Chapter 10

Psychotherapeutic Drugs

Understanding Mental Illness

Types of DisordersObsessive-compulsive behaviors,

psychosomatic ailments, panic disorders

Psychosis: Person loses contact with realityExamples: schizophrenia, bipolor affective disorder

Treatment Before 1950

Options very limited

Electroconvulsive therapy (ECT) used to treat depression and psychosis

Psychotherapeutic Drugs

Antidepressants Major Tranquilizers

ANTIDEPRESSANTS

Development began in the early 1950’s in TB Wards

Iproniazid Tricyclics Developed

ANTIDEPRESSANTS

TRICYCLICS: Similar to PhenothiazinesMECHANISM OF ACTION: BLOCKS

REUPTAKE OF NOREPINEPHRINE AND SEROTONIN MOOD REFLECTS A BALANCE BETWEEN

NOREPINEPRINE AND SEROTONIN

EFFECTS OF TRICYCLICS

ELEVATION IN MOOD INCREASED PHYSICAL ACTIVITY INCREASED MENTAL ALERTNESS INCREASED APPETITE INCREASED ABILITY TO SLEEP

EXAMPLES OF TRICYCLICS

TOFRANIL ELAVIL

IMPACT OF TRICYCLICS

TREATS DEPRESSION 60-70% OF STUDIES

CLOSE IN EFFECT TO ECT

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

NEWER ANTIDEPRESSANTS INTRODUCED IN 1987 EFFECTS SEROTONIN

PROZAC

SAFER THAN TRICYCLICS WEIGHT LOSS SIDE EFFECT SOME REPORTS OF VIOLENT/SUICIDAL

BEHAVIOR

Zoloft Most popular Antidepressant Used for depression and obsessive-

compulsive disorders, and panic disorders

Approved for use with children

PAXIL

The most heavily advertised antidepressant drug between 1999-2003.

Excellent patient response-59% believed that the drug was beneficial

Paxil negtive responses include

-21% felt drowsiness or disorientation-53% experienced decreased sexual interest-22% gained weight

FDA has concerns that children taking Paxil are 3.2 times more likely to attempt suicide

PaxilCR

PaxilCR is a derivative of Paxil with a a positive patient response especially for social anxiety disorder, panic disorder and premenstrual syndrome.

PaxilCR is about 1/3 of the cost of Paxil

Lithium

Lithium is effective for acute mania and for preventing mania and depression from recurring

Lithium has multiple side effects including nausea, thirst, excessive perspiration and hand tremors

Few withdrawal symptoms

MAJOR TRANQUILIZERS

“ANTI-PSYCHOTIC DRUGS” Phenothiazines (Thorazine)MENTAL HOSPITAL ADMISSIONS

DECREASED SIGNIFICANTLY AFTER THE INTRODUCTION OF MAJOR TRANQUILIZERS

MECHANISM OF ACTION

BLOCK POSTSYNAPTIC DOPAMINE RECEPTORS IN THE BRAIN

BLOCK ACETYLCHOLINE

MEDICAL BENEFITS

DECREASED ANXIETY DECREASED MANIA DECREASED DEPRESSION DECREASED STAY IN MENTAL

HOSPITALS

MAJOR TRANQUILIZERS

SIDE EFFECTS EXTRAPYRAMIDAL SYMPTOMS TARDIVE DYSKINESIA

EXTRAPYRAMIDAL SYMPTOMS

FACIAL TICS RIGIDITY SHUFFLING WALK

TARDIVE DYSKINESIA

SLOW PROTRUSION OF TONGUE LIP SMACKING

Summary

Psychotherapeutic drugs have been helpful in treating depression and other conditions

Antidepressants and Major Tranquilizers are two major categories of psychotherapeutic drugs

SSRIs are the most popular antidepressant drugs prescribed