Psychotherapeutic Drugs PDF

Psychotherapeutic drugs Antipsychotics ○ Typical antipsychotics (e.g., haloperidol aka Haldol) ○ Atypical antipsychotics (e.g., clozapine aka Clozaril) Antidepressants ○ Tricyclic antidepressants (TCAs) (e.g., amitriptyline aka Elavil) ○ Selective serotoni...

Psychotherapeutic drugs Antipsychotics ○ Typical antipsychotics (e.g., haloperidol aka Haldol) ○ Atypical antipsychotics (e.g., clozapine aka Clozaril) Antidepressants ○ Tricyclic antidepressants (TCAs) (e.g., amitriptyline aka Elavil) ○ Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine aka Prozac) ○ Serotonin and norepi reuptake inhibitors (SNRIs) (e.g., venlafaxine aka Effexor) ○ Monoamine oxidase inhibitor (MAOIs) (e.g., phenelzine aka Nardil) ○ Other antidepressants (e.g., bupropion aka Wellbutrin) Moodstabilizers (e.g., lithium aka Lithobid) CNS stimulants (e.g., methylphenidate aka Ritalin) Overview ○ Major psychiatric disorders include psychoses (e.g., schizophrenia) and affective disorders (e.g., depression) Psychoses – exhibit gross disturbances in comprehension of reality, has hallucinations (false perceptions) and delusions (false beliefs) Affective disorders – emotional disturbances in which mood in low (depression) or high (mania) Schizophrenia Schizophrenia ○ Most common form of psychosis (1% world’s population) ○ Hallmark symptoms of delusions, hallucinations, disorganized thinking and emotional abnormalities ○ Several forms including paranoid, disorganized, and catatonic forms EPS ○ Drug induced movement disorders with acute and tardive symptoms… Dystonia – continuous spasms and muscle contractions Akathisia – motor restlessness Parkinsonism – characteristic symptom like rigidity, bradykinesia and tremor Tardive dyskinesia – irregular, jerky movements Pharmacologic effects ○ Alleviate symptoms of schizophrenia by blocking dopamine and serotonin receptors Not fully understood why this works… ○ Receptors are blocked immediately, but drug still takes a few weeks to improve symptoms Dopamine neurotransmission  ○ Antipsychotic drugs produce 3 time-dependent changes in dopamine neurotransmission… Increase in dopamine synthesis, release, and metabolism Compensatory response to acute blockade Continued blockade leads to inactivation of dopaminergic neurons producing a depolarization blockade Reduced dopamine release from mesolimbic and nigrostriatal neurons This treats positive sx but causes EP Eventually leads to dopamine receptor up-regulation and supersensitivity to dopamine agonists May contribute to TD, a delayed type of EPS Neuroleptic malignant syndrome (NMS) ○ Severe form of drug toxicity, occurs in.5 to 1% of patients treated with antipsychotics; resembles malignant hyperthermia ○ Life-threatening, characterized by muscle rigidity, elevated T, AMS, and autonomic dysfunction (i.e., tachycardia, diaphoresis, tachypnea, urinary/fecal incontinence) ○ Managed by immediately discontinuing treatment and administering dantrolene to prevent further muscular abnormalities Typical antipsychotics Chlorpromazine aka Thorazine Fluphenazine aka Prolixin Thioridazine Haloperidol aka Haldol Mechanims ○ Typical exert their therapeutic effect as a result of D2 receptor antagonism ○ Positive symptoms usually subside in 1 to 3 weeks… Patient becomes less agitated and have fewer auditory hallucinations Grandiose or paranoid delusions subside and can sometimes disappear with continued treatment Sleeping and eating patterns normalize and behavioral improvement occurs Adverse effects ○ Akathisia – motor restlessness, feel compelled to pace, shuffle feet, or shift positions (can’t sit still) ○ Pseudoparkinsonism – rigidity, bradykinesia, and tremor ○ Dystonia – abnormal muscle tension of neck and facial muscles Fluphenazine aka Prolixin  ○ Relatively high-potency agent that produces fewer autonomic side effects but more EPS than low-potency drugs ○ Available in long-acting depot preparation for IM injection q1-3 weeks, useful for treating non-compliant patients Haloperidol aka