1. Psychopharmacology
Manuel D. Reich, DO

2. Psychopharmacology
The study and practice of the effects that drugs have on mood and behavior
A wide range of substances from plant sources to metals
Neuropsychopharmacology: the relationship between drugs and the cells in the nervous system that casue change in mood and behavior
Psychoactive drugs cause chemical interactions between target receptors in the CNS

3. History India: Fly Agaric 10,000 BCE
Hunter/Gather/Tribes: Hallucinogenic Drugs
Farming: cannabis, opium herbs, farming societies fermentation  alcohol
Scientific Revolution: rejection of herbs and natural preparations
20th Century: psychiatric drugs as a by-product of organic compounds and reassessment of traditional remedies

4. Psychoactive Categories
Antidepressants: TCA, MAOI, SSRI, SNRI, Other
Alcohol; a depressant
Anxiolytic: Benzodiazepines
Antipsychotic: 1* , 2*, 3*
Stimulants : Amphetamines
Mood Stabilizer: Anti-seizure
Hypnotic
Cannabis
Opiates: Narcotic analgesic
Hallucinogens
Hormones
Neurotransmitters

5. Research & Development
Chemical Models:
In relation to CNS anatomy and physiology
Designed based on organic properties
Physical properties
Mechanical properties
Neurotransmitters
Re-evaluation of existing medications

6. Specific Testing FDA Guidelines Lab chemical analysis Animal models
Human testing
Benefit over placebo
Distinct number of studies

7. Mental Illness and Medications
Significant percentage Americans suffers a diagnosable mental illness in any six month period
Significant percentage of these people will improve or recover if they get treatment
All medicines have effects based on their positive and negative effects
Chemical properties:
Therapeutic effect
Side effect

8. Mental Illnesses and Medications
People suffering from many mental illnesses have imbalances in brain physiology
The neurotransmitters
↓ Transmission
↑ Re-up take
∆ Production
? Anatomy ? Receptor – Neuroreceptor function

13. Nomenclature Diagnosis Physiological Action/ Administration SSRI
Anti-depressant
Anti-anxiety
Anti-psychotic
Anti-epileptic
Physiological Action/ Administration
SSRI
Stimulant
Transdermal
NSRI
Oral
Depot
Typical
Atypical
ODT

14. Chemical Formula
Receptor
Clinical Effect
Mood Stabilizer
Pain
Anxiolytic
Hypnotic
Anesthesia
Recreation
Ritual/Spiritual
Military

15. Generic Name Trade Name ® Clinical Utilization “Off Label” Use
FDA Indication
Age
Diagnosis
“Off Label” Use
Pharma
Medical

16. Anti-Depressants
Depression afflicts millions Americans in any six-month period
Profound and unremitting sadness, hopelessness, helplessness, guilt and fatigue, no happiness or joy in activities once enjoyed or being irritable for greater than 2 weeks
Depression can be lethal, patients are at high risk for suicide
80% of patients suffering from major illness respond well to treatment
Psychiatrists usually recommend treatment with anti-depressant medications for a minimum of six months after a 3 month stabilization period ( months)
Longer for multiple episodes especially after age 40

17. Anti-Depressant Medication
The classes of medication are used as anti-depressants
Tricyclics
MAOIs
SSRI (Specific Serotonin Re-Uptake Inhibitors)
SNRI (Norepinephine Serotonin Re-uptake Inhibitors)
Tetracyclic
Other

18. Tricyclic Anti-Depressants
Elavil (Amitryptiline)
Norpramin (Despiramine)
Tofranil (Imipramine)
Pamelor (Nortryptiline)

19. Tricyclic Antidepressants
Side Effects
Blurred vision
Constipation
Light-headedness
Dry mouth
Retention of urine
Side effects generally disappear after a few weeks
More serious side effects:
narrow-angle glaucoma
seizures
Confusion
Sweating
Racing heartbeat
Low blood pressure
Allergic skin reactions
Sensitivity to sun

