Psychiatric Drug Introduction Psychiatric medications can be broken down into the following categories: antidepressants antipsychotics bipolar medications anxiolytics Psychiatric Drug Table Antidepressants Tricyclics Name Mechanism Key Indication Key Toxicity 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) Depression Pain syndromes Convulsions Coma Cardiotoxicity Anti-cholinergic side effects Imipramine Blocks 5-HT, NE, dopamine, Ach reuptake (among many others) Bed-wetting Convulsions Coma Cardiotoxicity Anti-cholinergic side effects Non-Tricyclic SNRIs Name Mechanism Key Indication Key Toxicity Venlafaxine Duloxetine Serotonin-norepinephrine reuptake inhibitor Depression Anxiety Co-morbid headaches Diabetic peripheral neuropathy Stimulant effects Sedation Increased blood pressure SSRIs Name Mechanism Key Indication Key Toxicity Citalopram Fluoxetine Paroxetine Sertraline 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) NDRIs Name Mechanism Key Indication Key Toxicity Bupropion Weak norepinephrine-dopamine reuptake inhibitor (NDRI) Depression Smoking cessation Lowers seizure threshold Tachycardia Headache NO sexual side effects MAOIs Name Mechanism Key Indication Key Toxicity Isocarboxazid Phenelzine Tranylcypromine 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) Antipsychotics Low Potency Name Mechanism Key Indication Key Toxicity Chlorpromazine Thioridazine 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 High Potency Name Mechanism Key Indication Key Toxicity Droperidol Perphenazine D2 blockade Psychosis Extrapyramidal side effects Hyperprolactinemia Anti-muscarinic side effects Neuroleptic malignant syndrome Tardive dyskinesia Atypical SDAs Name Mechanism Key Indication Key Toxicity Clozapine Olanzapine Risperidone Quetiapine 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) Bipolar Medications Name Mechanism Key Indication Key Toxicity Carbamazepine Blocks Na+ channels Bipolar, esp. rapid cycling Trigeminal neuralgia Anti-epileptic Teratogenic Granulocytosis Aplastic anemia SIADHP450 inducer Steven-Johnson syndrome DiplopiaAtaxia 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 gainGI complications Treat overdose with carnitine Anxiolytics Name Mechanism Key Indication Key Toxicity 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