Psychotherapeutic Drugs & Mental Health Disorders

• Psychotherapeutic drugs are used to treat mental and emotional disorders.
• The classes of psychotherapeutic drugs include anxiolytic, mood-stabilizing, antidepressant, and antipsychotic medications.
• Three mental health disorders include anxiety, affective disorders, and psychotic disorders.
• Treatment with psychotherapeutic drugs can be considered when emotions significantly impact an individual's daily functions.
• Some emotional situations are situational and subside with time requiring possibly short term drug therapy

Causes of Mental Health Disorders

• The causes of mental health disorders aren't fully understood.
• The biochemical imbalance theory suggests mental health disorders arise from abnormal brain chemical levels of neurotransmitters.
• Evidence suggests neurotransmitters like dopamine, norepinephrine, serotonin, histamine, acetylcholine, GABA, along with sodium, potassium, and magnesium, play a key role in maintaining health.
• Drugs used to treat mental illness work by either blocking or stimulating the release of neurotransmitters.
• People with mental health disorders may be more susceptible to other health conditions.
• Patients may self-medicate with substances due to a societal stigma regarding mental health.
• Nonpharmacological treatments include cognitive behavior therapy, drug therapy, exercise, and good nutrition.
• Refractory depression may be treated with electroconvulsive therapy (ECT), Vagal Nerve Stimulation, Transcranial magnetic therapy, electric and deep brain therapy

Anxiety

• Anxiety presents as an unpleasant state of mind with dread and fear.
• It is often based on anticipated or past experiences.
• Anxiety may be exaggerated responses to imaginary negative situations or a normal reaction to stress.
• Anxiety can occur as a result of medical illnesses.

Anxiety Disorders

• Anxiety disorders include conditions like separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, panic attack, agoraphobia, generalized anxiety disorder, and substance- or medication-induced anxiety disorder.

Anxiolytic Drugs

• These drugs reduce anxiety by decreasing overactivity in the central nervous system (CNS).
• Benzodiazepines depress activity in the brainstem and limbic system.
• Benzodiazepines increase the action of GABA (inhibitory transmitter).
• Benzodiazepines increase the availability of serotonin, norepinephrine, and dopamine in the brain.
• Buspirone (BuSpar®) is a miscellaneous anxiolytic drug that is nonsedating and non-habit forming.
• Buspirone may interact with selective serotonin reuptake inhibitors (SSRIs).
• Buspirone should not be administered alongside monoamine oxidase inhibitors (MAOIs).

Benzodiazepines

• Examples of benzodiazepines include alprazolam (Xanax®), diazepam (Valium®) and lorazepam (Ativan®).
• Adverse effects of benzodiazepines include decreased CNS activity, sedation, amnesia, hypotension, drowsiness, loss of coordination, dizziness, headaches, nausea, vomiting, dry mouth, and constipation.
• Benzodiazepine overdose is dangerous when taken with other sedatives or alcohol requiring symptomatic and supportive treatment.
• Flumazenil may be used to reverse benzodiazepine effects.
• Alcohol and CNS depressants combined with benzodiazepines can result in severe CNS depression or death.
• Interactions are more likely to occur in patients with compromised renal or hepatic function.

Alprazolam (Xanax)

• Alprazolam is commonly used as an anxiolytic treating generalized anxiety disorder (GAD), panic disorder, short-term relief of anxiety symptoms, and anxiety associated with depression.

Diazepam (Valium)

• Diazepam indications are for the relief of anxiety, management of alcohol withdrawal, preoperative sedation, reversal of status epilepticus and as an adjunct to relieve skeletal muscle spasms.
• Avoid the use of Diazepam in patients with Hepatic dysfunction.

Lorazepam (Ativan)

• Lorazepam is an intermediate-acting benzodiazepine that can be administered intravenously or intramuscularly (diluted); useful in treating acutely agitated patients.
• It is a continuous infusion for agitated patients undergoing mechanical ventilation and is used to treat or prevent alcohol withdrawal.

Buspirone Hydrochloride

• Buspirone Hydrochloride, the mechanism of action is currently unknown.
• This drug, unlike benzodiazepines, lacks sedative effects and dependency potential.
• It is administered on a scheduled basis.
• Adverse effects include paradoxical anxiety, blurred vision, dizziness, and headache.

Affective Disorders (Mood Disorders)

• Affective disorders involve mood changes ranging from mania (abnormally pronounced emotions) to depression (abnormally reduced emotions).
• Some patients may exhibit both mania and depression, a condition known as bipolar disorder (BPD).
• Depression is characterized by a sad, empty, or irritable mood accompanied by somatic and cognitive changes.
• These disorders significantly affect the ability to function.

Major Depressive Disorder

• This is defined as a depressed mood and loss of interest or pleasure for more than 2 weeks.
• At least 5 symptoms must be present almost daily: worthlessness or guilt, anhedonia, fatigue or reduced energy level, reduced motivation, appetite changes, hypersomnia or insomnia, and recurrent thoughts of death or suicide.
• It is accompanied by significant sleep disturbances in 80% of patients and remains undertreated and underdiagnosed.

