Psychotherapeutic Drugs

Kim Edward Light, Ph.D.

Professor, College of Pharmacy

University of Arkansas for Medical Sciences

Objectives Identify the different categories of drugs having

therapeutic value in treating CNS disorders. Identify the spectrum of disorders of brain function For each category of drugs not previously

discussed Identify therapeutic uses and indications Present pharmacological mechanisms Discuss specific features of drug action Present adverse reactions and side effects Identify contraindications and complications

Drug Categories

Antipsychotics / Neuroleptics

Antimanic Antidepressants Alzheimer's Antiparkinsonian Anticonvulsants

Stimulant Medications Antianxiety

Medications Hypnotics Narcotics - Opioid

Analgesics Addiction Treatment

Medications

Spectrum of Disorders1 Attention Deficit Hyperactivity Disorder

(ADHD, ADD) Autism Spectrum Disorders (Pervasive

Developmental Disorders) Bipolar Disorder (Manic-Depressive Illness) Borderline Personality Disorder Depression Eating Disorders

Spectrum of Disorders2

Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder

(PTSD) Social Phobia (Social Anxiety Disorder)

Schizophrenia Seizure Disorders

Traditional Antipsychotic Drugs chlorpromazine Thorazine®, Largactil®

fluphenazine Prolixin®, Permitil®

haloperidol Haldol®

loxapine Loxitane, Daxolin®

mesoridazine Serentil®

molindone Moban, Lindone®

perphenazine Trilafon®, Etrafon®

pimozide Orap®

thioridazine Mellaril®

thiothixene Navane®

trifluoperazine Stelazine ®

Atypical Antipsychotic Drugs

aripiprazole Abilify®

clozapine Clozaril®

olanzapine Zyprexa®, Zyprexa®, Zydis®

quetiapine Seroquel®

risperidone Risperdal®

ziprasidone Geodon®

Antipsychotic Drug Adverse Reactions

Tardive Dyskinesia Involuntary movements Long-term use and older patients Women > men

Neuroleptic Malignant Syndrome Blood pressure up and down Dazed and confused Difficulty breathing Muscle stiffness Rapid heart rate Sweating and shakiness Temperature above normal

Antipsychotic Drug Side Effects Blurred vision, Dry mouth Drowsiness, Slurred speech, Dizziness Muscle rigidity Nasal congestion, Lowered blood pressure Restlessness, Slowed heart rate Sensitivity to bright light Upset stomach, Constipation Weight gain

Bipolar Disorder Drugs

Lithium Carbonate - Eskalith®, Eskalith CR®, Lithane®,

Lithobid®, Lithonate®, Lithotabs®

Citrate - Cibalith®

AnticonvulsantsNeuroleptics – atypical

olanzapine Zyprexa®, Zyprexa®, Zydis®

quetiapine Seroquel® risperidone Risperdal® ziprasidone Geodon®

Lithium Side Effects

ataxia, fine hand tremor, hyperactive reflexes blurred vision, drowsiness, diarrhea, vomiting muscular weakness, dry mouth, polyuria, cardiac arrhythmia, hypotension, epileptiform seizures, coma large output of dilute urine

Regular monitoring of blood levels necessary

Antidepressant DrugsOlder MAO Inhibitorsisocarboxazid Marplan®

phenelzine Nardil®

tranylcypromine Parnate®

Tricyclics & Quarta-cyclics amitriptyline Elavil®

amoxapine Asendin®

clomipramine Anafranil®

desipramine Norpramin®

doxepin Sinequan®

imipramine Tofranil®

maprotiline Ludiomil®

nortriptyline Pamelor®

protriptyline Vivactil®

Antidepressant DrugsNewerSSRIs citalopram Celexa®

escitalopram Lexapro®

fluoxetine Prozac®

fluvoxamine Luvox®

paroxetine Paxil®

sertraline Zoloft®

SNRIs venlafaxine Effexor®,

Effexor ER®

nefazodone Serzone®

mirtazapine Remeron®

Others bupropion Wellbutrin®

trazodone Desyrel®

Antidepressant Drugs Adverse Reactions

MAO Inhibitors Foods containing tyramine at high levels

Serotonin Syndrome Produced by combination of products that act to

increase serotonin Similar to Neuroleptic Malignant Syndrome Euphoria, drowsiness, exaggerated reflexes,

sweating, hyperthermia, mental status changes

Antidepressant Drugs Side Effects

Older agentsDry mouth, dizziness, constipation, blurred vision, cardiac arrhythmias

Orthostatic hypotension, sexual dysfunction, weight gain

Newer agentsHeadache, nausea, nervousness, agitation, Sexual dysfunction, insomnia, weight gainSeizure risk (bupropion) Suicide or aggressive acts especially in adolescents

Anti-Parkinsonian DrugsDA Boosters L-DOPA L-DOPA / carbidopa Sinemet® or Atamet® entacapone Comtan®

MAO-B Inhibitor Selegiline Eldepryl® Atapryl® Carbex®

DA Agonists bromocriptine Parlodel® pergolide Permax® pramipexole Mirapex®

ropinirole Requip®

amantadine Symmetrel®, Symadine®

Anti-Parkinsonian DrugsAdjuncts

Anticholinergics benztropine Cogentin®

trihexyphenidyl Artane®

Anti-Alzheimer's Drugs Donepezil Aricept®

Galantamine Reminyl® Rivastigmine Exelon®

Tacrine Cognex®

Memantine Namenda®

Side Effects Dizziness, Confusion, Sleep problems Increased respiratory secretions, Urinary frequency Cardiovascular problems

Anticonvulsant Drugs carbamazepine Tegretol®

divalproex sodium Depakote®, valproate Depacon®, Depakene®

gabapentin Neurontin®

lamotrigine Lamictal®

levetiracetam Keppra® oxcarbazepine Trileptal®

tiagabine Gabitril®

topiramate Topamax®

Anticonvulsant DrugsSide Effects weight gain, memory and cognitive function

disturbances, photosensitivity, dermatological sensitivity leading to rashes, sinus congestion, hair thinning, impaired absorption of B vitamins.

Summary Discussed the various major classes of

drugs used to treat various mental disorders including: Antipsychotic drugs Bipolar disorder drugs Antidepressant drugs Anti-Parkinsonian drugs Anti-Alzheimer’s drugs Anticonvulsant drugs

Psychotherapeutic Medications Information http://www.nimh.nih.gov/healthinformation/index.cfm