Psychotropic medications/ Psychoactive Medications

• Introduced during the 1950’s

• Exert their effect in the brain, altering emotions and affecting behaviors.
• Alleviate or remove symptoms of mental illness by regulating the secretions of neurotransmitters,
thus normalizing the transmission of messages.
Primary Mechanism of actions:
• Alter amount of neurotransmitter in the synapse
• Binds to specific receptor sites at the pre-synaptic and postsynaptic neurons
NOTE: it is used to modify behavior, relieve the symptoms of the illness but does not cure it.
Antipsychotic Medications
• Also known as “neuroleptics”
• Blocks dopamine receptors in the brain thereby reducing psychotic symptoms of the patient.
Contraindications
• Hypersensivity to the drug
• CNS depression
• Blood dyscrasias
• Liver and renal insufficiency
• Use with caution in diabetics, elderly and debilitated
• If used with alcohol = results to respiratory depression
• Cigarette smoking reduces plasma concentration of antipsychotics.
• If used with beta blockers ( antiHPN) = hypotension
• If used with antidepressants = increases antidepressants concentration. If used with SSRI’s may
cause suuden onset of EPS.
2 General Classifications
• Conventional/ Typical Antipsychotics
• Atypical Antipsychotics
Conventional/ Typical Antipsychotics
• Mechanism of action : An Antipsychotic which block specific dopamine receptor sites (D2) in the
limbic areas of the brain, brain hypothalamus and cerebral cortex, an action believed to reduce
psychotic symptoms.
• It also blocks the dopamine receptor in the basal ganglia causing the EPS and other side effects.
Indications
• relieves the patient of his positive (+) symptoms (eg. Hallucinations, delusions, paranoid thinking,
poor reality contact) which may occur in clients with schizophrenia, bipolar disorder and cognitive
impairment disorders.
• Also indicated for patients with severe agitation, rage or combativeness and hyperactive states.
Also used in treatment of tics, intractable vomiting, hiccups and vertigo.
Commonly used Conventional Antipsychotic
High-Potency Antipsychotic Drugs
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

Moderate-Potency Antipsychotic Drugs

• Loxapine (Loxicate)
• Molindone (Moban)
• Perphenazine (Trilafon)
Low-Potency Antipsychotic Drugs
• Chlorpromazine (Thorazine)
• Thioridazine (Mellaril)
• Chlorprothixene (Taractan)
Contraindications

• Any known allergic reaction to antipsychotics.

• In patients with severe CNS depression due to excessive alcohol or narcotic use, brain damage or
trauma, elderly and debilitated patients.
• Patients with blood dyscrasias
• Patients with narrow angle glaucoma –causes, increase ICP
-- Prostatic hypertrophy
Side effects
• Sedation/drowsiness
• Orthostatic Hypotension
• Depressed Hypothalamic Function
Extrapyramidal Syndrome (EPS)
4 symptoms
• Acute Dystonia
• Psuedoparkinsonism / Parkinsonnian Syndrome
• akathisia
• Tardive dyskinesia
Atypical Antipsychotics
• Mechanism of Action: Block dopamine receptor in the limbic system and affect serotonin
receptors in the cortical areas of the brain.
• Advantages over Typical/Conventional Antipsychotics: They reduce positive (+) symptoms
and negative (-) symptoms (Blunted affect, apathy, social withdrawal), they have decreased or no
EPS effects, It does not cause Tardive Dyskinesia.
Common Side Effects
Effects are similar those of conventional antipsychotic but usually of lesser severity. Atypical are
usually well tolerated by the patients.
toxic side effect
Seizures
Hematologic Effects
Commonly used Atypical Antipsychotics
• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Sertindole (Serlect)
• Ziprasidone (Zeldox)
ANTIDEPRESSANTS
3 Classifications
1. TRICYCLIC ANTIDEPRESSANT
2. MONOAMINE OXIDASE INHIBITORS (MAOIs)
3. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
TRICYCLIC ANTIDEPRESSANT
Mechanism of Action:
Blocks reuptake of norepinephrine, serotonin, acetylcholine, and dopamine thus increasing their
concentration in the synapse.
Indications:
• TCAs are used to treat depression, including symptoms of depressed mood, loss of interest in
activities or pleasure, altered sleep patterns and somatic complaints.
• TCAs are also used to treat anxiety symptoms that may occur as a part of the depressive
disorder.
• TCAs are also used to treat anxiety disorders, like panic attacks, phobic disorders and OCD
(Anafranil)
Side Effects
Anticholinergic S/E includes: dry mouth, blurred vision, hand tremors, urinary retention and
constipation.
Cardiovascular S/E: arrythmias, and heart failure.
GI Effects: anorexia and nausea
CNS effects: sedation and fatigue, decreased libido
Toxic effects
• not usually well tolerated by the patients as high doses can cause irregularities in heartbeat and
cardiac toxicity.
• overdose can be lethal: results to sedation, ataxia (loss of muscle coordination), agitation, stupor,
coma, convulsions and respiratory depression.
• agranulocytosis
• seizures
• serotonin syndrome – occurs as a result increased serotonin bioavailability thus resulting to
hypothermia, altered muscle tone or hyperflexia, altered consciousness, tachycardia, and
diaphoresis
Contraindications
• pts with CV diseases.
• pts with glaucoma (can cause increased IOP)
• pts with BPH
• liver and renal diseases
Commonly used TCAs
• Amitriptyline (Elavil)
• Imipramine (Tofranil)
• Clomipramine (Anafranil)
• Desipramine (Norpramine)
MONOAMINE OXIDASE INHIBITORS (MAOIs)
Mechanism of action: MAOI inhibits the enzyme monoamine oxidase which is responsible for
breaking down excess serotonin and norepinephrine at the synapse. When the enzyme MAO is
inhibited serotonin and norepinephrine remains active in the synapse.
Indications:
Used for treatment of depression. Most effective in treatment of Atypical Depression (s/s of
overeating and over sleeping, weight gain, highly reactive emotions, marked anxiety, at times
sleeplessness)

