Drugs Used in Mental Health
Antianxiety Drugs
Antianxiety Drugs
• Anxiety – a feeling of apprehension, worry, or uneasiness that may or may not e based on reality
• Anxiolytics – another name for antianxiety medications
Antianxiety Drugs
• Block neurotransmitter receptor sites preventing anxious feelings from reaching brain
• Also prevents body’s physical reaction to anxiety
Antianxiety Drugs
Common Uses
• Anxiety disorders and panic attacks
• Preanesthetic sedation and muscle relaxants• Convulsions or seizures - diazepam (Valium)
• Alcohol withdrawal
Antianxiety Drugs
• Benzodiazepines– diazepam (Valium) half life: 36-200 hr
– clonazepam (Klonopin) half life: 18-50 hr
– chlordiazepoxide (Librium) half life: 5-25 hr
– alprazolam (Xanax) half life: 6-12 hr
– lorazepam (Ativan) half life: 10-20 hr
Antianxiety Drugs
• Nonbenzodiazepines– doxepin (Sinequan) half life: 28-52 hr
– buspirone HCl (BuSpar) half life: 2-3 hr
* buspirone (BuSpar) drug of choice with elderly because it does not cause excessive drowsiness and poses less fall risk
Antianxiety Drugs
Side Effects / Adverse Reactions
• Drowsiness / sedation
• Lightheadedness / dizziness
• Headache, visual disturbances
• Lethargy, apathy, fatigue
• Confusion, restlessness, agitation
• GI disturbances, dry mouth
Antianxiety Drugs
• Benzodiazepine Toxicity– Results from overdose
– Sedation, respiratory depression, coma, death
– Antidote: flumazenil (Romazicon)
• Parenteral Alert– IM, IV route may lead to apnea and cardiac arrest
– Use care with elderly, debilitated, respiratory compromised
Antianxiety Drugs
High Risk for Physical Dependence• Long term use• Tolerance• Physical dependence• Withdrawal symptoms
After 3 months of use, do NOT discontinue abruptly
Antianxiety Drugs
Withdrawal Symptoms
• Increased symptoms of anxiety
• Fatigue, hypersomnia
• Metallic taste, nausea, sweating
• Headache, difficulty concentrating
• Cramps, tremors
• Hallucinations, convulsions
Contraindications
• Psychoses
• Acute narrow angle glaucoma
• Pregnancy– Floppy infant syndrome
• Lactation– Infant becomes lethargic and loses weight
• Significant hypotension / bradycardia
Precautions
• Use cautiously with elderly– Initial Low Dose: excreted more slowly, high risk
for toxic levels
– Exception: lorazepam (Ativan), safe for elderly at usual ranges
• Use cautiously in patients with– Impaired liver function
– Impaired kidney function
– Overall debilitation
• Avoid alcohol
Interactions
• Other CNS depressants: Increased risk of sedation, confusion, convulsions– Alcohol– Narcotic Analgesics– Other Psychotropics
• Digoxin– Increased risk for Digitalis Toxicity
Antidepressants
• Depression – feelings of hopelessness that interfere with daily functioning
Antidepressants
• Neurotransmisson– Important Neurotransmittors• Dopamine• Epinephrine• Norepinephrine• Serotonin
Antidepressants
Types of Antidepressants
• Tricyclic Antidepressants (TCA’s)
• Monoamine Oxidase Inhibitors (MAOI’s)
• Selective Serotonine Reuptake Inhibitors (SSRI’s)
• Miscellaneous
Antidepressants
• Tricyclic Antidepressants (TCA’s)– Earliest antidepressants
– Enhances movement of serotonin from one neuron to the next
– Examples• Doxepin (Sinequan)• Imipramine (Tofranil)
Antidepressants
• Tricyclic Antidepressants (TCA’s)–Uses• Depressive episodes• Bipolar disorder• Obsessive – compulsion disorder• Chronic neuropathic pain• Depression accompanied by anxiety• Enuresis
Antidepressants
• Tricyclic Antidepressants (TCA’s)– Side Effects• Anticholinergic-like side effects (insomnia,
dry mouth, lethargy, confusion, blurred vision, urinary retention)• Constipation• Photosensitivity
Antidepressants
• Tricyclic Antidepressants (TCA’s)–Contraindications and Precautions• Use with caution in patients with cardiac
history• Do not give during pregnancy or lactation• Use with caution with hyperthyroid disease• Use with caution with seizure disorder• Use with caution with hepatic / renal
impairment
Antidepressants
• Tricyclic Antidepressants (TCA’s)– Interactions• Avoid other CNS depressants, including alcohol
• Dicumarol (similar to warfarin): increased bleeding times
• Cimetidine (Tagamet): increased anticholinergic-like effects
• MAOI’s: hypertension, convulsions, fever
• Adrenergics: arrhythmias, hypertension
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)–No longer in common use
– Inhibit the enzyme responsible for inactivating (destroying) certain neurotransmittors
– Example• Phenelzine (Nardil)
