This document discusses various types of antidepressants and antipsychotics used to treat mood disorders such as depression. It describes three types of depression - reactive, major, and bipolar disorder. It then covers different classes of antidepressants including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, and monoamine oxidase inhibitors (MAOIs). Side effects and contraindications of these drug classes are also outlined. The document also discusses antipsychotics used to treat psychosis and their classification into typical and atypical drugs. Extrapyramidal side effects of typical antipsychotics are noted.

3.  is a psychiatric medication used to
alleviate mood disorders, such as major
depression and dysthymia.

4.  Depression
- is a common mental disorder that presents with
depressed mood, loss of interest or pleasure, feelings of
guilt or low self-worth, disturbed sleep or appetite, low
energy, and poor concentration.
Three (3) types of depression:
 Reactive depression - usually has sudden onset after
a precipitating event
› The client knows why she or he is depressed and may
call this the “blues.”
› Usually last for a month and benzodiazepine agent
may be required

5.  Major depression- is characterized by loss of
interest in work and home, inability to complete
task, and deep depression (dysphoria)
 Bo-polar affective disorder – involves swings
between two moods, the manic (euphoric) and
the depressive (dysphoria).
 Electroconvulsive Therapy
- was used to treat psychosis and
depression before the introduction of
antipsychotics and antidepressants.

6.  St.John’s wort – can decrease
reuptake of the neurotransmitters
serotonin, norepinephrie, and
dopamine.
 Gingko biloba- can be used for
memory enhancement and dementia

7. St. John’s wort
Gingko biloba

8. Four groups (4):
 tricyclic antidepressants (TCAs)
 selective serotonin reuptake inhibitors
(SSRIs)
 atypical antidpressants that affect
various neurotransmitters
 monoamine oxidase inhibitors
(MAOIs)

10.  are used to treat major depression,
because they are effective and less
expensive than SSRIs and other drugs.
 Imipramine was the first TCA marketed
in the 1950s.
 The action is to block the uptake of
the neurotransmitters norepinephrine
and serotonin in the brain.

11.  Thisgroup of drugs elevates mood ,
increased interest in daily living and
activity and decreases insomia.
 Given at night to minimize problems
caused by their sedative action.
 When discontinuing TCAs, the drugs
should be gradually decreased to
avoid withdrawal syndrome such as
nausea, vomiting, anxiety, and
akathisia.

12. Examples are:
 Amitriptyline (Elavil)
 doxepin (Sinequan)
 trimipramine (Surmontil)
 imipramine
 desipramine
 nortriptyline
 Polydrug therapy- the practice of giving
several antidepressant or antipsychotic
together, should be avoided because of
possible serious side effects.

13.  orthostatic hypotension
 sedation
 anticholigernic effects
 cardiac toxicity such as dysrhythmias
 seizures
 allergic reaction (skin rash , pruritus, and
petechiae)
 sexual dysfunction (impotence and
amennorhea)
 blood dyscrasias (leukopenia,
thrombocytopenia, and agranulocytosis)

14. Contraindications
All antidepressants are
contraindicated in patients with
a history of hypersensitivity to
any component.

15.  Alcohol,hynotics, sedatives and
barbiturates potntieate central nervours
system (CNS ) depression when taken
with TCAs.
 Concurrent use of MAOIs with amitrityline
may lead to cardiovascular instability
and toxic psychosis.
 Anti-thyroid medications taken with
amitripyline may increase the risk of
dysrhymias

17.  was first classified as second generation and anti
depressants.
 Today they have been reclassified asselective
serotonin reuptake inhibitors ( SSRIs ).
 blocks the reuptake of serotonin into the nerve
terminal of the CNS, thereby enhancing its
transmission at the serotonergic synapse.
 do not block the uptake of dopamine or nor-
epinephrine, nor they block the cholinergic alpha-
adrenergic receptors.

