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Antidepressants, Antipsychotics, Antianxiety Agents, and Alcoholism: Overview and Treatment Options

Learn about the different classes of antidepressants, antipsychotics, and antianxiety agents, as well as their uses, side effects, and treatment options. Explore topics such as panic disorders, sleep disorders, and alcoholism.

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Antidepressants, Antipsychotics, Antianxiety Agents, and Alcoholism: Overview and Treatment Options

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  1. Chapter 7 Antidepressants, Antipsychotics, Antianxiety Agents, and Alcoholism

  2. Chapter 7 Topics • Antidepressants • Antipsychotics • Antianxiety Agents • Panic Disorders • Sleep Disorders • Alcoholism

  3. Learning Objectives • Differentiate the antidepressant, antipsychotic, and antianxiety agents. • Be prepared to discuss the antidepressantclasses, their uses, and their side effects. • Know why and how lithium and other drugs are used in treating bipolar disorders.

  4. Learning Objectives • Be familiar with antipsychotics and the drugs that prevent their side effects. • Define anxiety, learn its symptoms, and know the drugs used in its treatment. • Recognize the course and treatment of panic disorders, insomnia and alcoholism.

  5. Antidepressants • Used to treat depression • Depression, common feelings • Pessimism • Worry • Intense sadness • Loss of concentration • Slowing of mental processes • Problems with eating and sleeping

  6. Loss of interest in usual activities Low self-esteem Self-pity Significant weight loss or gain Insomnia or hypersomnia Extreme restlessness Loss of energy Feelings of worthlessness Diminished ability to think Feelings of guilt Recurrent thoughts of death Suicide attempts AntidepressantsCommon Symptoms of Depression

  7. Antidepressants Depression • Women are affected more often than men • When men are affected, it is usually later in life • Levels of neurotransmitters in the brain may be a causative factor

  8. Mood Disorders • Mania • Bipolar Disorder • Unipolar Disorder

  9. Mood Disorders • Mania Mood of extreme excitement, excessive elation, hyperactivity, agitation, and increased psychomotor activity • Bipolar Disorder • Unipolar Disorder

  10. Mood Disorders • Mania • Bipolar Disorder Mood swings alternate between major depression and mania • Unipolar Disorder

  11. Mood Disorders • Mania • Bipolar Disorder • Unipolar Disorder Major depression with no previous occurrence of mania

  12. Discussion Describe the differences that may be seen in patients with unipolar and bipolar disorders.

  13. Discussion Describe the differences that may be seen in patients with unipolar and bipolar disorders. Answer Unipolar – Depression Symptoms Bipolar – Depression and Mania Symptoms

  14. Treatment for Depression Electroconvulsive Therapy • Introduction of brief, but convulsive electrical stimulation through the brain • Can induce seizures • Effective for major and delusional depression

  15. Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRIs) • Cyclic Antidepressants • Monoamine Oxidase Inhibitors (MAOIs)

  16. Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs) • Block the reuptake of serotonin, with little effect on norepinephrine • Fewer side effects than older meds

  17. Treatments Cyclic Antidepressants • Two Types • Tricyclic antidepressants (TCAs) • Tetracyclic antidepressants • Prevent reuptake of norepinephrine and/or serotonin • Agents in this class differ in adverse effects, cost, and response

  18. Treatments Monoamine Oxidase Inhibitors (MAOIs) Allows for buildup of norepinephrine at the synapse

  19. Drug List SSRIs for Depression • citalopram (Celexa) • escitalopram (Lexapro) • fluoxetine (Prozac,) • paroxetine (Paxil) • sertraline (Zoloft) • venlafaxine (Effexor)

  20. Dispensing Issues Look-Alike Drugs • Prozac and Proscar (urinary drug) • Zoloft and Zocor (high cholesterol) • Celexa and Cerebyx (seizures) and Celebrex (arthritis) Warning!

  21. SSRIDispensing Issues • Do not discontinue abruptly • Alcohol consumption should be avoided while taking these medications Warning!