Psychosis

• Psychosis is a severe emotional disorder that impairs mental function to the point where individuals cannot participate in activities of daily living.
• Hallmarks of psychosis include a loss of contact with reality.
• Examples include schizophrenia and depressive and drug-induced psychoses.

Psychotropic Drugs

• These are among the most commonly prescribed drugs in Canada.
• Drug response varies, and drug selection is often a process of trial and error.
• A common problem is nonadherence to the prescribed medication regimen often due to fears about adverse effects or associated social stigma.

Mood-Stabilizing Drugs

• Mood-stabilizing drugs are used in the treatment of bipolar disorder.
• Dopamine and Norepinephrine/Serotonin play an important role in the development of BPD.
• Effective for maintenance and acute mania
• Other drugs may be used in combination with lithium, including benzodiazepines, antipsychotic and antiepileptic drugs, and dopamine receptor agonists.

Lithium

• Lithium is the drug of choice for the treatment of mania.
• It is thought to potentiate serotonergic neurotransmission.
• At a neuronal level, lithium reduces excitatory neurotransmission but increases inhibitory (GABA).
• Has a narrow therapeutic range: acute mania requires a serum level of 1 to 1.5 mmol/L, and maintenance requires levels of 0.6 to 1.2 mmol/L.
• Levels exceeding 1.5 to 2.0 mmol/L can result in toxicity, including gastrointestinal discomfort, tremor, confusion, somnolence, seizures, and possibly death.
• Sodium levels should be kept in the normal range (135 to 145 mmol/L).
• Adverse effects include cardiac dysrhythmia, drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements, ataxia, and hypotension.
• Long-term treatment can cause hypothyroidism.
• Contraindications are dehydration, sodium imbalance, and kidney or cardiovascular disease.

Antidepressants

• First generation antidepressants, including Tricyclics, Tetracyclics and MAOIs, and second-generation antidepressants including SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and miscellaneous antidepressants.

Antidepressant Drugs

• They are the treatmentof choice for major depressive disorders.
• Most commonly used in men 25-44 and women 25-79.
• Useful in treating anxiety disorders, eating and personality disorders, migraine, chronic pain, sleep disorders, hot flashes, and PMS.
• Antidepressants increase neurotransmitter concentrations, such as serotonin, dopamine, and norepinephrine.
• Alterations in these neurotransmitters are widely believed to cause depression.
• Anxiety and depression often occur together and reinforce each other.
• Dose optimization is recommended before changing to other drugs.
• Health Canada issued special warnings about the increased potential for suicide and agitation in clinical trials and post-marketing reports.
• Requires immediate evaluation.

Tricyclic Antidepressants: Mechanism of Action

• They block the reuptake of neurotransmitters, causing accumulation at the nerve endings.
• It is believed that these drugs help regulate malfunctioning neurons.
• Tricyclic Medications have largely been replaced by SSRIs as first-line antidepressant drugs • Considered second line drugs, for patients for whom SSRIs or other newer generation antidepressants fail, and are used as adjunct therapy with newer-generation antidepressants.
• An example drug is amitriptyline (Elavil®)
• Indications:
• Neuropathic pain, insomnia
• Childhood enuresis (imipramine)
• Obsessive compulsive disorders (OCDs) (clomipramine)
• Sometimes, anorexia
• Adverse effects: -Sedation -Impotence -Orthostatic hypotension
• Overdose can be lethal
• CNS and cardiovascular systems are mainly affected
• Death results from seizures or dysrhythmias
• No specific antidote -> Decrease drug absorption with activated charcoal. -> Speed elimination by alkalinizing urine. -> Manage seizures and dysrhythmias. -> Provide basic life support.

Amitriptyline (Elavil)

• Amitriptyline is one of the oldest and most widely used tricyclic antidepressant.
• Was originally indicated for depression.
• Commonly used to treat insomnia and neuropathic pain.
• It is contraindicated with known allergies
• Pregnancy
• Recent myocardial infarction
• Adverse effects:
• Dry mouth, constipation, blurred vision, urinary retention, and dysrhythmias

Second Generation Antidepressants

• BPD, obesity, eating disorders, OCD, Panic attacks or disorders, Stress disorder, alcoholism
• They are highly bound to albumin, when given with other similar drugs may compete for binding resulting in more free drug, greater drug effect.
• Adverse effects: insomnia (partly caused by reduced rapid eye movement sleep), weight gain, and sexual dysfunction
• Selective serotonin reuptake inhibitors SSRIs are responsible for increasing serotonin levels in the brain, a neurotransmitter that helps regulate mood, sleep, memory and social behavior
• Serotonin carries signals between nerve cells in the brain _After carrying a signal, serotonin is usually reabsorbed by nerve cells in a process called reuptake
• SSRIs block this reuptake process, making more serotonin available to pass messages between nerve cells
• SSRIs are the most commonly prescribed type of antidepressant drug

Second -Generation Antidepressants

• fluoxetine
• sertraline
• paroxetine
• fluvoxamine
• citalopram
• escitalopram

Fluoxetine (Prozac)

