Psychopharmacology

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Psychopharmacology

• Manuel D. Reich, DO

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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

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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

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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

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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

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Specific Testing

• FDA Guidelines
• Lab chemical analysis
• Animal models
• Human testing
• Benefit over placebo
• Distinct number of studies

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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
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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

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Nomenclature

• Diagnosis
• Anti-depressant
• Anti-anxiety
• Anti-psychotic
• Anti-epileptic
• Physiological Action/ Administration

SSRI Stimulant Transdermal
NSRI Oral Depot
Typical Atypical ODT
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• Chemical Formula
• Receptor
• Clinical Effect
• Mood Stabilizer
• Pain
• Anxiolytic
• Hypnotic
• Anesthesia
• Recreation
• Ritual/Spiritual
• Military

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• Generic Name
• Trade Name
• Clinical Utilization
• FDA Indication
• Age
• Diagnosis
• Off Label Use
• Pharma
• Medical

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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 (
  9-12-18 months)
• Longer for multiple episodes especially after age
  40

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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

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Tricyclic Anti-Depressants

• Elavil (Amitryptiline)
• Norpramin (Despiramine)
• Tofranil (Imipramine)
• Pamelor (Nortryptiline)

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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

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MAOIs

• Nardil
• Marplan
• Emsam
• Diet Considerations

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Serotonin-Specific Agents

• Celexa
• Paxil

• Luvox
• Lexapro

• 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

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Serotonin Norepinephrine Reuptake Inhibition
(dual action)

• Fetzima
• Effexor
• Pristiq
• Cymbalta

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Tetracyclics and Others

• Remeron
• Ludiomil
• Viibryd
• Brintellix

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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

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Mood Stabilizer Anti-Epileptic

• Depakote
• Tegretol
• Lithium
• Trileptal
• Lamictal
• Neurontin
• Topomax
• Atypical Anti-psychotics

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• 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

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Atypical Anti-Psychotic

• Abilify
• Zyprexa
• Geodon
• Seroquel
• Risperdal
• Rexulti
• Metabolic Syndrome

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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

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Anxiolytics

• SSRI
• NSRI
• Anti-psychotic
• TCA
• Azaspirodecanediones (Buspar)
• Benzodiazepines
• Barbiturates
• Sedative hypnotics

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

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Antipsychotic Drugs

• Psychosis is a symptom, not a disease
• Part of several mental illnesses such as
  schizophrenia, bipolar disorder, major depression
• Psychosis alters persons 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)

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• Example
• Schizophrenia
• Bipolar Disorder
• Brief Reactive Psychosis
• Delusional Disorder
• Schizoaffective Disorder

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• 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

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• Insomnia
• Sedative hypnotics
• Lunesta
• Sonata
• Ambien
• Barbiturates
• Narcotics

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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

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Stimlulants II

• Methylphenidate products are for 5 and older
• Amphetamine products Dexedrine, Adderall,
  Vyvanse
• Methylphenidate products Ritalin, Focalin,
  Concerta
• Listed short to long acting

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Non-Stimulants

• Strattera
• Alpha agonists (short and long acting)
• Clonidine
• Tenex

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