Psychopharmacology

citalopram (Celexa), escitalopram (Lexapro),fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine(Paxil), sertraline (Zoloft)

SSRIs inhibit 5HT reuptake butdo not act on NE or dopamine

increased levels of 5HT in CNS --> Altered mental status, agitation, fever, hypotension,ataxia, hyperreflexia, myoclonus

Concern with combining any agents that increase CNS 5HT levels (SSRIs, MAOIs, TCAs, psycho stimulants,dopamine agonists, buspirone, sumatriptan, meperidine, dextromethorphan)

and

MAOI + SSRI, dextromethorphan,meperidine, TCAs, trazodone, lithium,

or

SSRI + another SSRI venlafaxine, dextromethorphan,buspirone, carbamazepine, lithium, mirtazapine, tramadol, nefazodone, sumatriptan, or “ecstasy”

Transient dizziness and vertigo, lethargy, paresthesias(paroxetine), nausea, vivid dreams, irritability

Treat by tapering dose

- Fluoxetine: longest half-life and active metabolite with longest half-life, side effects include reduced appetite

- Fluoxetine and fluvoxamine: best profile inregard to sexual side effects

- Sertraline: worst profile in regard to sexual side effects, most potent blocker of dopamine transporters, has active metabolite with short half-life

Fluvoxamine and paroxetine: no active metabolites, more likely to cause discontinuation syndrome with abrupt withdrawal of drug

Citalopram: most selective for 5HT

Paroxetine: most potent SSRI, side effects include weight gain and somnolence

• isocarboxazid (Marplan),
• phenelzine (Nardil),
• tranylcypromine (Parnate)

TCAs + alcohol, carbamazepine, phenytoin, cigarette smoking --> increased metabolism of TCAs sub therapeutic levels of TCAs

• TCA + neuroleptics, SSRIs (especially paroxetine and fluoxetine), cimetidine methylphenidate (Ritalin),quinidine, thyroid medications --> decreased metabolism of
• TCAs -->potentially toxic levels of TCAs

Nortriptyline: therapeutic window from 50 to 150 ng/mL, less effective at both very high and very low doses

Amitriptyline: therapeutic range is 75 to 175 ng/mL

bupropion, duloxetine,mirtazapine, nefazodone, trazodone, venlafaxine

DA/NE reuptake inhibitor

Indications: smoking cessation, MDD, adult ADHD

5HT/NE reuptake inhibitor

Indications: MDD, diabetic peripheral neuropathic pain

enhances NE and 5HT release via α2-antagonism, potent histamine antagonist, antagonist of 5HT2, 5HT3 receptors

Indications: MDD, improves sleep/appetite

inhibitor of serotonin uptake and weakly of NE reuptake, antagonist of 5HT2A, may selectively activate 5HT1A

Indications: MDD

blocks 5HT2 receptor, weak inhibitor of 5HT reuptake

Indications: MDD, insomnia

inhibits 5HT reuptake at lowdoses, NE/DA at higher doses

Indications: MDD, GAD, social anxiety disorder

clozapine, risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone

Aripiprazole (Abilify): partial agonist D2, 5HT1A receptors and antagonist at 5HT2A receptors

Clozapine (Clozaril): low potency, EPS/TD nearly absent, good with positive and negative symptoms, Warning—agranulocytosis potential, seizures

Quetiapine (Seroquel): low potency, few EPS, less sexual dysfunction, no prolactin increase

Olanzapine (Zyprexa): medium/high potency, fewEPS, high weight gain

Risperidone (Risperdal): high potency, few EPS,can increase prolactin, more sexual dysfunction

• Ziprasidone (Geodon): good for positive and negativesymptoms, improves cognition and depression,low EPS, not associated with weight gain
• Warning—can lead to QT prolongation

Indications:Psychotic disorders, schizophrenia, mood disorderwith psychotic features, delirium, acute mania, aggressive behaviors, psychosis due tomedical condition or substances

(subjective feelings of anxiety, tension, agitation): treat by lowering dose of antipsychotic, try β-blocker, clonidine, amantadine, or benzodiazepine

oxazepam,lorazepam, temazepam (“out the liver”)

• 1) have no active metabolites
• 2) Relatively short acting

• -Other anxiolytics, sedative-hypnotics
• - Used for generalized anxiety disorder: effects seenafter 1 to 2 weeks

- Relatively nonsedating, no abuse potential

ECT may improve both mood and motor symptoms of patients with advanced Parkinson’s disease, but effects may be short lived from days to weeks to 6 months, according to variousstudies

• -active pulmonary infection,
• -recent MI,
• -unstable CAD,
• -CHF,
• -uncontrolled hypertension,
• -space-occupying brain lesion,
• -increased ICP,
• -recent cerebrovascular accident,
• -history of anesthesia complications,
• -seizure,
• -reflux,
• -aneurysms,
• -venous thrombosis,
• -recent bone fracture (especiallycervical spine)

• -brief episode of hypotension or hypertension,
• -bradyarrhythmia or tachyarrhythmia,
• -prolonged seizures,
• -prolonged apnea (due to pseudocholinesterase deficiency),
• -postictal confusion,
• -headache,
• -nausea,
• -muscle pain,
• -memory impairment (retrograde amnesia forshort time surrounding hospitalization)

80%

inhibits inositol-1-phosphatase

Indications: mania, augmentation of antidepressants, prophylaxis of mania/depression,schizoaffective disorder, aggression, impulsivity

Concerns: thyroid/kidney, pregnancy (Ebstein’sanomaly)

enhances GABA Indications: mania, augmentation of antidepressants, alcohol withdrawal states, rapid cycling

Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869[1] to denote a condition with symptoms of fatigue, anxiety, headache,neuralgia and depressed mood.

Neurasthenia is currently a diagnosis in the World Health Organization's International Classification of Diseases (and in the Chinese Classification of Mental Disorders, translated as 神经衰弱). However, it is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[2] (popularized by William James). Today, the condition is still commonly diagnosed in Asia.

introduced in 1930s, dextroamphetamine (Dexedrine), combination of amphetamine and dextroamphetamine (Adderall)

• Clinical use:
• 1) Narcolepsy and other sleep disorders, attentiondeficit/ hyperactivity disorder in children, obesity
• 2) Has also been used for depression by augmenting antidepressant effects, neurasthenia, AIDS dementia, encephalopathy from brain injury

• b. Mechanism of action
• 1) Causes direct release of dopamine and NE from neurons
• 2) Blocks reuptake of catecholamines
• 3) Peak plasma levels in 1 to 3 hoursc.

Effects: CNS stimulation, appetite suppression, vasoconstriction, hypothermia, tolerance can developd.

Adverse effects: stomach pain, anxiety, irritability, insomnia, tachycardia, arrhythmias, dysphoria, may worsen tics, psychosis, paranoia, delusions, delirium, seizurese.

Monitor: blood pressure and pulse initially and after changes in dose, weight and height initially and several times annually

related toamphetamine, but milder stimulant (little or no abusepotential)

Modafinil (Provigil): novel stimulant for narcolepsy