodone) – Anxiety, Depression (34,665,828 prescriptions – $115 million)
5. Wellbutrin (bupropion) – Depression (34,472,232 prescriptions – $1.024 billion)
6. Adderall (dextroamphetamine and amphetamine) – ADHD (33,807,381 prescriptions – $1.914 billion)
7. Prozac (fluoxetine) – Depression (31,190,127 prescriptions – $294 million)
8. Celexa (citalopram) – Depression (28,011,615 prescriptions – $46 million)
9. Cymbalta (duloxetine) – Depression (26,032,770 prescriptions – $378 million)
10. Ativan (lorazepam) – Anxiety (23,833,390 prescriptions – $137 million)
11. Effexor (venlafaxine) – Depression (21,717,245 prescriptions – $414 million)
12. Seroquel (quetiapine) – Bipolar disorder, Depression (20,844,624 prescriptions – $273 million)
13. Lamictal (lamotrigine) – Bipolar disorder (15,434,708 prescriptions – $731 million)
14. Concerta (methylphenidate) – ADHD (15,104,867 prescriptions – $2.176 billion)
15. Kapvay (clonidine) – ADHD (15,058,561 prescriptions – $171 million)
16. Remeron (mirtazapine) – Depression (13,539,039 prescriptions – $89 million)
17. Paxil (paroxetine) – Depression (12,874,006 prescriptions – $123 million)
18. Elavil (amitriptyline) – Depression (12,843,459 prescriptions – $96 million)
19. Vyvanse (lisdexamfetamine) – ADHD (11,569,232 prescriptions – $3.594 billion)
20. Depakote (divalproex) – Bipolar disorder (11,263,321 prescriptions – $363 million)
21. Abilify (aripiprazole) – Bipolar disorder, Depression, Schizophrenia (10,680,324 prescriptions – $1.704 billion)
22. Risperdal (risperidone) – Bipolar disorder, Schizophrenia (10,416,641 prescriptions – $485 million)
23. Zyprexa (olanzapine) – Bipolar disorder, Schizophrenia (7,192,047 prescriptions – $126 million)
24. Intuiv (guanfacine) – ADHD (5,696,366 prescriptions – $70 million)
25. Trileptal (oxcarbazepine) – Bipolar disorder (4,548,937 prescriptions – $322 million)

Psychiatric medications should only be prescribed by your treating psychiatrist or physician. The most effective treatment for most mental disorders is rarely medication alone. A combined treatment approach, that includes psychotherapy, results in quicker, more positive outcomes for most people who are coping with mental illness.

I know that many people take a medication alone. Or they take a medication prescribed by their family doctor, having never seen a mental health professional such as a psychologist or psychiatrist. If you’ve had a long-term disorder you’re living with, this may be just fine.

But if you’re a newly diagnosed individual with a mental disorder, you really should reach out to a psychiatrist or psychologist to confirm your diagnosis, and consider additional treatment options. There are a wealth of self-care strategies that a therapist can help you with as well. Many people find online support groups helpful, too. The important thing is to receive the best possible and most comprehensive treatment you can.

We last wrote about the the top psychiatric prescription drugs in 2016, and previously in 2013.

We would like to thank the good folks at IQVIA for providing the data.

How to Avoid Fighting with Your Partner During the Stressful Holiday Season

The holidays are here! That time of year when we get to spend time with our families and friends and celebrate the season. It can also be the time of year when we navigate old emotional, unhealed wounds from our childhood, experience increased financial pressure, and face the stresses of traveling, holiday shopping, meal preparation and spending time with people who may push our buttons.

Many of us feel complicated emotions around the holidays, feelings that may be outside our awareness but cause us to be easily triggered and emotionally reactive in our relationship with our partner. Higher stress levels and the worries of the season can make us more likely to snap and less capable of keeping our cool in conflict.

From negotiating travel plans to the pressures of gift-buying, from coming up against family issues and experiencing feelings of grief if we’ve lost family or friends, this can be an intense time of year for us and our relationships.

I’ve been working with individuals and couples in my therapy practice for over 20 years and have developed some tools to help people become more mindful and present with one another, including when tensions are high.

This holiday season, if you find yourself feeling stressed out, tense, or angry at your partner, try using this mindfulness process to slow down your emotional response and tune in to what your partner is telling you. Often when we’re in conflict with our partners, we’re not really able to clearly see their experience as our own unprocessed feelings are coloring our vision. But, when we can slow down the spin of our own emotions, we have a better chance of staying centered and balanced, and can more easily navigate the bumps that arise.

Throughout the day, as you interact with your partner, whether you feel loving towards them or annoyed, do this:

Try giving your partner your full attention. Let them express themselves without interruption. Put judgment aside and let yourself get curious. Listen to what they are saying but also to the feelings beneath the words. As your partner is talking, tune into your body and try to sense what they’re feeling.

Our ability to be able to feel what another is feeling may be due, in part, to “mirror neurons,” a type of brain cell that may enable us to understand the actions, intentions, and emotions of another person. As the name implies, mirror neurons apparently get activated both when we experience an emotion ourselves, as well as when we witness someone else experiencing an emotion. So, when we see our partners feeling sad, angry, happy, or afraid, our mirror neurons light up, and we feel similarly. We resonate with their emotional experience, and we mirror them — or feel what they are feeling.

Pay attention to your partner’s nonverbal cues (facial expressions, tone of voice, body language). Notice what happens inside you when you do. Notice what you feel in your body. Let yourself make eye contact with your partner, even for brief moments. Notice what you see in their eyes. Notice what happens for you emotionally when you do.

With a felt sense of your partner’s emotional experience, consider why they’re feeling the way they’re feeling. Try to imagine what it would be like to be them. Put yourself aside and consider their perspective. Notice how you then feel toward your partner. How are you inclined to respond to what’s happening? What is your inner sense of what would be the best thing to do for both of you?

If you’re having a hard time connecting with your partner’s emotional experience, try picturing them as their younger self. See that child’s face in your mind’s eye. Look into your partner’s eyes and notice what happens inside of you. Notice what happens in your body. How do you feel toward that child? How does that make you feel toward your partner? How do you feel inclined to respond?

Then, if you’re so inclined, share your understanding of your partner’s emotional experience with them. You might say, “I’m getting the sense that you’re feeling stressed out.” And then ask for feedback, “Did I get that right?” See if it rings true for them. If it does, notice how your partner responds emotionally to being seen in this way, to having their experience reflected back to them. Notice how that makes you feel.

If your understanding of their feelings wasn’t quite accurate, allow yourself to take in the feedback with curiosity and not with resentment at being corrected or devastated for being wrong. If your sense of them does not quite resonate in this moment, ask your partner for clarification and ask them to help you better understand their experience. Your partner will likely appreciate your interest and care, and your wish to really know and understand her or him.

Both of you can work on these skills of empathy, both during the holidays and throughout the year. When we let go of reactions that are triggered by old wounds, assumptions, misunderstandings, or plain old stress, we can get closer to our partners and deepen our relationships.

This holiday season, give your partner the gift of mindful attention.