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