Psychotherapeutic Drugs Psychotherapeutic Drugs Used in the treatment of emotional and mental disorders o Ability to cope with emotions can range from occasional depression or anxiety to constant emotional distress o When emotions significantly affect an individual s ability to carry out normal daily functions treatment with a psychotherapeutic drug is a possible option Three main emotional and mental disorders o Anxiety o Affective disorders mood disorders o Psychoses schizophrenia Types of psychotherapeutic drugs o Anxiolytic drugs anxiety o Mood stabilizing drugs bi polar o Antidepressant drugs o Antipsychotic drugs most potent strongest Anxiety Unpleasant state of mind characterized by a sense of dread and fear May be based on actual anticipated experiences or past experiences May be exaggerated responses to imaginary negative situations Anxiety Disorders Six major anxiety disorders persistent anxiety o Obsessive compulsive disorder OCD o Posttraumatic stress disorder PTSD o Generalized anxiety disorder GAD o Panic disorder o Social phobia social anxiety disorder o Simple phobia Affective Disorders Mood Disorders Changes in mood that range from mania abnormally pronounced emotions to depression abnormally reduced emotions Some patients may exhibit both mania and depression bipolar disorder BPD Psychosis Severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in activities of daily living Hallmark loss of contact with reality Examples o Schizophrenia o Depressive and drug induced psychoses Anxiolytic Drugs Reduce anxiety by reducing overactivity in CNS Benzodiazepines o Depress activity in the brainstem and limbic system o Don t use commonly anymore Poor adverse effects addiction properties and overdose use Miscellaneous drug buspirone BuSpar o Best anti anxiety medication o Nonsedating and non habit forming o May have drug interaction with SSRIs serotonin syndrome o Do not administer with MAOIs Benzodiazepines Lam pam drugs o Best for short term anxiety alprazolam Xanax diazepam Valium o People overdose on this lorazepam Ativan o Great drug o Quieting o Helps hospitalized patients sleep Midazolam Versed o Amnesia drug o Don t remember things Quieting for pre surgery patient Adverse Effects o Benzodiazepine adverse effects are an overexpression of their therapeutic effects Decreased CNS activity sedation Hypotension Drowsiness loss of coordination dizziness headaches Nausea vomiting dry mouth constipation Others Can effect kidneys and liver in older people Overdose o Dangerous when taken with other sedatives or alcohol o Treatment is generally symptomatic and supportive o Flumazenil may be used to reverse benzodiazepine effects Miscellaneous Anxiolytic buspirone BuSpar o Unknown mechanism of action o Administered on a scheduled basis about the same time every day o Adverse effects Paradoxical anxiety opposite effect Blurred vision Headache Nausea o Well tolerated o Complications Serotonin syndrome Mood Stabilizing Drugs Lithium carbonate and lithium citrate o Stabilizes mood better than anything else Other drugs may be used in combination with lithium o Benzodiazepines o Antipsychotic drugs o Antiepileptic drugs o Dopamine receptor agonists Lithium is the drug of choice for the treatment of mania o It is thought to potentiate serotonergic neurotransmission o Narrow therapeutic range maintenance serum levels should range between 0 6 and 1 2 mEq L Lithium toxic on the higher side leads to death Need to have regular serum concentration drawn Interact with NSAIDS and thyazide diuretics Antidepressants Tricyclic antidepressants Monoamine oxidase inhibitors MAOIs Second generation antidepressants o Selective serotonin reuptake inhibitors SSRIs o Serotonin norepinephrine reuptake inhibitors SNRIs o Miscellaneous Tricyclic Antidepressants Have largely been replaced by SSRIs as first line antidepressant drugs Considered second line o For patients who fail with SSRIs or other newer generation antidepressants o As adjunct therapy with newer generation antidepressants amitriptyline Elavil o Use for TMJ migraine headaches tinnitus adjunct therapy for chronic pain and antidepressant Good for post partum depression o Can cause cardiac dysrythmias o Puts you to sleep Mechanism of Action o Block reuptake of neurotransmitters causing accumulation at the nerve endings o It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression Indications o Depression o Childhood enuresis imipramine bed wetting o Obsessive compulsive disorders clomipramine o Adjunctive analgesics for chronic pain conditions such as trigeminal neuralgia nerve inflammation o Eating disorders Adverse Effects o Sedation Biggest problem o o o o o Impotence Orthostatic hypotension Overdose Others Older patients Dizziness postural hypotension constipation delayed micturation edema muscle tremors EPS Overdose o Lethal 70 to 80 die before reaching the hospital o CNS and cardiovascular systems are mainly affected o Death results from seizures or dysrhythmias o No specific antidote Decrease drug absorption with activated charcoal Speed elimination by alkalinizing urine Manage seizures and dysrhythmias Basic life support Monoamine Oxidase Inhibitors MAOIs Highly effective Considered second line treatment for depression not responsive to cyclics o Seriously ill or depressed used later on when nothing else works last resort Disadvantage potential to cause hypertensive crisis when taken with tyramine o Have a lot of food interactions Examples o phenelzine Nardil o tranylcypromine Parnate Mechanism of Action o Inhibit the MAO enzyme system in the CNS o Amines dopamine serotonin norepinephrine are not broken down resulting in higher levels in the brain o Result alleviation of symptoms of depression Indications o Depression especially types characterized by reverse vegetative symptoms such as increased sleep and appetite o Depression that does not respond to other drugs such as tricyclics Adverse Effects o Few adverse effects orthostatic hypotension most common o Tachycardia Dizziness Insomnia Anorexia Blurred vision Palpitations Drowsiness Headache Nausea and Impotence Overdose o Symptoms appear 12 hours after ingestion o Tachycardia circulatory collapse seizures coma o Treatment protect brain and heart eliminate toxin Urine acidification Hemodialysis MAOIs and Tyramine o Ingestion of foods or