  22. fluoxetine (Prozac) • Indicated for major depression and obsessive-compulsive disorder (OCD) • Anorexia is a possible adverse effect • Take in the morning to avoid insomnia

  23. paroxetine (Paxil) • Indicated for depression, obsessive-compulsive disorder, and panic disorder

  24. venlafaxine (Effexor) • Blocks reuptake of serotonin and norepinephrine • Indicated for depression • May cause increase in blood pressure and blurred vision

  25. sertraline (Zoloft) • Indicated for depression and obsessive-compulsive disorder • Primary side effect is nausea • May also cause drowsiness

  26. citalopram (Celexa) • Indicated for depression and obsessive-compulsive disorder • Minimal drug interactions

  27. escitalopram (Lexapro) • Similar to Celexa • More potent with fewer side effects

  28. Drug List Cyclic Antidepressants Tricyclic • amitriptyline (Elavil) • nortriptyline (Pamelor)

  29. Tricyclic Antidepressants Dispensing Issues • Improvements are usually seen in 10 to 21 days • Can be cardiotoxic in high doses • May cause postural hypotension Warning!

  30. Tricyclic AntidepressantsDispensing Issues Do not discontinue abruptly. Warning!

  31. Cyclic Antidepressants Side Effects • Sedation is common, but tolerance usually occurs • Have many anticholinergic effects

  32. Discussion Why would cyclic antidepressants be prescribed for bed wetting in children?

  33. Discussion Why would TCAs be prescribed for bed wetting in children? Answer They may be prescribed because of their anticholinergic side effects.

  34. Drug List MAOIs • phenelzine (Nardil) • selegiline (Eldepryl) • tranylcypromine (Parnate)

  35. MAOI Dispensing Issues Be cautious of many interactions with foods such as aged cheeses, concentrated yeast extracts, pickled fish, sauerkraut, broad bean pods, chocolate, and alcohol. Warning!

  36. MAOI Dispensing Issues If changing to another class of antidepressant, patient must have a two-week “wash out” period before starting the new medication. Warning!

  37. Drug List Other Antidepressants • bupropion (Wellbutrin, Zyban) • mirtazapine (Remeron) • trazodone (Desyrel)

  38. trazodone (Desyrel) • Prevents reuptake of serotonin and norepinephrine • Has a better side effect profile than TCAs • Caution: possible interaction with Ginkgo

  39. bupropion (Wellbutrin, Zyban) • Dopamine-uptake inhibitor • Does not cause sedation, blood pressure changes, or ECG changes • Do not discontinue abruptly • Approved in the aid of smoking cessation

  40. Other Antidepressant Dispensing Issues • Wellbutrin SR = BID dosing • Wellbutrin XL = QD dosing Warning!

  41. Bipolar Disorders Signs or Symptoms • Decreased need for sleep • Elevated or irritable mood • Excessive involvement in pleasurable activities with a big potential for painful consequences • Grandiose ideas • Pressure to keep talking • Racing thoughts

  42. Discussion What is the drug of choice for treating bipolar disorders?

  43. Discussion What is the drug of choice for treating bipolar disorders? Answer Lithium

  44. Discussion What is the two-fold objective of drug therapy for bipolar disorder?

  45. Discussion What is the two-fold objective of drug therapy for bipolar disorder? Answer Treat acute episodes Prevent subsequent attacks

  46. Drug List Drugs to Treat Bipolar Disorders • carbamazepine (Tegretol) • divalproex (Depakote) • lithium (Lithobid) • olanzapine-fluoxetine (Symbyax) • valproic acid (Depakene)

  47. Lithium Side Effects • Gastrointestinal • Dermatologic • Hematologic • Neuromuscular • Weight • Renal • Teratogenic

  48. Lithium Dispensing Issues Lithobid tablets are only effective for 6 months. Be sure to highlight expiration dates on containers. Warning!

  49. divalproex (Depakote) • Beneficial for patients with rapid mood changes • Take with food or milk, but not carbonated drinks • Beware of symptoms of thrombocytopenia

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