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Psychiatric Medications
Damian Apollo

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Review Topic 3 /3 1 /1

Psychiatric Drug Introduction

Psychiatric medications can be broken down into the following categories:

antidepressants
antipsychotics
bipolar medications
anxiolytics

Psychiatric Drug Table

Antidepressants
Name Mechanism Key Indication Key Toxicity
Tricyclics

Blocks reuptake of
Amitryptyline
norepinephrine and serotonin

Depression
Pain syndromes Convulsions
Action on 5-HT, muscarinic,
Coma
Nortriptyline dopaminergic, histaminic
Cardiotoxicity
receptors (among many others)
Anti-cholinergic side effects

Blocks 5-HT, NE, dopamine, Ach

Imipramine Bed-wetting
reuptake (among many others)

Non-Tricyclic SNRIs
Venlafaxine
Depression
Stimulant effects
Serotonin-norepinephrine Anxiety
Sedation
Duloxetine reuptake inhibitor Co-morbid headaches
Increased blood pressure
Diabetic peripheral neuropathy

SSRIs
Citalopram
Serotonin syndrome (in combination with
Fluoxetine
Depression MAOi's, SNRI's, TCA's)
Paroxetine
Serotonin reuptake inhibitor Anxiety Sexual dysfunction
Social Anxiety (paroxetine) GI distress
Sertraline SIADH (manage with cyproheptadine)

NDRIs

Lowers seizure threshold

Weak norepinephrine-dopamine Depression Tachycardia
Bupropion
reuptake inhibitor (NDRI) Smoking cessation Headache
NO sexual side effects

MAOIs
Isocarboxazid
Inhibits monoamine oxidase Hypertensive crisis (with tyramine consumption)
Phenelzine Atypical depression
(MAO) increasing catecholamine Serotonin syndrome (with SSRIs, SNRIs, TCAs
Social anxiety
Tranylcypromine and dopamine levels as well as many other drugs)

Antipsychotics
Low Potency
Chlorpromazine
Extrapyramidal side effects
Hyperprolactinemia
Psychosis Anti-muscarinic side effects
D2, α1, cholinergic, histaminic
Schizophrenia Neuroleptic malignant syndrome
Thioridazine blockade
Mania Tardive dyskinesia
Corneal (chlorpromazine) and retinal
(thioridazine) deposits

High Potency
Droperidol
Extrapyramidal side effects
Hyperprolactinemia
D2 blockade Psychosis Anti-muscarinic side effects
Perphenazine
Neuroleptic malignant syndrome
Tardive dyskinesia

Atypical SDAs
Clozapine
Agranulocytosis (must monitor WBC levels)
Olanzapine Psychosis
Weight gain
Risperidone Bipolar
Anti-pyramidal symptoms (less than traditional)
Affects serotonin, dopamine, α1, OCD
Anti-cholinergic side effects
and histamine receptors Anxiety
QT prolongation
Quetiapine Depression
Hyperlipidemia (olanzapine)
Mania
Hyperprolactinemia (risperidone)

Bipolar Medications

Teratogenic
Granulocytosis
Aplastic anemia
Bipolar, esp. rapid cycling
SIADH
Carbamazepine Blocks Na+ channels Trigeminal neuralgia
P450 inducer
Anti-epileptic
Steven-Johnson syndrome
Diplopia
Ataxia

Nephrogenic diabetes insipidus

Hypothyroidism
Lithium Unknown Bipolar
Teratogenic
Ebstein anomaly (teratogenic)

Blocks voltage-gated Na+ Hepatotoxic

channels Teratogenic
Bipolar
Inhibits GABA transaminase Tremor
Valproic acid Anti-epileptic
(increases GABA) Weight gain
Absence seizure (2nd line to ethosuximide)
Blocks thalamic T-type Ca2+ GI complications
channels Treat overdose with carnitine

Anxiolytics

Sedation
Benzodiazepines (lorazepam, Increase frequency of GABA Seizures Tolerance
diazepam) channel opening Anxiolytic Respiratory depression
Dependence

Sedative
Respiratory and cardiovascular depression
Barbiturates (phenobarbital, Increase duration of GABA Anxiolytic
Dependence
pentobarbital, thiopental) channel opening Seizures
P450 induction
General anesthesia (thiopental)

Ataxia
Insomnia Headaches
Zolpidem GABA channel agonist
Muscle relaxant Confusion
Dependence

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QUESTIONS

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(M2.PH.16.4688) A 28-year-old female patient with a history of schizophrenia, type 2 diabetes mellitus, and hypothyroidism comes to clinic stating she
would like to be put back on a medication. She recently stopped taking her haloperidol as it made it hard for her to "sit still." She requests to be put on
olanzapine as a friend from a support group said it was helpful. Why should this medication be avoided in this patient? ) Tested Concept
QID: 107491

1 The patient is at a high risk for torsades de pointes

2 There is a high risk for retinopathy

3 The patient has type 2 diabetes

4 The patient may develop galactorrhea

5 Tardive dyskinesia will likely result from the prolonged use of olanzapine

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