Side Effects:
1. swelling of legs and ankles.
2. Decreased libido
3. CNS stimulation which may result to anxiety, agitation, restlessness, insomia.
Toxic Effects:
1. Agranulocytosis
2. Hepatic toxicity
3. Hypertensive Crisis
4. Lethal effects if combined with other antidepressants.

Contraindications:
1. Cardiovascular dse or history of stroke
2. Hyperthyroidism
3. Patient’s for surgical procedure- should be discontinued 2 wks prior surgery.
Commonly used MAOIs:
Phenelzine Nardil
Tranycypromine Parnate
Isocarboxazid Marplan
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Also known as Atypical Antidepressants.
DOC of most psychiatric practitioners because it is well tolerated by the patients, has fewer side
effects and lower risk.
Mechanism of action: blocks reuptake of serotonin in the synapse. Because other neurotransmitters
are not affected, these medications have lesser side effects compared to MAOIs and TCAs.
Indications
For treatment of depressive disorders, symptoms of depression, depression in substance abuse and
organic brain disorder.
Also used in treatment of anxiety disorders such as OCD, social phobia, PTSD and panic disorder.
Used for management of eating disorder with depression.
Alleviation of dysphoria of PMS and for treatment of enuresis.
Side Effects / Management
Insomia – take the dose early in the day, eliminate caffeine, use relaxation measures before going to
bed.
Headache – may use analgesics as prescribed. If headache becomes severe, then may require
discontinuance of the medication.
Weight Loss – Encourage adequate caloric intake. Use with caution in patients with eating disorder.
Sexual Dysfunction – Anorgasmia in women and ejaculatory dysfunction in men. If problem persists,
another antidepressant may be recommended.

Contraindications:
1. use with caution in patients with cardiac arrhythmias.
2. with hypersensitivity reactions
3. Severe hepatic and renal disease
4. Seizures
5. Diabetes mellitus
Commonly used SSRIs
• Citalopram Celexa
• Fluoxetine Prozac
• Sertraline Zoloft
Other classifications
SRIs – Serotonin Reuptake Inhibitors
• Buproprion Welbutrin – may cause seizure
• Trazodone Dysrel - risk for digitalis toxicity if taken
together
• Venlafaxine Effexor - risk for hypertension

SNRIs – Selective Norepinephrine Reuptake Inhibitors

• These drugs are still under development, only Mirtazaple (Remeron) has been FDA approved.
• Common S/E: Insomia, dry mouth, constipation and Tachycardia
Other Information
1. Effects of the drug usually take place 3 weeks to 1 month after initial dose.
2. Do not discontinue the drug prematurely.
3. the drug may alleviate depression of the patient, but suicidal thoughts and ideation may persist.
ANXIOLYTICS /ANTI-ANXIETY AGENTS
• Supplementary medications in psychiatry, but also widely used in medical setting (pre-op and post
op sedation)
• Also known as SEDATIVE- HYPNOTICS
• Chemical classification : BENZODIAZEPINES
• Mechanism of action : Potentiates the effect of GABA (modulator or
• Other neurotransmitter) which result to a CALMING EFFECT but does not modify psychotic
behavior.
Conraindications

• Combination with CNS depressants.

• Patients with renal or hepatic failure
• History of drug abuse, depression and suicidal tendencies.

