Psychotherapeutic DrugsPsychotherapeutic Drugs- Used in the treatment of emotional and mental disorderso 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 Anxietyo Affective disorders – mood disorders o Psychoses – schizophrenia - Types of psychotherapeutic drugso Anxiolytic drugs – anxiety o Mood-stabilizing drugs – bi-polar o Antidepressant drugso 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 disordero Social phobia (social anxiety disorder)o Simple phobiaAffective 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 thatthe individual cannot participate in activities of daily living- Hallmark: loss of contact with reality- Exampleso Schizophreniao Depressive and drug-induced psychosesAnxiolytic Drugs- Reduce anxiety by reducing overactivity in CNS- Benzodiazepineso Depress activity in the brainstem and limbic systemo 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 formingo May have drug interaction with SSRIs (serotonin syndrome)o Do not administer with MAOIsBenzodiazepines- 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 Effectso 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 - Overdoseo Dangerous when taken with other sedatives or alcoholo Treatment is generally symptomatic and supportiveo Flumazenil may be used to reverse benzodiazepine effectsMiscellaneous Anxiolytic- **buspirone (BuSpar) o Unknown mechanism of actiono Administered on a scheduled basis – about the same time every day o Adverse effects Paradoxical anxiety – opposite effect  Blurred vision Headache Nauseao Well toleratedo Complications: Serotonin syndrome Mood-Stabilizing Drugs- Lithium carbonate and lithium citrateo Stabilizes mood better than anything else- Other drugs may be used in combination with lithiumo Benzodiazepineso Antipsychotic drugs o Antiepileptic drugs o Dopamine receptor agonists- Lithium is the drug of choice for the treatment of maniao It is thought to potentiate serotonergic neurotransmissiono 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 diureticsAntidepressants- Tricyclic antidepressants- Monoamine oxidase inhibitors (MAOIs)- Second-generation antidepressantso Selective serotonin reuptake inhibitors (SSRIs)o Serotonin-norepinephrine reuptake inhibitors (SNRIs)o MiscellaneousTricyclic Antidepressants- Have largely been replaced by SSRIs as first-line antidepressant drugs- Considered second lineo For patients who fail with SSRIs or other newer-generation antidepressantso 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 Actiono Block reuptake of neurotransmitters, causing accumulation at the nerve endingso It is thought that increasing concentrations of neurotransmitters will correct the abnormally low levels that lead to depression- Indicationso Depressiono 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 Effectso Sedation – Biggest problemo Impotenceo Orthostatic hypotensiono Overdose o Otherso Older patients – Dizziness, postural hypotension, constipation, delayed micturation, edema, muscle tremors – EPS- Overdoseo Lethal—70% to 80% die before reaching the hospitalo CNS and cardiovascular systems are mainly affectedo Death results from seizures or dysrhythmiaso No specific antidote Decrease drug absorption with activated charcoal Speed elimination by alkalinizing urine Manage seizures and dysrhythmias Basic life supportMonoamine Oxidase Inhibitors (MAOIs)- Highly effective- Considered second-line treatment for depression, not responsive to cyclicso Seriously ill or depressed, used later on when nothing else works – last resort - Disadvantage: potential to cause hypertensive crisis when taken with tyramineo Have a lot of food interactions- Examples:o phenelzine (Nardil)o tranylcypromine (Parnate)- Mechanism of Actiono Inhibit the MAO enzyme system in the CNSo Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the braino Result: alleviation of symptoms of depression- Indicationso Depression, especially types characterized by reverse vegetative symptoms such as increased sleep and appetiteo Depression that does not respond to other drugs such as tricyclics- Adverse Effectso Few adverse effects—orthostatic hypotension most commono Tachycardia, Dizziness, Insomnia, Anorexia, Blurred vision, Palpitations, Drowsiness, Headache,Nausea, and Impotence- Overdoseo