Drugs Across the Spectrum Raymond Goldberg Chapter 10 Psychotherapeutic Drugs

1. Albia Dugger • Miami Dade College
Chapter 10
Psychotherapeutic
Drugs

2. Mental Illness
• The National Alliance on Mental Illness defines mental
illnesses as: “medical conditions that disrupt a person’s
thinking, feeling, mood, ability to relate to others and daily
functioning”
• Serious mental illnesses include major depression,
schizophrenia, bipolar disorder, obsessive compulsive
disorder (OCD), panic disorder, posttraumatic stress disorder
(PTSD), and borderline personality disorder

3. Understanding Mental Illness
• One definition of a mental disorder is “an abnormal state of
mind (whether of a continuous or an intermittent nature),
characterized by delusions, or by disorders of mood or
perception or volition or cognition”

4. Mental Illness and Medicine
• Medical model
• The premise that a pathogen is responsible for a person’s
illness or disease
• Pathogen
• Any organism that produces disease
• The application of the medical model to emotional problems
gives rise to some concern – behaviors deemed inappropriate
might not be the result of any given disease

5. Mental Illness and Special Populations
• Ethnic and racial minorities often face cultural and social
stressors that pose greater risk factors for mental illness
• People of lowest socioeconomic status are more likely than
those of higher strata to suffer from a mental illness
• American adolescents are experiencing major depressive
episodes and dysthymia at an increasing rate
• Other groups affected by depression include postpartum
women and the elderly

6. Types of Disorders
• Neurosis
• Long-term disorder featuring the symptoms of anxiety
and/or exaggerated behavior dedicated to avoiding
anxious feelings
• Includes obsessive-compulsive behaviors, psychosomatic
ailments, phobias, and panic attacks
• Anxiety typically is treated with antianxiety drugs

7. Types of Disorders
• Psychosis
• Severe mental condition marked by loss of contact with
reality
• Organic psychoses
• Have physical causes such as excessive drug use, brain
infections, metabolic or endocrine disorders, brain tumors,
and neurological diseases
• Functional psychoses
• Have no known or apparent cause (e.g. schizophrenia)

8. Mood Disorders
• Mood disorders
• Forms of psychosis that affect the person’s emotions
• Can be depression or mania
• Depression
• Dejection characterized by withdrawal or lack of response
to stimulation
• Mania
• Characterized by inappropriate elation, an irrepressible
mood, and extreme cheerfulness

9. Mood Disorders
• Bipolar affective disorder
• A mental condition characterized by alternating moods of
depression and mania
• Formerly called manic-depression
• Unipolar depression
• Mental disorder marked by alternating periods of
depression and normalcy

10. Mood Disorders
• Depression can cause substance abuse, but substance abuse
also can lead to depression
• Clinical depression is a real illness that can be treated
effectively
• Some individuals with substance abuse problems are
misdiagnosed with bipolar illness
• A frequent problem among people with bipolar disorder is
noncompliance with medications

11. Depression
• Women experience
twice the rate of
depression as men,
regardless of race or
ethnic background

12. Common Mood Disorders

13. Dual Diagnosis (Co-Occurring Disorders)
• Dual diagnosis (co-occurring disorders) describes a person
with two or more existing mental illnesses, each of which can
be diagnosed independent of the others
• Common co-occurring disorders include substance
abuse/addiction or alcoholism and a mental illness such as
depression, anxiety, or a personality disorder
• Major psychiatric disorders increases an individual’s risk for
substance abuse

14. Major Psychiatric Disorders

15. Treatment of Mental Illness Before 1950
• Before 1950, mentally ill people were subjected to
bloodletting, given sneezing powder, were flogged and
starved, and had hot irons applied to their bodies
• Psychoanalysis grew in popularity starting with Freud –
today, it seldom is used to treat mental problems
• Depression was treated with drugs such as amphetamines;
other types of mental illnesses were treated with
antihistamines, barbiturates and other depressants

16. Treatment of Mental Illness Before 1950
• Electroconvulsive therapy (ECT), first developed in 1938,
was used to treat depression and psychosis
• Electrical activity in the brain is temporarily interrupted and a
seizure within the brain is triggered
• Many patients experienced adverse cognitive effects
• Despite concerns, ECT is still a treatment option

17. Demographics of Drugs and Mental Disorders
• 10-15% of the general population receive drugs for emotional
problems each year
• 43% of people with mental disorders reside in the US and
Europe
• 1 in 3 Americans suffer from a mental disorder
• Antidepressants are the medication most frequently used by
people aged 18–44

