Psychopharmacology for counselors: the drug classes the exam expects you to recognize.
Antidepressants, mood stabilizers, antipsychotics, anxiolytics and stimulants. What they treat, what to watch for, and what a counselor does about it.
By Dr. Andrew Wichterman · September 15, 2026 · 6 min read
Counselors do not prescribe, and the exam does not test dosing. It tests whether you can recognize a medication class from a name or a description, know what it is for, know the side effects and risks a counselor should notice, and know when to refer or coordinate. Here is the level of detail required.
Antidepressants
- SSRIs (fluoxetine/Prozac, sertraline/Zoloft, escitalopram/Lexapro, paroxetine/Paxil, citalopram): first line for depression and most anxiety disorders. Take two to six weeks to work. Side effects: GI upset, sexual dysfunction, sleep changes. Black box warning for increased suicidal thinking in youth and young adults early in treatment; monitor. Abrupt stopping causes discontinuation symptoms.
- SNRIs (venlafaxine/Effexor, duloxetine/Cymbalta): similar, also used for pain.
- Bupropion (Wellbutrin): atypical; fewer sexual side effects; also for smoking cessation; seizure risk at high doses or with eating disorders.
- Tricyclics (amitriptyline, nortriptyline) and MAOIs (phenelzine): older; more side effects; tricyclics are dangerous in overdose; MAOIs require dietary restrictions (tyramine).
- Serotonin syndrome from combining serotonergic drugs is a medical emergency.
Mood stabilizers
Lithium: narrow therapeutic range; blood levels monitored; toxicity signs include tremor, GI symptoms, confusion. Anticonvulsants used as mood stabilizers: valproate/Depakote, lamotrigine/Lamictal (rash risk), carbamazepine. Antidepressants alone can trigger mania in bipolar disorder, which is why the exam wants you to screen for mania before a depressed client is referred for medication.
Antipsychotics
First generation (haloperidol, chlorpromazine): extrapyramidal side effects and tardive dyskinesia. Second generation (risperidone, olanzapine, quetiapine, aripiprazole, clozapine): metabolic effects (weight gain, diabetes risk); clozapine requires blood monitoring for agranulocytosis. Used for schizophrenia, bipolar disorder and as augmentation. A counselor who notices involuntary movements or rapid weight gain coordinates with the prescriber.
Anxiolytics and sleep
Benzodiazepines (alprazolam/Xanax, lorazepam/Ativan, clonazepam/Klonopin, diazepam/Valium): fast acting, effective short term, dependence and dangerous withdrawal, dangerous with alcohol and opioids. Buspirone: non-addictive, slower. Hydroxyzine, and the Z-drugs (zolpidem) for sleep. Beta blockers (propranolol) for performance anxiety.
Stimulants and others
Methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Vyvanse) for ADHD: appetite and sleep effects, diversion risk. Atomoxetine (Strattera) is a nonstimulant option. Naltrexone, buprenorphine (Suboxone), methadone and acamprosate for substance use disorders. Prazosin for trauma nightmares.
The counselor's role
- Refer for evaluation when symptoms are severe, not responding to counseling, or when the diagnosis suggests medication is standard of care (bipolar disorder, schizophrenia, severe depression).
- Obtain a release and coordinate with the prescriber.
- Monitor and report side effects, adherence and effectiveness; do not advise on dosing or tell the client to stop.
- Address ambivalence about medication with MI, not persuasion.
- Know the interactions with alcohol and other drugs that create risk.
Practice this. The flashcards and practice tests on this site are sorted by content area, so you can drill this one until it holds.
Class, indication, the side effects a counselor can see, and the referral. That is the depth the exam wants.