Medication Management: Understanding How Psychiatric Medications Work—and Why Healing the Brain Itself Is Essential
— By Brian Mears, DNAP, APRN, CRNA, PMHNP-BC
Psychiatric medications can play a vital role in restoring mental health. For many individuals struggling with depression, anxiety, ADHD, PTSD, or bipolar disorder, medications can offer much-needed relief. However, what’s less commonly understood is how these medications work at the cellular level—and why they sometimes seem to stop working over time.
At Alleviant Integrated Mental Health, we believe that objective, brain-based care is critical to lasting healing. Understanding medication mechanisms, limitations, and the importance of actually rehabilitating the brain (not just medicating symptoms) is central to our approach.
How Psychiatric Medications Work: A Brief Overview
Psychiatric medications primarily work by modifying communication between neurons at the synapse—the small gap where neurons pass chemical messages to one another.
Pre-synaptic neuron: releases neurotransmitters (e.g., serotonin, dopamine, norepinephrine).
Post-synaptic neuron: contains receptors that detect and respond to those neurotransmitters.
Most psychiatric medications target these two areas:
Increasing neurotransmitter availability (by blocking reuptake, preventing breakdown, or boosting production).
Enhancing receptor sensitivity (helping neurons respond more strongly to available neurotransmitters).
In simpler terms, medications amplify the signal between neurons.
Common Types of Psychiatric Medications and Their Mechanisms of Action
| Class | Mechanism | Common Examples |
|---|---|---|
| SSRIs (Selective Serotonin Reuptake Inhibitors) | Block reabsorption (reuptake) of serotonin, increasing its availability in the synaptic gap | Prozac, Zoloft, Lexapro |
| SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) | Block reuptake of both serotonin and norepinephrine | Cymbalta, Effexor |
| Atypical Antidepressants | Affect dopamine, norepinephrine, or multiple neurotransmitters | Wellbutrin, Remeron |
| Mood Stabilizers | Regulate ion flow across neuron membranes, stabilize mood swings | Lithium, Lamictal |
| Antipsychotics | Block dopamine and/or serotonin receptors to control psychosis or mood symptoms | Abilify, Seroquel, Risperdal |
| Stimulants | Increase dopamine and norepinephrine availability, enhancing focus and alertness | Adderall, Vyvanse |
What to Expect When Starting Psychiatric Medications
Starting a psychiatric medication is often a process of careful adjustment. Here’s what you can generally expect:
Initial Adjustment Period: Symptoms like mild nausea, headaches, fatigue, or jitteriness can occur as the brain adjusts.
Onset of Effectiveness: Most medications take 2–6 weeks to show their full effect, as neural circuits begin responding to the altered neurotransmitter balance.
Monitoring and Dose Adjustments: Fine-tuning is essential. Some individuals respond quickly at low doses; others may need gradual increases or medication changes based on side effects or insufficient response.
Common Side Effects of Psychiatric Medications
While often helpful, medications can come with side effects, including:
Gastrointestinal upset (nausea, diarrhea)
Sleep disturbances (insomnia, drowsiness)
Weight changes (gain or loss)
Emotional blunting (feeling “numb”)
Sexual dysfunction
Agitation or restlessness
Headaches or dizziness
Importantly, these effects are often temporary and can be minimized with careful management and lifestyle support.
Why Medications Sometimes Stop Working—or Don’t Fully Help
Here’s a critical insight many providers overlook: Medications work at the synaptic gap, relying on healthy neuronal structures. But what happens if the neurons themselves have atrophied?
When the brain undergoes chronic stress, trauma, inflammation, or untreated mental illness, the following can happen:
Dendritic atrophy: The “branches” (dendrites) of neurons shrink or retract.
Reduced synaptic density: Fewer connections are available to transmit signals.
Loss of receptor sites: Fewer receptors are available on the post-synaptic membrane.
In simple terms: if the dendrite is damaged or missing, the medication can’t find its intended receptor.
Instead, the medication may work elsewhere in the brain where receptors are still intact—but not in the specific circuits most needing repair. This explains why:
Some patients feel partial improvement but never fully recover.
Medications sometimes lose effectiveness over time.
Higher doses are needed to achieve the same effect, increasing side effect risks.
Medications can help, but they cannot rebuild atrophied neurons.
Why Brain Rehabilitation with NeuroSync™ Is Critical
At Alleviant, we recognize that true healing requires restoring the brain’s physical and functional health.
This is why we offer NeuroSync™: a personalized brainwave optimization program based on your spectral EEG (sEEG) brain map.
NeuroSync™ works by:
Stimulating brain regions gently and precisely to encourage neuroplasticity (the brain’s ability to rewire and heal).
Rebuilding dendritic connections and increasing synaptic density.
Optimizing brainwave synchronization, helping networks function in harmony rather than chaotic dysregulation.
With NeuroSync™, we rehabilitate the foundation—so that medications (if still needed) work more effectively and, in many cases, can be reduced or discontinued under medical supervision.
How Alleviant’s Medication Management Process Is Different
We believe psychiatric medication management should be data-driven, personalized, and integrative. Our approach includes:
Spectral EEG Mapping to visualize brainwave dysfunction.
Objective Diagnostic Testing for thyroid, gut, inflammation, and nutrient status.
Customized Treatment Plans combining medications, brain stimulation, nutrition, and lifestyle interventions.
Frequent Monitoring with follow-up sEEGs every 5th session during NeuroSync™ programs.
Patient Education and Empowerment, helping you understand your brain and actively participate in your recovery journey.
Conclusion: Medication Is a Tool—But True Healing Requires Brain Restoration
Medications can save lives, restore function, and provide critical relief. But at Alleviant, we understand that medications alone are not enough if the brain itself remains damaged, inflamed, or out of sync.
If you are struggling with medication side effects, feel that your antidepressant or other psychiatric medication “isn’t working like it used to,” or simply want a more complete, objective way to optimize your mental health—we can help.
Let’s move beyond managing symptoms. Let’s heal.
References
Duman, R. S., & Aghajanian, G. K. (2012). Synaptic dysfunction in depression: Potential therapeutic targets. Science, 338(6103), 68-72. https://doi.org/10.1126/science.1222939
Krystal, J. H., et al. (2009). Neuroplasticity as a target for the pharmacotherapy of depression. Biological Psychiatry, 66(7), 549-557. https://doi.org/10.1016/j.biopsych.2009.04.034
Pittenger, C., & Duman, R. S. (2008). Stress, depression, and neuroplasticity: a convergence of mechanisms. Neuropsychopharmacology, 33(1), 88-109. https://doi.org/10.1038/sj.npp.1301574