Psychotherapeutic Drugs Kim Edward Light, Ph.D. Professor, College of Pharmacy University of Arkansas for Medical Sciences

Objectives Identify the different categories of drugs having therapeutic value in treating CNS disorders. Identify the spectrum of disorders of brain function For each category of drugs not previously discussed  Identify therapeutic uses and indications  Present pharmacological mechanisms  Discuss specific features of drug action  Present adverse reactions and side effects  Identify contraindications and complications

Drug Categories Antipsychotics / Neuroleptics Antimanic Antidepressants Alzheimer's Antiparkinsonian Anticonvulsants Stimulant Medications Antianxiety Medications Hypnotics Narcotics - Opioid Analgesics Addiction Treatment Medications

Spectrum of Disorders 1 Attention Deficit Hyperactivity Disorder (ADHD, ADD) Autism Spectrum Disorders (Pervasive Developmental Disorders) Bipolar Disorder (Manic-Depressive Illness) Borderline Personality Disorder Depression Eating Disorders

Spectrum of Disorders 2 Generalized Anxiety Disorder  Obsessive-Compulsive Disorder (OCD)  Panic Disorder  Post-Traumatic Stress Disorder (PTSD)  Social Phobia (Social Anxiety Disorder) Schizophrenia Seizure Disorders

Traditional Antipsychotic Drugs chlorpromazine Thorazine ®, Largactil ® fluphenazine Prolixin ®, Permitil ® haloperidol Haldol ® loxapine Loxitane, Daxolin ® mesoridazine Serentil ® molindone Moban, Lindone ® perphenazine Trilafon ®, Etrafon ® pimozide Orap ® thioridazine Mellaril ® thiothixene Navane ® trifluoperazine Stelazine ®

Atypical Antipsychotic Drugs aripiprazole Abilify ® clozapine Clozaril ® olanzapine Zyprexa ®, Zyprexa ®, Zydis ® quetiapine Seroquel ® risperidone Risperdal ® ziprasidone Geodon ®

Antipsychotic Drug Adverse Reactions Tardive Dyskinesia  Involuntary movements  Long-term use and older patients  Women > men Neuroleptic Malignant Syndrome  Blood pressure up and down  Dazed and confused  Difficulty breathing  Muscle stiffness  Rapid heart rate  Sweating and shakiness  Temperature above normal

Antipsychotic Drug Side Effects Blurred vision, Dry mouth Drowsiness, Slurred speech, Dizziness Muscle rigidity Nasal congestion, Lowered blood pressure Restlessness, Slowed heart rate Sensitivity to bright light Upset stomach, Constipation Weight gain

Bipolar Disorder Drugs Lithium  Carbonate - Eskalith ®, Eskalith CR ®, Lithane ®, Lithobid ®, Lithonate ®, Lithotabs ®  Citrate - Cibalith ® Anticonvulsants Neuroleptics – atypical  olanzapine Zyprexa ®, Zyprexa ®, Zydis ®  quetiapine Seroquel ®  risperidone Risperdal ®  ziprasidone Geodon ®

Lithium Side Effects ataxia, fine hand tremor, hyperactive reflexes blurred vision, drowsiness, diarrhea, vomiting muscular weakness, dry mouth, polyuria, cardiac arrhythmia, hypotension, epileptiform seizures, coma large output of dilute urine Regular monitoring of blood levels necessary

Antidepressant Drugs Older MAO Inhibitors isocarboxazid Marplan ® phenelzine Nardil ® tranylcypromine Parnate ® Tricyclics & Quarta-cyclics amitriptyline Elavil ® amoxapine Asendin ® clomipramine Anafranil ® desipramine Norpramin ® doxepin Sinequan ® imipramine Tofranil ® maprotiline Ludiomil ® nortriptyline Pamelor ® protriptyline Vivactil ®

Antidepressant Drugs Newer SSRIs citalopram Celexa ® escitalopram Lexapro ® fluoxetine Prozac ® fluvoxamine Luvox ® paroxetine Paxil ® sertraline Zoloft ® SNRIs venlafaxine Effexor ®, Effexor ER ® nefazodone Serzone ® mirtazapine Remeron ® Others bupropion Wellbutrin ® trazodone Desyrel ®

Antidepressant Drugs Adverse Reactions MAO Inhibitors Foods containing tyramine at high levels Serotonin Syndrome Produced by combination of products that act to increase serotonin Similar to Neuroleptic Malignant Syndrome Euphoria, drowsiness, exaggerated reflexes, sweating, hyperthermia, mental status changes

Antidepressant Drugs Side Effects Older agents Dry mouth, dizziness, constipation, blurred vision, cardiac arrhythmias Orthostatic hypotension, sexual dysfunction, weight gain Newer agents Headache, nausea, nervousness, agitation, Sexual dysfunction, insomnia, weight gain Seizure risk (bupropion) Suicide or aggressive acts especially in adolescents

Anti-Parkinsonian Drugs DA Boosters L-DOPA L-DOPA / carbidopa Sinemet ® or Atamet ® entacapone Comtan ® MAO-B Inhibitor Selegiline Eldepryl ® Atapryl ® Carbex ® DA Agonists bromocriptine Parlodel ® pergolide Permax ® pramipexole Mirapex ® ropinirole Requip ® amantadine Symmetrel ®, Symadine ®

Anti-Parkinsonian Drugs Adjuncts Anticholinergics benztropine Cogentin ® trihexyphenidyl Artane ®

Anti-Alzheimer's Drugs Donepezil Aricept ® Galantamine Reminyl ® Rivastigmine Exelon ® Tacrine Cognex ® Memantine Namenda ® Side Effects  Dizziness, Confusion, Sleep problems  Increased respiratory secretions, Urinary frequency  Cardiovascular problems

Anticonvulsant Drugs carbamazepine Tegretol ® divalproex sodium Depakote ®, valproate Depacon ®, Depakene ® gabapentin Neurontin ® lamotrigine Lamictal ® levetiracetam Keppra ® oxcarbazepine Trileptal ® tiagabine Gabitril ® topiramate Topamax ®

Anticonvulsant Drugs Side Effects weight gain, memory and cognitive function disturbances, photosensitivity, dermatological sensitivity leading to rashes, sinus congestion, hair thinning, impaired absorption of B vitamins.

Summary Discussed the various major classes of drugs used to treat various mental disorders including:  Antipsychotic drugs  Bipolar disorder drugs  Antidepressant drugs  Anti-Parkinsonian drugs  Anti-Alzheimer’s drugs  Anticonvulsant drugs Psychotherapeutic Medications Information