A detailed yet very well organized and simplified presentation on psychotropic (psychiatric) medications that are commonly used in clinical practice including the classes, common examples, mechanism of actions, indications, side effects.

1. Halder Jamal August 27th, 2023
Psychotropic Medications

2. Psychotropic Medications
Antipsychotics Antidepressants Mood Stabilizers Anxiolytics

3. D2 antagonists
symptoms
D2 & 5-HT2 antagonists
& symptoms
2 Groups
Antipsychotics
Typical (First-Generation):
Atypical (Second-Generation):

4. Antipsychotics
High Potency
• Haloperidol
• Pimozide
• Fluphenazine
• Perphenazine
• Trifluoperazine
Low Potency
• Thioridazine
• Chlorpromazine
• Aripiprazole
• Asenapine
• Clozapine
• Olanzapine
• Quetiapine
• Iloperidone
• Paliperidone
• Risperidone
• Lurasidone
• Ziprasidone
Typical (First-Generation): Atypical (Second-Generation):

5. • Psychosis:
- Schizophrenia spectrum disorders.
- Bipolar with psychosis, MDD with psychotic features.
- Clozapine for resistant cases or those with persistent suicidality.
- Delirium.
• Bipolar disorder (prevent relapse)
• Obsessive compulsive disorder
• Tourette syndrome
• Huntington disease
Indications
Antipsychotics

6. Dopamine
Extrapyramidal symptoms (Acute Dystonia, Akathisia, Parkinsonism, Tardive dyskinesia)
Hyper-prolactinemia, neuroleptic malignant syndrome.
Histamine Sedation, weight gain, diabetes.
Adrenergic Postural hypotension, dizziness, syncope.
Muscarinic
Dry mouth, blurred vision, urinary retention, constipation, tachycardia, hypertension,
memory & cognitive problems, diabetes
Serotonin Metabolic: increased appetite, weight gain, diabetes, dyslipidemia.
• High potency FGAs: more anti-Dopamine side effects
• Low potency FGAs: more anti-HαM side effects
• SGAs: more anti-Serotonin side effects
Adverse Effects
Antipsychotics

7. Psychotropic Medications
Antipsychotics Antidepressants Mood Stabilizers Anxiolytics

8. • SSRIs: Selective Serotonin Reuptake Inhibitors
• SNRIs: Serotonin Norepinephrine Reuptake Inhibitors
• TCAs: Tricyclic antidepressants
• MAOIs: Monoamine Oxidase Inhibitors
• Atypical antidepressants.
Antidepressants
5 Groups

9. Add MoAs

10. SSRIs: Fluoxetine, paroxetine, sertraline, citalopram, escitalopram.
Antidepressants
• Mood: MDD, Dysthymia, PMDD (1st line)
• Anxiety: GAD, Panic disorder, Social phobia, Agoraphobia.
• Eating disorders: bulimia, binge-eating disorder, pica.
• Others: OCD, PTSD, Premature ejaculation.
• GI distress, headache.
• Rebound effects: anxiety, insomnia, mania (if given to bipolar)
• Sexual dysfunction: anorgasmia, erectile / ejaculatory dysfunction,↓ libido
• SIADH
• Serotonin syndrome (if combined with others)

11. SNRIs: Venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran.
Antidepressants
• MDD, GAD (2nd line)
• Panic disorder, Social phobia, PTSD, OCD (Venlafaxine).
• Neuropathic pain (e.g diabetic neuropathy)
• Fibromyalgia (Duloxetine and milnacipran)
•Similar to SSRIs, but also stimulant effects from norepinephrine:
• Sweating
• Insomnia
• Dry mouth
• Constipation
•Increased HR & BP

12. TCAs: Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin.
Antidepressants
• MDD
• OCD (clomipramine), nocturnal enuresis (imipramine).
• Neuropathic pain treatment, Migraine prophylaxis.
• Anti-HαM.
• Prolong QT interval.
• Serotonin syndrome (if combined with others).
• Overdose is fatal: Convulsions, Cardiotoxicity, Coma, respiratory depression
Treatment: NaHCO3 to prevent arrhythmias, bezos for convulsions

13. MAOI: Tranylcypromine, phenelzine, isocarboxazid, selegiline
Antidepressants
• Atypical depression.
• Parkinson disease (selegiline).
• Hypertensive crisis: most notably with ingestion of tyramine foods.
• : Contraindicated with other serotinergic agents,
If stopped MOAI, you need to wait 2 weeks before changing to another
agent or stopping dietary restrictions.
Serotonin Syndrome

14. A potentially life-threatening condition caused by serotonergic overactivity
due to overdose or concomitant use of serotonergic drugs
Serotonin Syndrome
Treatment:
• Benzodiazepines and supportive care.
• Cyproheptadine (serotonin antagonist) if no improvement.
• Autonomic dysfunctios: Hyperthermia, Diaphoresis, Tachycardia, HTN.
• Neuromuscular Activity: Hyperreflexia, Hypertonia, Clonus.
• Altered mental status: Delirium, Coma.

15. Atypicals antidepressants:
Antidepressants
• Bupropion: inhibits NE & DA reuptake, less risk of sexual dysfunction &
weight gain.
• Mirtazapine: α2 antagonist, lead to sedation (good for insomnia),
increased appetite, weight gain (good for underweight patients)
• Trazodone: primarily for insomnia.
• Vilazodone.
• Vortioxetine.

16. Psychotropic Medications
Antipsychotics Antidepressants Mood Stabilizers Anxiolytics

17. • Lithium (1st line in European guidelines)
• Valproate (1st line in American guidelines)
• Lamotrigine (esp for depressive episode)
• Carbamazepine
• Atypical antipsychotics
• These drugs are used to terminate the acute episodes of bipolar disorder
(mania, hypomania, depression) and to prevent relapse.
• Avoid prescribing antidepressants to patients with bipolar disorder before
initiating mood stabilizers, because antidepressants can precipitate a
manic episode.
Mood Stabilizers

18. Nausea, vomiting, Dizziness, Tremors, Acne, Mild hypercalcemia,
Nephrogenic diabetes insipidus, Thyroid dysfunction, Teratogenic.
Narrow therapeutic index for toxicity.
Tremor, GI distress, Rash, Joint pain, Weight loss or gain, Teratogenic
Blurry vision, GI distress, weight losses, Stevens Johnson syndrome
Dizziness, Dry mouth, Constipation, Diplopia, Ataxia,
Agranulocytosis, Aplastic anemia, SIADH, SJS.
Adverse effects:
Lithium
Valproate
Lamotrigine
Carbamazepine
Mood Stabilizers

19. Psychotropic Medications
Antipsychotics Antidepressants Mood Stabilizers Anxiolytics

20. Anxiolytics
• Beta blockers
• Antidepressants
• Antipsychotics
• Antiepileptics
• Benzodiazepines
• Buspirone

21. Anxiolytics
• Benzodiazepines
• Buspirone
• Short-acting (half-life 1-12 h): midazolam, triazolam
• Intermediate-acting (12-40 h): lorazepam, oxazepam, alprazolam
• Long-acting (> 40 h): diazepam, clonazepam, tetrazepam, chlordiazepoxide.
• Enhances GABAa effect (inhibitory).
• Causes sedation, tolerance, dependence, respiratory depression, amnesia.
• Partial 5-HT1A receptor agonist.
• Does not cause sedation, addiction, or tolerance.