Psychopharmacology Manuel D Reich DO Psychopharmacology The study

Psychopharmacology Manuel D. Reich, DO

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

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

n n n 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

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

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

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

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

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

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

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

Anti-Depressants n n n 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 antidepressant 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

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

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

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

MAOI’s Nardil n Marplan n Emsam n n Diet Considerations

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

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

Tetracyclics and Others Remeron n Ludiomil n Viibryd n Brintellix n

Mood Stabilizers n n 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: n n n Extremely high energy Grandiose and unrealistic ideas Spending sprees Go for days without sleeping Thoughts become chaotic, speak rapidly

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

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

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

Anti-Anxiety Medications n n n 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: n n Obsessive-compulsive disorder n n Panic disorder has both physical and mental symptoms Repeated, unwanted and often very disturbing thoughts and/or ritualistic behaviors and actions Post-traumatic stress disorder

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

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

Antipsychotic Drugs n n n 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: n n n Any/all of the five senses (hallucination) Thinking and communication (formal thought disorder) Ideation (paranoia, delusions)

n Example: Schizophrenia n Bipolar Disorder n Brief Reactive Psychosis n Delusional Disorder n Schizoaffective Disorder n

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

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

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

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

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

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