18. Mood Stabilizers
• Depression is treated with five major classes of drugs:
• Monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Atypical antidepressants that do not fall into one of the
above categories

19. Many Available Antidepressants

20. Monoamine Oxidase Inhibitors
• Monoamine oxidase (MAO) is an enzyme on the outer
membranes of mitochondria – inactivates the
neurotransmitters serotonin, dopamine, and norepinephrine
• MAOIs block the action of monoamine oxidase
• Four principal MAOIs in the US:
• Tranylcypromine (Parnate)
• Phenelize (Nardil)
• Isocarboxazid (Marplan)
• Selegiline (Emsam)

21. Monoamine Oxidase Inhibitors
• Work well for neurotic conditions such as acute anxiety,
obsessive-compulsive behavior, phobias, panic attacks
• Toxic effects occur when MAOIs interact with foods
containing tyramine – release of catecholamines produces
sympathomimetic effects
• MAOIs interact dangerously with certain medications,
especially dextromethorphan, Demerol, and other
antidepressants that affect serotonin such as Prozac

22. Tricyclic Antidepressants
• Amitriptyline (Elavil) is used for depression accompanied by
agitation
• Imipramine (Tofranil) is given for depression involving
psychomotor retardation, as well as for agoraphobia, panic
attacks, and obsessive-compulsive behavior
• Clomipramine (Anafranil) also has been used to treat
obsessive-compulsive behaviors

23. Tricyclic Antidepressants

24. Tricyclic Antidepressants
• Antidepressant action takes 3-4 weeks
• Tricyclics are also effective in moderating pain, and can be
beneficial in treatment of the eating disorder bulimia
• Common side effects are distorted vision, tachycardia, dry
mouth, constipation, sleepiness, and urinary retention
• With alcohol, risk of a deadly reaction increases – overdose
causes coma, cardiac difficulties, and respiratory problems

25. Tricyclic Antidepressants
• If patients cease taking tricyclics abruptly, they demonstrate
withdrawal symptoms
• Even at low dosage, tricyclics can be toxic – excessive levels
can be fatal
• Another side effect is development of type 2 diabetes,
especially when taken with the newer antidepressants

26. Side Effects of Tricyclic Antidepressants
• Tachycardia
• Dry mouth
• Confusion
• Hypotension
• Disorientation
• Impotence
• Glaucoma
• Distorted vision
• Sleepiness
• Constipation
• Urinary retention
• Tremors
• Rashes
• Jaundice
• Respiratory problems
• Coma
• Death

27. Selective Serotonin Reuptake Inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
• Antidepressant medications that increase the
concentration of serotonin in the brain
• Reduce aggressive and violent behavior
• Adverse effects include sexual dysfunction, increase in
weight, and altered sleep patterns
• Not much more effective than placebos

28. Selective Serotonin Reuptake Inhibitors
• Prozac (fluoxetine)
• Fewer serious side effects
• Also used for bulimia, obesity, anxiety, and OCD
• Implicated in a number of suicides
• Zoloft (sertraline)
• Especially effective with elderly patients
• Prescribed for patients with acute coronary syndrome
• Also used to treat OCD

29. Selective Serotonin Reuptake Inhibitors
• Paxil (paroxetine)
• Increased risk of suicides in children
• When taken during pregnancy, increases risk of cardiac
malformations and neonatal complications
• New version: PaxilCR
• Lexapro (escitalopram)
• Also used for OCD, panic disorder, social anxiety disorder,
PTSD, premenstrual dysphoric disorder, menstrual mood
swing and irritability, and compulsive gambling

30. Atypical Antidepressants
• Nefazodone (Serzone)
• No longer available in the US
• Reported as causing severe liver failure
• Trazodone
• Mood elevator
• Side effects may include confusion, concentration
difficulties, headaches, and nervousness

31. Atypical Antidepressants
• Mirtazapine
• May cause mood changes, unusual thought processes,
seizures, lowered libido, and changes in menstrual cycle
• Bupropion (Wellbutrin)
• Inhibits uptake of dopamine and norepinephrine.
• Also used for smoking cessation and seasonal affective
disorder
• Side effects are usually mild

32. SNRIs
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Work by decreasing the reabsorption of both serotonin and
norepinephrine in the brain
• Side effects may include pain in the eyes, vision blurring,
or blindness
• May cause a variety of other side effects, from diarrhea
and agitation to irregular heartbeats and convulsion