20. MAOI’s
Nardil
Marplan
Emsam
Diet Considerations

21. Serotonin-Specific Agents
Prozac
Zoloft
Less effect on the cardiovascular system (safer if overdose)
Generally have fewer effects than other classes of anti-depressants
Side Effects
Anxious or nervous, sleep disturbances, stomach cramps, nausea, skin rash and, rarely, sleepiness
Extremely rare cases may develop a seizure
Discontinuation syndrome
Serotonin syndrome
Celexa
Paxil
Luvox
Lexapro

22. Serotonin – Norepinephrine Reuptake Inhibition (dual action)
Fetzima
Effexor
Pristiq
Cymbalta

23. Tetracyclics and Others
Remeron
Ludiomil
Viibryd
Brintellix

24. Mood Stabilizers
Bipolar Disorder patients have symptoms of severe depression that alternate with periods of feeling normal and/or periods of excessive excitement and activity known as mania
Manic Phases may include:
Extremely high energy
Grandiose and unrealistic ideas
Spending sprees
Go for days without sleeping
Thoughts become chaotic, speak rapidly

25. Mood Stabilizer – Anti-Epileptic
Depakote
Tegretol
Lithium
Trileptal
Lamictal
Neurontin
Topomax
Atypical Anti-psychotics

26. Effective in controlling wild thoughts and behaviors of mania
Treats manic symptoms in seven to ten days and reduces depressive symptoms
Effective in controlling wild thoughts and behaviors of mania
Side Effects
Tremor
Weight gain
Nausea
Diarrhea
Confusion
Slurred speech
Fatigue
Weakness
Difficulty walking
Blood count changes
Liver changes
Steven Johnson Syndrome

27. Atypical Anti-Psychotic
Abilify
Zyprexa
Geodon
Seroquel
Risperdal
Rexulti
Metabolic Syndrome

28. Anti-Anxiety Medications
Generalized anxiety
Phobias – a strong persistent fear of objects, activities, persons and situations, which is excessive, and unreasonable and interferes with life function and is beyond self control
Panic disorders:
Panic disorder has both physical and mental symptoms
Obsessive-compulsive disorder
Repeated, unwanted and often very disturbing thoughts and/or ritualistic behaviors and actions
Post-traumatic stress disorder

29. Anxiolytics SSRI NSRI Anti-psychotic TCA Azaspirodecanediones (Buspar)
Benzodiazepines
Barbiturates
Sedative hypnotics

30. Variable drugs in all classes Chronic and acute indications
Side Effects
Depends on class and type
Sedation
Dependence

31. Antipsychotic Drugs Psychosis is a symptom, not a disease
Part of several mental illnesses such as schizophrenia, bipolar disorder, major depression
Psychosis alters person’s ability to test reality as shown by alteration of:
Any/all of the five senses (hallucination)
Thinking and communication (formal thought disorder)
Ideation (paranoia, delusions)

32. Example: Schizophrenia Bipolar Disorder Brief Reactive Psychosis
Delusional Disorder
Schizoaffective Disorder

33. Medications
Abilify, Clozaril, Geodon, Haldol, Prolixin, Risperdal, Seroquel, Stelazine, Trilafon, Zyprexa, Navane, Loxitane, Moban, Mellaril
Side Effects: dry mouth, blurred vision, constipation and drowsiness
Other Side Effects: photo sensitivity, blood cell count, low blood pressure, parkinsonism, tardive dyskinesia, movement disorder
Metabolic syndrome, weight gain

34. Insomnia Sedative hypnotics Barbiturates Narcotics Lunesta Sonata
Ambien
Barbiturates
Narcotics

35. Stimluants Amphetamine products Methylphenidate products
These are named for the believed pharmacological action of stimulating the neurotransmission in the CNS
Long and short acting preparations
Coverage is from 2 – 10 hours depending on the preparation; each dose is discreet

36. Stimlulants II Methylphenidate products are for 5 and older
Amphetamine products: Dexedrine, Adderall, Vyvanse
Methylphenidate products: Ritalin, Focalin, Concerta
Listed short to long acting

37. Non-Stimulants Strattera Alpha agonists (short and long acting)
Clonidine
Tenex

38. Q & A