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Psychotropic Medications

You have probably heard of Prozac

Even...Halcion or Lithium. These are powerful medications, which benefit many people. With any prescription drug, of coarse, there may be misuse, adverse reactions, and potentially harmful results. Deciding whether medication might be beneficial to you should be a thoughtful process including your being an informed consumer and getting accurate information and an evaluation from a physician. Hopefully, this brochure will help you as a consumer. It highlighted the major psychotropic medications available today, general information about the drug, its use, and factors to consider when medication is recommended.

Psychotropic Medications

Psychotropic/psychiatric medications affect the brain and central nervous system. They alter the process of brain chemicals called neurotransmitters, which act as chemical messengers between the brain cells. Medication is prescribed when symptoms of mental or emotional illness are severe, persistent, and interfere with normal functioning. Psychotropic drugs help control symptoms such as anxiety, agitation, profound sadness, depression, disrupted patterns of appetite and sleep, confused thinking, poor concentration, altered perceptions and sensations, and discomfort from physical pain. Some psychotropic drugs are prescribed for medical and neurological disorders. On occasion, two or more medications may be prescribed to relieve multiple symptoms. Which medication is prescribed depends on an individual's unique characteristics-severity of symptoms, health, age, pregnancy, etc. All drugs require careful monitoring and may necessitate initial and ongoing lab work and blood tests, special dietary restrictions, and lifestyle changes. Some of the newer medications target specific neurotransmitters and provide more effective treatment with manageable doses and fewer side effects such as sedation and addictive qualities.

Medical Intervention

Psychotropic medications usually are prescribed by psychiatrists who are physicians trained in the diagnosis and treatment of mental and emotional problems. They are experienced in prescribing and monitoring psychotropic medication. Other physicians such as internists, family practitioners, gynecologists, and pediatricians also prescribe these drugs. Frequently, they may consult with, or recommend you meet with, a psychiatrist for diagnostic and treatment purposes. Whenever psychotropic medication is prescribed, counseling may be recommended. Counseling and medication often facilitate treatment and hasten a return to health and well-being.

What you need to know

There are several factors to consider when working with a physician to determine if psychotropic medication is appropriate for you

  • What is the diagnosis, and why is a particular medication recommended? What symptoms relief can you expect and when?
  • By all means take medication as prescribed, but what should you do if you happen to miss a dose?
  • What are common side effects (routine or predicted reactions) and how long will they last? Be ware of possible adverse reactions (such as rash, severe headaches, nausea, and vomiting, breathing difficulties, etc.) and what should you do?
  • What initial and ongoing medical tests/lab work (usually to rule out other medical problems and establish a baseline from which to gauge the therapeutic dose for you) are required?
  • How long will you be on medication, and how do you discontinue (taper off) the drug?
  • Will your routine activities or diet be restricted in any way?
  • What follow-up medication appointments and treatment sessions are required?

Remember

A doctor-patient relationship in which trust, mutual respect, and open communication exists is one of the keys to successful treatment. Medication is no magic cures for emotional of psychological pain. The most effective treatment includes counseling whenever psychotropic drugs are prescribed. Consider your options (perhaps get a second opinion), weigh the risks, and make the best, most informed decision for yourself.

Antidepressants

Depression is a syndrome with varied causes. Multiple symptoms may include disrupted patterns of sleep and eating (too much/too little,) poor concentration, impaired memory, increased agitation or lethargy, pervasive sadness and hopelessness, etc. Discovered in the 1960's, antidepressants generally increase the level and availability of the neurotransmitters-serotonin and norepinephrine. Medication may take 4-6 weeks for full effect. An additional (interim) drug may be prescribed for 6 months to a year or longer (unusually 6 months after symptoms subside). These drugs are also used for pain management.

Brand Name Generic Name Comments
TRICYCLICS
Elavil amitriptyline TCA's discovered in the 1960's. Anticholinergic side effects: dry mouth, constipation, blurred vision, urinary retention, dizziness, etc.
Tofranil imipramine
Norpramin desipramine
Pamelor nortriptyline
Sinequan doxepin
Anafranil clomipramine
OCD (Obsessive Compulsive Disorder)
Vivactil protriptyline  
Surmontil trimipramine
MAOIs (monoamine oxidase inhibitors)
Nardil phenelzine Inhibits action of the MAO enzyme; restricted tyramine diet and use of other medications; atypical depression; panic and phobic disorders
Parnate tranylcypromine
Marplan isocarboxazid
SSRIs (selective serotonin reuptake inhibitors)
Prozac fluoxetine wide applicability; panic disorder and OCD; quick acting; fewer side effects; simpler dosage
Paxil paroxetine
Zoloft sertraline
OTHER
Wellbutrin buproprion dopamine reuptake inhibitor; rapid cycler bipolar; seizure risk
Desyrel trazodone depression with anxiety
Asendin amoxapine quick acting; potential tardive dyskinesia; seizures
Ludiomil maprotiline  
Effexor venlafaxine blocks reuptake of serotonin and norepinephrine

 

Mood Stabilizers

Bipolar (manic-depressive) mood swings alternate between extreme depression and mania (elation, grandiosity, hyperactivity, etc.). Drugs alter the metabolism, liver, kidney, and thyroid functioning, and possibly an electrocardiogram, may be required. Regular bloods tests (weekly/monthly) help establish the therapeutic dose. Short-term use of a major tranquilizer or antidepressant along with a mood stabilizer normalizes the mood range.