Haldol ○ One of the most widely used antipsychotics ○ Properties similar to fluphenazine, can cause significant EPS ○ Available in long-acting depot injection ○ Also used to treat tourette syndrome Atypical Antipsychotics Clozapine aka Clozaril Olanzapine aka zyprexa Quetiapine aka Seroquel Risperidone aka Risperdal Aripiprazole aka Abilify Olanzapine aka Zyprexa ○ Chemical analogue of clozapine, has similar properties but has fewer autonomic side effects, does not cause agranulocytosis ○ Has twice affinity of 5-HT2 receptors as it does for D2 receptors, can also block D3 and D4 receptors ○ Blocks muscarinic, histamine, and ɑ1 receptors to a lesser extent than clozapine Aripiprazole aka Abilify ○ Differs slightly, partial dopamine agonist at dopamine and 5-HT1A receptors but antagonizes 5-HT2A receptors ○ Used to treat schizophrenia and bipolar disorder, adjunct in major depressive disorder ○ First drug approved to treat irritability in autistic children Affective disorders Bipolar disorder ○ Manic phase – elevated mood, inflated self-esteem (grandiosity), increased talking (pressure of speech), racing thoughts (flight of ideas), increased social or work activity, and decreased need for sleep ○ Occurs just before or just after a depressive episode ○ Episodes can last several weeks or months Antidepressant drugs ○ Depression can be treated with tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepi reuptake inhibitors (SNRIs) ○ If no response, may try monamine oxidase inhibitors (MAOIs)  Indications ○ Newer SSRIs and SNRIs used to treat depression, eating disorders and anxiety disorders ○ May also be effective in management of other conditions like fibromyalgia, autism, and premenstrual dysphoric disorder TCAs Amitriptyline aka Elavil Clomipramine aka Clofranil Desipramine Imipramine aka Tofranil Nortriptyline aka Pamelor TCAs ○ Highly effective in treating depression and several other disorders ○ Associated with high incidence of adverse effects ○ Can cause severe toxicity when taken excessively Mechanism ○ Block neuronal reuptake of norepi and serotonin by blocking norepi transporter (NET) and serotonin transporter (SERT) ○ Occurs as soon as drug administration begins, causes immediate increase in concentration of serotonin and norepi Specific drugs ○ Nortriptyline and desipramine are secondary amines formed by demethylation of amitriptyline and imipramine Secondary amines block norepi uptake more than they block serotonin reuptake ○ Amitriptyline, clomipramine, and imipramine are tertiary amines, block serotonin reuptake more than secondary amines (also produce more sedation and autonomic s/e) SSRIs Fluoxetine aka Prozac® Fluvoxamine aka Luvox® Paroxetine aka Paxil® Sertraline aka Zoloft® Citalopram aka Celexa® Escitalopram aka Lexapro® SSRIs ○ Newer class of anti-depressants ○ Most widely used drugs for treating depression and certain anxiety disorders (i.e., panic disorder and OCD) ○ As effective as TCAs but cause fewer autonomic s/e and less sedation  ○ Much safer too in regard to overdose, seldom cause arrhythmia and induce seizures Adverse effects ○ Produce fewer sedative, autonomic, and CV side effects than TCAs ○ Usually given in the morning because they increase alertness ○ May cause nervousness, dizziness, and insomnia ○ Occasionally cause male sexual dysfunction (e.g., priapism, impotence) SNRIs Venlafaxine aka Effexor® Desvenlafaxine aka Prestique® Duloxetine aka Cymbalta® SNRIs ○ Even newer drugs that are selective for both serotonin and norepi reuptake transporters ○ Unlike older TCAs, they don’t interact with other receptor types to produce adverse effects Do not block muscarinic, adrenergic, or histamine receptors Fewer autonomic, sedative, and CV s/e MAOIs Isocarboxazid aka Marplan® Phenelzine aka Nardil® Tranylcypromine aka Parnate® Selegiline aka Eldepryl® Potentially serious drug and food interactions Not considered drug of choice in treating depression Generally used as alternative therapy when pt fail to respond to other treatments