Psychiatric Drug Introduction Psychiatric medications can be broken down into the following categories: antidepressants antipsychotics bipolar medications anxiolytics Psychiatric Drug Table Antidepressants Name Mechanism Key Indication Key Toxicity Tricyclics Amitryptyline Blocks reuptake of norepinephrine and serotonin Depression Pain syndromes Convulsions Coma Cardiotoxicity Anti-cholinergic side effects Nortriptyline Action on 5-HT, muscarinic, dopaminergic, histaminic receptors (among many others) Imipramine Blocks 5-HT, NE, dopamine, Ach reuptake (among many others) Bed-wetting Non-Tricyclic SNRIs Venlafaxine Serotonin-norepinephrine reuptake inhibitor Depression Anxiety Co-morbid headaches Diabetic peripheral neuropathy Stimulant effects Sedation Increased blood pressure Duloxetine SSRIs Citalopram Serotonin reuptake inhibitor Depression Anxiety Social Anxiety (paroxetine) Serotonin syndrome (in combination with MAOi's, SNRI's, TCA's) Sexual dysfunction GI distress SIADH (manage with cyproheptadine) Fluoxetine Paroxetine Sertraline NDRIs Bupropion Weak norepinephrine-dopamine reuptake inhibitor (NDRI) Depression Smoking cessation Lowers seizure threshold Tachycardia Headache NO sexual side effects MAOIs Isocarboxazid Inhibits monoamine oxidase (MAO) increasing catecholamine and dopamine levels Atypical depression Social anxiety Hypertensive crisis (with tyramine consumption) Serotonin syndrome (with SSRIs, SNRIs, TCAs as well as many other drugs) Phenelzine Tranylcypromine Antipsychotics Low Potency Chlorpromazine D2, α1, cholinergic, histaminic blockade Psychosis Schizophrenia Mania Extrapyramidal side effects Hyperprolactinemia Anti-muscarinic side effects Neuroleptic malignant syndrome Tardive dyskinesia Corneal (chlorpromazine) and retinal (thioridazine) deposits Thioridazine High Potency Droperidol D2 blockade Psychosis Extrapyramidal side effects Hyperprolactinemia Anti-muscarinic side effects Neuroleptic malignant syndrome Tardive dyskinesia Perphenazine Atypical SDAs Clozapine Affects serotonin, dopamine, α1, and histamine receptors Psychosis Bipolar OCD Anxiety Depression Mania Agranulocytosis (must monitor WBC levels) Weight gain Anti-pyramidal symptoms (less than traditional) Anti-cholinergic side effects QT prolongation Hyperlipidemia (olanzapine) Hyperprolactinemia (risperidone) Olanzapine Risperidone Quetiapine Bipolar Medications Carbamazepine Blocks Na+ channels Bipolar, esp. rapid cycling Trigeminal neuralgia Anti-epileptic Teratogenic Granulocytosis Aplastic anemia SIADH P450 inducer Steven-Johnson syndrome Diplopia Ataxia Lithium Unknown Bipolar Nephrogenic diabetes insipidus Hypothyroidism Teratogenic Ebstein anomaly (teratogenic) Valproic acid Blocks voltage-gated Na+ channels Inhibits GABA transaminase (increases GABA) Blocks thalamic T-type Ca2+ channels Bipolar Anti-epileptic Absence seizure (2nd line to ethosuximide) Hepatotoxic Teratogenic Tremor Weight gain GI complications Anxiolytics Benzodiazepines (lorazepam, diazepam) Increase frequency of GABA channel opening Seizures Anxiolytic Sedation Tolerance Respiratory depression Dependence Barbiturates (phenobarbital, pentobarbital, thiopental) Increase duration of GABA channel opening Sedative Anxiolytic Seizures General anesthesia (thiopental) Respiratory and cardiovascular depression Dependence P450 induction Zolpidem GABA channel agonist Insomnia Muscle relaxant Ataxia Headaches Confusion Dependence