Drugs for Mental Health

chapter-31“the Mentally Healthy person” – one who

can perceive reality accurately and has control over expression of emotions

Mental Health: not a concrete achievable goal …but a lifelong process resulting in a sense of harmony and balance in a person’s life

-difficult to define, highly individualized

-varies from person-to-person

Medication in Psychotherapy

• Among the most prescribed drugs

• Used to reduce/alleviate symptoms of STRESS …to allow the patient’s participation in other psychotherapies

• DRUGS – temporarily change behavior, addiction/dependence are major concerns

• PSYCHOTHERAPY – more long-term, but … the results are more permanent

Neurosis vs Psychosis

• Neurosis: • patient is still in contact with reality• Unable to adjust favorably with

surroundings• anxiety is major symptom

• Psychosis: • patient is out of contact with reality,• unable to communicate• 2 major types

• schizophrenia • major depression

ANXIOLYTICS

• DRUGs for Anxiety (Table 31-1)

• known generally as ‘anxiolytics’ which literally means ‘to break apart, or dissolve anxiety’

• Benzodiazepines • short acting • long acting

• Misc Anxiolytics

Benzodiazepines • Introduced in the 1960’s

• Generic names end in ‘-pam’ - diazepam, lorazepam, clonazepam (exception: alprazolam, whose brand name is Xanax)

• ‘drugs-of-choice’ – safer, lower abuse potential, less tolerance and dependence (again, except for Xanax!)

• Effect: a calming-effect without extreme sedation

• (2)general types: Short-acting and Long-acting

Benzodiazepines Patient-education

• Take with food if GI symptoms occur

• Take exactly as directed (don’t modify dose)

• DO NOT mix with alcohol!

• Drowsiness occurs … careful in hazardous situations, driving, machinery, etc

• Physical dependence is rare, except Xanax !

• Benzo’s should NOT be used in pregnancy!

Misc Anxiolytics

• Buspar (buspirone)

• Vistaril/Atarax (hydroxyzine pamoate/hcl)

• Paxil (paroxetine)

• Effexor (venlafaxine)

• Desyrel (trazodone)

• See “Facts about Anxiolytics” on p.662

Major tranquilizers/ Neuroleptics

• Drugs used to treat Psychosis (see Table 31-2) are also known as “Antipsychotics”

• Antipsychotics are effective in 3 main areas: • hallucinations,delusions,combativeness

(psychosis)• relief of nausea/vomiting (chemo, narcotic s/e)• to increase potency of analgesics (ex:

promethazine)

• The two major forms of Psychosis are … • Schizophrenia• Depression

Anti-Mania & Bi-polar drugs

• Bi-polar Disorder (formerly referred to as Manic-Depression)

• Common meds used in the bi-polar patient:• lithium (Lithobid, Eskalith) – mainstay• carbamazepine (Tegretol) – developed

as an anti-seizure drug • valproic acid (Depakote, Depakene) –

also originally for seizure disorders

Depression

• !(study Box 31-3 on p. 668)

• aka ‘mood-disorders’ or ‘affective-disorders’

• Among the most common psychiatric disorders, and is of (2) major types …• Exogenous – “the blues”, a response to

‘external’ factors, normally self-limiting• Endogenous (unipolar) – no apparent

‘external’ cause, basis is typically genetic or biochemical …

Exogenous/Endogenous Depression (cont)

• Exogenous Depression:• Caused by external factors such as -

divorce, loss of loved one, job loss, serious illness, etc

• Drug therapy often successful w/ Exogenous

• Endogenous: • seems to come from ‘within’ the person,

biochemical imbalance, hereditary• Endogenous type DOES NOT respond

well to medication therapy

Anti-depressant Drugs

(study Box 31-4 on p.669)• All major classes have a similar response rate …

• So the choice-of-drug is based on things like: *side-effects *patient-history *if sedation is needed

• MAOI’s (monoamine oxidase inhibitors)

• TCA’s (tricyclic antidepressants)

• SSRI’s (selective serotonin reuptake inhibitors)

• SNRI’s (selective norepinephrine reuptake inhibitors)

• NRI’s (natural reuptake inhibitors) –herbal, St.John’s

wort for

example

MAOI (patient education)

• Very high number of potentially dangerous DRUG and FOOD interactions!

• Avoid TYRAMINE containing foods, such as *cheese *wine *beans *chocolate (31-4, p.672)

• See DDI (Dangerous-Drug-Interactions) (31-5,p.672)

• MAOI must be ‘cleared’ from body before starting any new antidepressant (taper)

‘Atypical’ Antidepressants (2nd

generation) • Introduced in the 1980’s

• These will treat --- major depressions, reactive depressions, and anxiety disorders• Wellbutrin (bupropion)• Remeron (mirtazapine)• Desyrel (trazodone)

Alzheimer’s disease ~ 250,ooo

new cases per year!• Progressive (worsening) illness

• Degradation of nerve pathways (cholinergic)

• Impaired thinking, confusion, disorientation, ‘sundowning’ = symptoms worse in evening

• No specific ‘test’ for this , can only be diagnosed with certainty by autopsy

• Drugs are used to slow the deterioration and/or improve patient’s nerve function

Drug therapy for Alzheimer’s

• See Table 31-6 on p.675

• Cognex, Aricept: increases nerve-function only

• Reminyl: slows disease progression AND improves nerve function (increased Ach)

• Namenda: newest agent – ‘anti-Alzheimer’ agent, reduces deterioration of cholinergic nerve pathways in moderate-severe cases

ADHD

• Common behavioral disorder (average of one ADHD child per classroom) – cause unknown!

• Diagnosis usually based on symptoms that occur before age 7, and last > 6 months

• Symptoms (begin from 3 – 7 years, thru teenage)• Inattention• Hyperactivity• Impulsivity

Drugs for ADHD(study Table 31-7 on p.677)

• Central Nervous System (CNS) Stimulants

• Not to be given >1 year without a ‘break’ from the drug! …may suppress child’s growth• Break is known as ‘Drug-Holiday’• Suggested Drug-Holiday

opportunities …• Weekends, summer-breaks, vacations, etc

ADHD drug names

• Methylphenidate (Ritalin) – CII (schedule-2)

• Dextroamphetamine (Dexedrine) -CII

• Amphetamine (Adderall) -CII

• Lisdexamfetamine (Vyvanse) -CII

• Atomoxetine (Strattera) only one that’s not a ‘scheduled’ drug, also used as antidepressant

ADHD drug side-effects

• CII’s (methylphenidate, etc) – insomnia, growth suppression, headache, abdominal pain, lethargy, weight loss, dry mouth, irritability

• Strattera (lisdexamfetamine) – headache, dyspepsia, nausea/vomiting, fatigue, decreased appetite, dizziness, altered mood

• Clonidine (HTN agent) – hypotension, sedation

ANY QUESTIONS

?REVIEW