Other important Health Teachings:

• Avoid activities that need alertness and attention such as driving or operating heavy machinery.
• Discontinuance causes withdrawal symptoms.

Commonly used Anxiolytics

• Chlordiazepoxide Hcl (Librium, Lipoxide)

• Diazepam ( Valium, Diastat)
• Alprazolam (Xanax, Xanor)
• Oxazepam (Serax)
• Clorazepate (Tranxene)
• Clonazepam ( Kloponin )
• Buspirone Hcl (Buspar) nonbenzodiazepine
Mood stabilizers
1.)LITHIUM
• - Conventional mood stabilizing agent
• Mechanism of action : Lithium modulates or normalizes reuptake of
• Certain neuro transmitters such as serotonin, norepinephrine, acetylcholine and dopamine. It
balances fluctuating emotions, lowers violent tendencies during the manic period and prevents
relapse.
Plasma Common side effects
lithium level
<1.5 Fine hand tremor, Mild
Thirst, Nausea muscle
weakness, restlessness.
1.5-2.0 Coarse hand Tremors,
(1.5- toxic diarrhea, vomiting,
level) drowsiness, lack of
coordination (Early sign of
toxicity)
2.0-3.0 Blurred vision, vertigo,
tinnitus, slurred, speech,
twitching hyperreflexia,
confusion
>3.0 Seizures, Arrhythmias,
peripheral vascular collapse,
COMA.

Indications
1.) Treatment of symptoms of MOOD Disorders such as mood swings, elation, flight or ideas,
aggressive, violent and self destructive
behavior.
2.)Manic episodes of the Bipolar disorder.
• Long term maintenance treatment for Bipolar disorder
• Adjunct treatment for schizoaffective disorder, impulse control
• Disorders, conduct disorder and PDD.
Side effects
• Nausea, polyuria and polydipsia, weight gain, dry mouth and fine hand tremor.
• Maintenance therapy can cause hypothyroidism, leukocytosis ( reversible once tx is d/c ), acne,
psoriasis and kidney damage.
Contraindication
• Patients with renal disease, cardiac problems, severe dehydration, Na depletion.
• Na depletion or hyponatremia can lead to marked lithium retention and possible toxicity.
• Use with caution in elderly, patients with diabetes, thyroid disorders, urinary retention and seizure
disorders.
Other Health Teachings
• Blood levels should be monitored regularly, one a month.
• If toxic side effects occur, discontinue the drug and inform health care provider.
• Increase oral fluid intake at least 2-2 L/day and eat a balanced diet with Normal Na Intake.
• Effects of lithium can be felt 2-3 weeks after initial dose. Do not discontinue medications without
doctor’s advise.
• Lithium should be taken with food.
Commonly used Lithium CO4
Lithobid, Priadel, Lithonate, Quilonum-R, Eskalith, Lithotabs

2.) Antiepileptic Medications with anti-manic properties and other mood Regulating
ANTIPARKINSONIAN DRUGS
3 Types of Anti-Parkinsonian drugs used in psychiatry
1. Antihistamines- blocks effects of Histamine resulting to Anticholinegic effects.
2. Anticholinergics- Normalize the imbalance of cholinergic/Dopaminergic transmission in the basal
ganglia.
3. AntiParkinsonism- Increase Dopamine release.

Indications
• Decreased EPS (in patients receiving Penothiazenes)
• Reverse acute dystonia by reducing severity of rigidity.
• Suppression of drooling and other signs of Parkinson’s.

Side effects:
• Dry mouth, burred vision, drowsiness, nausea.
• Orthostatic hypotension, tachycardia, palpitations.
• Confusion, memory loss.
• Urinary retention.
• Psychiatric s/s: depression & hallucinations.
• Cardiac arrhythmia if taken with Erythromycin.

Contraindications:
• Pregnancy and lactation, asmathic attacks.
• Benadryl & Cogentin – Obstruction of bladder, plylorus duodenum, protastic hypertrophy.
• Cogentin- patients with glaucoma, myasthenia gravis.
• Symmetrel- history of seizure, liver disease, eczema like rash, CHF, renal disease.

Important Health Teachings:

• Use with caution, especially when working with machineries.
• Report swelling, difficulty urinating, shortnes of breath, difficulty walking tremors or slurred speech
immediately.
• Some of the Drugs can be abused – monitoring is required.
• Commonly used AntiParkinsonian Agents

Anticholonergics / antimuscaranics
• Benztropine (Cogentin)
• Trihexyphenidyl (artane)
• Biperiden Hcl (Akineton)
• Procyclidine (kemadrin)
• Antihistamine
• Diphenhydramine Hcl ( Benadryl)
• Dopamine agonist / Antiparkinson
• Amantadine (Symmetrel)
• Ropinirole (Requip)