33. SNRIs
• Venlafaxine (Effexor XR)
• Side effects similar to SSRIs
• Overdose can be dangerous or fatal
• Desvenlafaxine (Pristiq)
• Similar to venlafaxine and causes similar side effects
• Duloxetine (Cymbalta)
• May help relieve physical pain in addition to depression
• Side effects include nausea, dry mouth, constipation
• Heavy drinkers or those with certain liver or kidney
problems should not take duloxetine

34. Antidepressant Medications

35. Lithium
• Lithium
• A positively charged ion, similar to sodium
• Used to treat symptoms associated with mania
• Side effects include tremors, excessive thirst, frequent
urination, fluid retention, and weight gain
• Inability to excrete lithium can lead to toxic levels in the
body
• Chlorpromazine
• Alternative antimanic with fewer toxic effects

36. Effectiveness of Lithium
• Lithium is effective for acute mania and for preventing mania
and depression from recurring
• Maximal benefit is achieved in one to two weeks
• Effective for people who have unipolar depression and do not
respond to tricyclic antidepressant drugs
• The therapeutic window is small – three to four times the
therapeutic level can cause grave consequences

37. Side Effects of Lithium
• Nausea
• Excessive perspiration
• Water retention
• Vomiting
• Confusion
• Drowsiness
• Tinnitus
• Kidney dysfunction
• Respiratory depression
• Polydipsia
• Hand tremors
• Polyuria
• Diarrhea
• Weight gain
• Muscular weakness
• Distorted vision
• Coma
• Death

38. Antipsychotic Drugs
• Antipsychotic drugs (major tranquilizers or neuroleptics)
used particularly for schizoprenia
• Antipsychotic drugs, are pharmacologically different from
minor tranquilizers and other sedative-hypnotic drugs
• Chlorpromazine – an anesthetic used to ameliorate anxiety
and shock during surgery – was marketed for mental
disorders in 1955 under the trade name Thorazine

39. Antipsychotic Drugs
• Well-known antipsychotic drugs:
• Haloperidol (Haldol)
• Trifluoperazine (Stelazine)
• Fluphenazine (Prolixin)
• Olanzipine (Zyprexa)
• Quetiapine (Seroquel)
• Promazine (Sparine)
• Thioridazine (Mellaril)

40. Antipsychotic Drugs
• Schizophrenic patients have to take antipsychotic drugs for
four to six weeks for maximum effectiveness
• One problem is that they are absorbed erratically
• Some patients receive injections of antipsychotic drugs so the
drug can be released slowly into the bloodstream
• These drugs build up in fatty areas of brain and lungs, and
cross the placenta to affect the fetus

41. Children and Antipsychotic Drugs
• Antipsychotic drugs are prescribed more often to children in
the US than to children in other developed countries
• Adverse effects in children (particularly females):
• Excessive weight gain
• Type 2 diabetes
• Neurological symptoms
• Digestive problems
• Cardiovascular conditions

42. Effectiveness of Antipsychotic Drugs
• Schizophrenics receiving antipsychotic drugs almost always
show improvement, but a small percentage gets worse
• Improvement is most rapid during the first several weeks of
treatment
• Although many people taking antipsychotic drugs relapse, it
appears that these drugs reduce violent behavior

43. Side Effects of Antipsychotic Drugs
• Antipsychotic drugs produce undesirable motor problems
(extrapyramidal symptoms)
• Inappropriate motor movements (acute dyskinesias)
sometimes appear within a year after treatment:
• Parkinsonism
• Dystonia
• Akathesia

44. Side Effects of Antipsychotic Drugs
• Tardive dyskinesia
• Motor disorders such as involuntary repetitive facial
movements, lip smacking, involuntary movement of trunk
and limbs, and twitching
• Less severe side effects:
• Difficulty urinating, constipation, dry mouth
• Altered skin pigmentation, jaundice, and extreme
sensitivity to sunlight
• Changes in heart rate

45. Psychotherapeutic Drug Abuse
• About 7 million Americans over age 12 report recent use of
psychotherapeutic drugs for nonmedical purposes
• Unintentional poisoning deaths involving psychotherapeutic
drugs, such as sedative-hypnotics and antidepressants,
increased by 84% from 1999 to 2004
• In many cases, individuals had been abusing multiple drugs of
different classes, compounding the toxicity