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List of psychiatric medications

Psychiatric medications used for mental illness or distress. Prescription information including Drugs class (i.e Mood Stabilizers), uses, mechanism and side-effects.

Drug Name Class Examples Mechanism Uses Side Effects Notes
Monoamine Oxidase Inhibitors (rarely used) Antidepressants (60% 1st response) Phenelzine, Tranylcypromine Irreversible inhibition of MAO; increases norepinephrine, dopamine, serotonin Depression Orthostatic hypotension, hypertensive reaction to tyramine, sexual dysfunction, GI problems, edema Iproniazid for TB, withdrawn due to hepatotox; must low tyramine diet, NO OTC cold medicines (hypertensive crises), take off other a-Depression drugs 1-2 wks, lethal OD
Tricyclics (not used as much) Antidepressants (60% 1st response) Imipramine, Amitriptyine, Nortriptyline (can get bld levels), desipramine Block reuptake of norepinephrine and serotonin only Depression Sedation, orthostatic hypotension, EKG changes, dry mouth, constipation (start metamucil), lethal in OD, uniquely effective in some old ppl use after SSRI, SNRI, maybe used for chronic pain
SSRIs Antidepressants (60% 1st response) Fluoxetine, Sertraline, Paroxetine, Fluvoxamine, Citalopram, Escitalopram Block reuptake of serotonin Depression Headaches, GI upset, delayed ejaculation (sexual dysfunction), sedation, activation (sleep, anxiety) 1st line of treatment, once a day dose, NOT lethal in OD
Dual Action (SNRIs) Antidepressants (60% 1st response) Venlafaxine, Duloxetine, nefazodone, Bupropion (little sexual dysfxn), Mirtazapine Block reuptake of norepinephrine, serotonin, +/- dopamine Depression, SSRIs first, Dual action second, SSRIs - anxiety, TCAs - chronic pain Venlafaxine (increased diastolic BP, GI distress, withdraw, stim/anxiety), Duloxetine (Gi distress, sedation, dizziness), Bupropion (stimulating, lowers seizure threshold, tachycardia/HTN, no sex dysfxn), Mirtazapine (sedating, fatness, low sex SE) use in pts who don't respond to SSRI
ECT Antidepressants (60% 1st response) increased Glu, decreased NMDA receptor fxn        
*all work via Inositol depletion, GSK-3/Wnt signaling? Mood Stabilizers Lithium (dec inositol) Unknown Acute mania, prophylaxis of mania/depression, antidepressant augmentation, maintenance Thirst, polyuria, tremor, weight gain, hypothyroidism, interstitial nephritis, high levels (delerium, seizures, RF, dysarthria, ataxia) measure bld lvls, NSAIDs, Thiazides increase Li level
Anticonvulsants, Lamotrigine Mood Stabilizers Lamotrigine Not given Bipolar depression, prophylaxis of depression>mania, MAINTENANCE Rash, Stevens-Johnson slowly titrate drug
Anticonvulsants, Divalproex (dec inositol) Mood Stabilizers Divalproex (dec inositol) Valproic acid x 2, cleaved when ingested Acute mania, no use in maintenance Nausea, diarrhea, tremor, sedation, ataxia, alopecia, weight gain measure bld levels
Anticonvulsants, Carbamazepine (dec insotitol) Mood Stabilizers Carbamazepine (dec insotitol) Tricyclic structure, unique absorption (erratic) Acute mania, prophylaxis against relapse Vertigo, nystagmus, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), hepatic failure, pancreatitis measure blood levels, as autoinduces metabolism of itself, lethal od
Classic (phenothiazine) Neuroleptics (antipsychotics) Fluphenazine (piperazine), Chloropromazine (some anti-hist, Cl+alkyl), Haloperidol (Pure D2 blocker, no fatness), Promazine (no Cl, Alkyl) Blockade of dopamine receptors (extrapyramidal regions, limbic regions, hypothalamic sites) Schizophrenia, Mania? Parkinsonian, akathesia, tardive dyskinesia, othostatic hypotension+sedation (most in alkyl drugs, from block of a adrenergic R), weight gain only affects positive sx's, neuroleptics with more anti-cholinergic activity are LESS likely to cause extrapyramidal effects, piperazine+halo/risperid (less anti-Ach) have high EP SE's
Atypical Neuroleptics (antipsychotics) Clozapine, Olanzapine, Risperidone, quetiapine, ziprasidone (inc QT interval), Aripiprazole (inhibits DA release pre-synaptically, less fatness) Blockage of dopamine receptors, blockage of 5HT2 serotonin receptors Schizophrenia, Mania? Do NOT use in AD, causes inc mortality Lesser extrapyramidal side effects, benefit negative symptoms, Clozapine (no tardive dyskinesia, v sedating, anti-cholinergic, big weight gain b/c block Hist1 R, agranulocytosis, drooling), Others (less sedating) benefits neg + positive sx's, clozapine and olanzapine both have rare EP SE's are very antiAch, but are very sedative and hypotensive
Benzodiazepines Sedatives Short (oxazepam, temazepam, lorazepam), close to glucuronide rxn in liver), Int, Long Binds BZD receptor (near GABA), opens Cl- channel, suppresses postsynaptic neuron Short-term sleep Don't use with alcohol or other CNS stimulants, as age goes up, use less BZD; ONLY use as short tern hypnotic b/c tolerance develops (awake during last part of night) oxazepam, temazepam, lorazepam, NOT metabolized by 1st pass enzymes, lethal overdose very rare, UNLESS with EtOH
Imidazobenzodiazepine Sedatives Flumazenil Displaces BZD from receptor, no effect on GABA transmission, specific for CNS BZD overdose Seizures (chronics BZD users), resedation VERY short acting
Z Drugs, Zolpidem NON BZD Sedatives Zolpidem NON BZD Binds BZDR, less effect on stages of sleep Sleep? Few anxiolytic, anticonvulsant, muscle relaxant effects, BZD side effects VERY long acting, along with diazepam, so if OD need to constantly give flumazenil
Z Drugs, Zalepon NON BZD Sedatives Zalepon NON BZD Binds BZDR Sleep? - low potential for abuse Next day somnolence, anterograde amnesia, withdraw (seizures), rebound insomnia (high doses)  
Z Drugs, Eszopiclone NON BZD Sedatives Eszopiclone NON BZD Binds BZDR Sleep? Same as BZD  
Barbituates Sedatives None Bind near GABA, not same site as BZD, increased duration BUT NOT frequency of openings of Cl- channel Rarely used more addicting, more withdrawl sx's than BZD rarely used as sedative and hypnotic
Melatonin Mimics Sedatives Ramelteon Melatonin receptor agonist, selective for M1/2 (circadian), NOT M3 Sleep Hormonal problems (prolactin), Don’t give with CYPA12 or CYP3A4 inhibitors such as fluvoxamine (SSRI) and ciprofloxacin, teratogenic, high-fat meals impair absorption, rifampin induces metabolism M1 regulates sleepiness, M2 is for biological clock
Antihistamines Sedatives Diphenhydramine N/A Sleep Tolerance develops rapidly, next day sedation, dry mouth, urinary retention  
Antidepressants , trazodone Sedatives trazodone sedative      

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