• It is a Prototypical SSR medication class
• It is indicated for Depression, bulimia, OCD, panic disorder, and premenstrual dysphoric disorder
• It is contraindicated with known drug allergy and concurrent MAOI therapy
• Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others

Mirtazapine (Remeron)

• Mirtazapine promotes the presynaptic release of serotonin and norepinephrine •Sedation • For depression, BPD, sexual adverse effects with men and an appetite stimulant •Contra drug allergies and MAOIs •Adverse effects ;drowsiness, dreams, constipation, increased appetite and asthenia •Drug-additive CNS depressant effects Cytochrome P-450 inhibitor with alcohol • Bupropion- treatment for depression; also and aid and cessation • Smoking and sexual adverse effects secondary to ssri • Approved for Zyban cessation of treatment for Zyan with free smoking to treat dependance

Tricyclic Indications

• neuropathic pain.
• Childhood enuresis
• OCD
• Anorexia

SSRIs

• Increase serotonin levels in the brain.
• Are most commonly prescribed types

Duloxetine

• For depression
• Generalized and pain and fibromyalgia
• Dizzy headache Gl upset and hepatoxicity SSRIS- and alcohol

Antipsychotics

• They are used to treat mental illnesses like drug-induced psychoses, schizo, and autism
• Lithium , BPD depression and Tourette
• First Generation Antipsychotics for treatment is Phenothiazine, then comes 2nd generation for
• Antipsychotic and atypical antypsychotics

Antipsychotic Mechanics

• Block dometic receptor
• (limbic ganglia emotion cognitive, motor)
• Reduce tranquility

Positive and Negative Symptoms of Schizophrenia

Positive- illusions disorder

• Negative - social withdrawal blunt
• All antipsychotics show the effect of positive
• Conventional drugs are less negative and atypical positive are the best

Action

• Drugs for indications = schizo
• And mood disorders
• orchlorphen (anticholergic)
• Adverse- anemia CNS effects (drow)
• NMS , EPS treated ( benzotriazine )
• tardive dyskenia

Antipsychotic

• NMS= Potent. Life threatening
• EPS-involuntary with similar to Parkinson -Akathisia
• Treated with benzotriazine
• Weight and insulin levels •Haloperidol is a long-term treatment •Cont- hyper •Oral and intra • Useful for schizophrenia

Nursing Indications

• Drugs with sun protection
• Avoid taking it within one hour of a dose
• Avoid alcohol and other depressants
• Long term my for
• Tremors nausea. Report
• Oral can me take with medicine
• . Dizziness.

Antipsychotics

• Clogs apine ( Clozaril )
• Respiridone (Risperdal)
• ziprasidone (Zeldox)
• Aripiprzalole (Abilify)
• lurasidone (Latuda) - asenapine (Saphris)
• paliperidone (Invega)
• quetapine (Seroquel)
• olonzapine (Zyprexa)

Actions

• Blocks all special dopamine receptors
• Serotonin
• The improve
• Safe profile all
• Clozapine Blocks

Herbal Product: St. John's

• Used in depression, anxiety,ness
• May cause
• Interactions w/ SSRis
• Food with Tyramine

Drugs

• Assess the physical and emotional status
• Baseline vital signs/blood - tests on liver Nursing
• Assess counterindications
• Assess the level of consciousness
• Mouth if
• Explain med to patients' effects and
• Avoid withdraw
• Change signs for injury

Contraindications

• Therapy is for effective coping
• Avoid suicide
• Never with Alcohol
• Monitor adults
• Monitor adverse effects patients
• Adult/ wean

Interactions

• Cautious effects
• Inform with to work
• Therapeutic support close Adverse effects
• Caffine/ cig can
• Avoid alcohol, and teach families with food

Depressants to nervous system:

Drugs Reduce 1.Nervousness 2.Excitability 3.Irritability 4.Causes sleep

• Sleep a sedative Three Groups 1-Barbituates 2=Benzio 3- misc
• calm can
• calm

Benefits

• Sedative Sedative hypnos
• Anxiety
• Anxiety

Benzodiazepines

• Control the anxiety
• Reduces inducing.leep
• Skelatal muscle
• Anxiety related decrease
• Treat alcohol

Mechanism of Action

Depress CNS Affect hypothalmic in system Attach to benzodiazepine

•Does not suppress REM like.

Herbal Product

Mild headache 1.Paradoxical 2.Vertico

• *Interactions Azole grapefruit
• CNS depressants, avoid depressants
• Overdose 1.Somniolence 2,Dimished 3 supportive

Benzodiazepines

1. long acting 2.Intermediate acting
2. Short acting

• Available 1st was diazepam
• Oral use at peak Midazolam Liquids for kids

A herb

• Avoid. With draw
• Important

Kava

1.Sleep and tension 2.Yellow Skin 3.No medication

Medicine

Administer medication •Drowsiness •Use safety support

•Monitor, few or more

Explore psychotherapeutic drugs used for mental and emotional disorders, including anxiolytic, mood-stabilizing, antidepressant, and antipsychotic medications. Learn how biochemical imbalances, particularly neurotransmitter levels, contribute to mental health disorders like anxiety, affective disorders, and psychotic disorders. Understand the role of drug therapy in situational and chronic emotional disturbances.