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)–Uses• Depressive episodes• Unlabelled used: bulemia, night terrors,
migraines, seasonal affective disorder (SAD), multiple sclerosis
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)– Side Effects• Orthostatic hypotension• Anticholinergic-like side effects (insomnia,
dry mouth, lethargy, confusion, blurred vision, urinary retention)• Constipation• Hypertensive Crisis
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)–Hypertensive Crisis with Foods
Containing the amino acid Tyramine• Cheese• Wines (especially red)• Caffeine• Soy
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)– Symptoms of Hypertensive Crisis• Headache (usually occipital)• Stiff, sore neck• Nausea, vomiting• Sweating, fever, chest pains, mydriasis• Severe hypertension
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)– Contraindications and Precautions• Use with caution in patients with cerebrovascular
disease
• Use with caution in patients with history of hypertension and/or congestive heart failure
• Do not give to pregnant women or children
• Use with caution with hepatic / renal impairment
Antidepressants
• Monoamine Oxidase Inhibitors (MAOI’s)– Interactions• Avoid other CNS depressants, including alcohol
• Hydrochlorothiazide: increased hypotension
• Tyramine, tryptophan: increased risk of hypertensive crisis
• TCA’s: hypertension, convulsions, fever
• Adrenergics: arrhythmias, hypertension
Antidepressants
Inhibiting Serotonin Reuptake
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Widespread use– Inhibits reuptake of serotonin, thus allowing
more serotonin to travel across neurons– Examples• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)–Uses• Depressive episodes• Obsessive – compulsion disorder• Bulemia nervosa• Unlabelled uses: menstrual disorders, post
traumatic stress disorder (PTSD), phobias
– Therapeutic Effect: 2-4 weeks
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Side Effects• Somnolence, insomnia, dizziness• Headache, tremors, weakness• Constipation, dry mouth, nausea• Pharyngitis, rhinitis• Loss of libido, erectile dysfunction• Serotonin syndrome
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Serotonin Syndrome (increased levels of
serotonin)• Increased metabolism (diarrhea, vomiting, fever)
• Increased cardiovascular (tachycardia, hypertension)
• Increased neuromuscular (agitation, ataxia, muscle spasms)
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Contraindications and Precautions• Use with caution in patients with cardiac history
• Use with caution in patients with diabetes
• Do not give until two weeks after stopping MAOI
• Use with caution with hepatic / renal impairment
• Monitor closely for serotonin syndrome during first two weeks of therapy or dosage increase
Antidepressants
• Selective Serotonin Reuptake Inhibitors (SSRI’s)– Interactions• Avoid other CNS depressants, including alcohol
• Other antidepressants: increased toxic effects
• Cimetidine (Tagamet): increased anticholinergic effects
• Aspirin, NSAID’s: increased risk of GI bleeding
• Lithium: increased risk of lithium toxicity
Antidepressants
• Miscellaneous– Brupropion HCl (Wellbutrin): often used
for smoking cessation as well as depression
–Duloxetine HCl (Cymbalta): often used for diabetic neuropathy discomfort as well as depression
Drugs Used in Mental Health
Antipsychotic Drugs
Antipsychotic Drugs
• Psychosis – affects mood and behavior
• Characterized by hallucinations and / or delusions
Antipsychotic Drugs
Common Uses
• Acute and chronic psychoses
• Bipolar illness
• Agitated behaviors associated with dementia
Antipsychotic Drugs
Common Medications
• Aripiprazole (Abilify)
• Haloperidol (Haldol)
• Risperidone (Risperdal)
• Lithium
Antipsychotic Drugs
Side Effects / Adverse Reactions
• Drowsiness / headache
• Dry mouth / constipation
• Photophobia / photosensitivity
• Extrapyramidal symptoms
• Tardive dyskinesia
• Neuroleptic malignant syndrome
Antipsychotic Drugs
Lithium Toxicity
• High levels of lithium toxic to body
• Antacids: decreased effectiveness of lithium
• Loop diuretics: increased risk for lithium toxicity
Psychotropics: Patient Teaching
• Take as directed• Do not discontinue abruptly• Avoid hazardous activity• Advise physician of all OTC medications and
supplements• Do not drink alcohol• Mouth care, hard candies, sugarless gum for dry
mouth• Fluids and fiber to prevent constipation