Brand Name Generic Name Comments
Lithium Carbonate lithium Discovered effective for mania in 1949; increased thirst and urination; fine hand tremor
Eskalith  
LITHIUM SUBSTITUTES (anticonvulsants)*
Tegretol carbamazepine Used for forms of epilepsy in the 1960's; helpful for BP (bipolar) who are nonresponsive to lithium; atypical depression (increased sleep and weight gain)
Depakene/Depakote valproic acid Increases levels of GABA neurotransmitter and inhibits abnormal nerve impulses which cause seizures; used with wide and rapid mood changes (rapid cyclers)
Klonopin clonazepam Adjunctive drug for BP (bipolar); anti-anxiety drug with potential physical dependence
*Use of anticonvulsants developed from the theory of mania known as kindling (persistent excitability in the brain causes an affective seizure or manic attack)

 

Psychostimulants

This medication increases the release of norepinephrine and causes wakefulness, alertness, and increased attention span. Prescribed for hyperactive children, and those with attention deficit disorder, it relieves distractibility, impulsiveness, and restlessness. Also, it is prescribed for narcolepsy, some depressive conditions, and for those with serious medical illness. Careful monitoring, with routine medical tests, is recommended.

Brand Name Generic Name Comments
Ritalin methylphenidate  
Cylert pemoline periodic liver function tests
Dexedrine dextroamphetamine  

 

Anti-Anxiety Drugs (Anxiolytics)

Primarily used for temporary relief of anxiety, these drugs are prescribed for panic disorder, phobias, OCD (obsessive compulsive disorder), alcohol/drug withdrawal, and symptoms related to medical problems. These drugs alter the activity of the GABA neurotransmitter and slow the limbic system. Possible drug dependence requires careful monitoring of dose, length of treatment, and tapering off the medication. Frequently, antidepressants, and more than one drug, may help relieve anxiety.

Brand Name Generic Name Comments
BENZODIAZEPINES
Xanax alprazolam short-acting; anxiety with depression, panic and phobias; potential anterograde memory (forget things that occur a few hours before taking the drug)
Librium chlordiazepoxide used with alcohol/drug withdrawal
Klonopin clonazepam used for seizure disorder; adjunctive with BP (bipolar) and psychoses
Tranxene chlorazepate  
Valium diazepam
Paxipam halazepam
Ativan lorazepam short-acting
Serax oxazepam short-acting
Centrax prazepam  
OTHER
BuSpar buspirone affects dopamine, norepinephrine and serotonin; effective long-term with generalized anxiety; non-sedating with few side effects
Benadryl diphenhydramine antihistamines; mild sedation with anti-anxiety qualities
Vistaril hydroxyzine
Equanil meprobamate high risk for dependency
BETA-BLOCKING AGENTS
Inderal propranolol short-term relief of social phobia, performance anxiety; blocks action of sympathetic nervous system; lowers oxygen demand and blood pressure; relief from migraine headaches
Tenormin atenolol social phobia/preformance anxiety; relieves high blood pressure and angina

 

Anti-Psychotics (Major Tranquilizers) (Neuroleptics)

First developed in the 1940's to calm pre-surgery patients, these drugs sedate and relieve symptoms of confused, disordered thoughts and sever bipolar mood swings. The medication reduces/blocks the dopamine neurotransmitter. Though non-addictive, these drugs are potentially harmful. Careful monitoring is required to prevent irreversible side effect. An additional medication may be prescribed to counteract side effects from the primary drug.

Brand Name Generic Name Comments
TYPICAL
Thorazine chlorpromazine  
Mellaril thioridazine low potency
Serentil mesoridazine  
Prolixin fluphenazine high potency - high risk for EPS (extrapyramidal symptoms) parkinsonian-like symptoms: muscle weakness, slow rigid movement, muscle spasms, restlessness, involuntary movement of the face, mouth, eyes, neck, etc.
Trilafon perphenazine
Stelazine trifuoperazine
Navane thiothixene
Haldol haloperidol
Loxitane loxapine
Moban molindone
ATYPICAL (dopamine and serotonin inhibitors)
Clorazil clozapine FDA approved in 1990; this has fewer side effects; targets lethargy, mood and withdrawn behavior; requires weekly blood tests to avoid risk of agranulocytosis (white blood cell abnormality)
Risperdal risperidone  
Orap pimozide requires weekly monitoring; Tourette's syndrome
DRUGS TO COUNTERACT SIDE EFFECTS (ANTIDYSKINETICS)
Cogentin benztropine  
Artane trihexyphenidyl  
Benadryl diphenhydramine  
Symmetrel amantadine  

 

Hypnotics

A complex brain function, sleep is influenced by many factors and unique to each individual. Medication is prescribed for a limited time period, at a low dose, because it fosters dependency, and has side effects with rebound insomnia. It is used as an adjunctive drug with antidepressants (which take 4-6 weeks to take effect). Rarely life threatening, sleep deprivation can impair thinking, perceptions, and physical activity. Sleep disorder clinics provide definitive diagnosis of a prolonged sleep problem.

Brand Name Generic Name Comments
BENZODIAZEPINES (acts on the thalamus, hypothalamus, and limbic system)
Pro-Som estazolam short-acting
Dalmane flurazepam  
Doral quazepam  
Restoril temazepam  
Halcion triazolam shortest acting, potential anterograde amnesia (impairs recall of new information)
BARBITURATES
Amytal amobarbital very sedating/addictive
Nembutal pentobarbital  
Seconal secobarbital  
ANTIHISTAMINES  
Benadryl diphenhydramine over-the-counter medication with sedative qualities
Unisom doxylamine
Atarax hydroxyzine  
OTHER
Noctec chloral hydrate one of the oldest (1860) - "Mickey Finn" short term effect (two weeks)
Placidyl ethclorvynol high abuse potential
Noludar methyprylon  
Ambien zolpidem