18.  The primary use of SSRIs is for major depressive
disorder.
 They are also effective fro treating anxiety
disorders such as obsessive-compulsiveness,
panmic, phobias,post traumatic stress disorders,
and other forms of anxiety
EXAMPLE OF SSRIs
 Fluoxetine ( Prozac )
 Fluvoxamine ( Luvox )
 Sertraline ( Zoloft )
 Paroxetine ( Paxil )
 Citalopram ( Celexa )
 Escitalopram ( Lexapro )

19.  Dry mouth
 Blurred vision
 Insomnia
 Headache
 Nervousness
 Anorexia
 Nausea
 Diarrhea
 Suicidal ideation
 Some clients may experience sexual
dysfunction

21.  also called second-generation antidepressants
 became available in the 1980s and have been
used for major depression, reactive depression
and anxiety
 They affect 1 or 2 of the 3 neurotransmitters:
› Serotonin
› Norepinephrine
› Dopamine
 should not be taken with MAOIs and should not
be used within 14 days after discontinuing MAOIs.

22. Examples:
 amoxapine (Asendin)
 bupropion (Wellbrutin)
 maprotiline (Ludiomel)
 nefazodone (Serzone)
 trazodone (Desyrel)
 mirtazipine (Remeron)
 venlafaxine (Effexor)

23.  Manic episodes in persons with bipolar disorder (If
not combined with a mood-stabilizing drug,
atypical antidepressants may induce manic
episodes in individuals with bipolar disorder.)
 Seizures (Atypical antidepressants may lower the
threshold for seizures; that is, seizures may occur
more easily. Caution is advised for individuals
prone to seizures or those who have a history of
seizures.)
 Drowsiness (Caution is advised when operating
machinery, driving, or performing other tasks that
require alertness.)

25.  relieve depression by preventing the enzyme
monoamine oxidase from metabolizing the
neurotransmitters norepinephrine,
serotoninand dopamine in the brain
 are currently not the antidepressants of
choice and are usually prescribed when the
client does not repond to TCAs or second-
generation antidepressants.
 Should not be taken together with TCA when
treating depression

26.  MAO- A – inactivates dopamine in
the brain
 MAO- B – inactivates norepinephrine
and serotonin

27. 1. tranyclypromine sulfate (Panate)
2. isocarboxazid (Marplan)
3. phenelzine sulfate (Nardil)

28.  Orthostatic hypotension
 CNS stimulation (agitation,
restlessness, insomnia)
 Anticholinergic effects

29.  MAO inhibitors may cause serious and
possibly life-threatening reactions, such as
sudden high blood pressure, when taken with
certain foods, beverages, or medicines.
 The dangerous reactions may not begin until
several hours after consuming these items.
 Aged cheeses, red wines, smoked or pickled
meats, chocolate, caffeinated beverages,
and foods containing monosodium
glutamate (MSG) are among the foods and
drinks to be avoided

30.  Anyone who is taking MAO inhibitors should not
use any other medicine unless it has been
approved or prescribed by a physician who
knows that they are taking MAO inhibitors, this
includes:
› nonprescription (over-the-counter) medicines
such as
 sleep aids; medicines for colds, cough,hay
fever, or asthma (including nose drops or
sprays); medicines to increase alertness or
keep from falling asleep; and appetite
control products.

32.  also known as neuroleptics or
psychotropics
 have been available since the
mid-1950s.
 refers to any drug that modifies
psychotic behavior and exerts an
antipsychotic effect

33. Psychosis
 or losing contact with reality
 is manifested in a variety of mental or psychiatric disorders
 is usually characterized by more than one symptom, but these
may include difficulty in processing information and coming to
a conclusion, delusions, hallucinations, incoherence,
catatonia, and aggressive or violent behavior
 sometimes called dopamine antagonist
 block D2 dopamine receptors in the brain, reducing psychotic
symptoms
 many antipsychotics block the chemoreceptor trigger zone
and vomiting center in the brain, producing an antiemetic
effect

34. Schizophrenia
a chronic psychotic disorder
 is the major category of psychosis in which
many of these symptoms are manifested
 symptoms usually develop in adolescence
or early adulthood

35.  “Positive” symptoms
- may be characterized exaggeration of
normal function, incoherent speech,
hallucination, delusion, and paranoia
 “Negative” symptoms
– are characterized by a decrease or loss in
function and motivation
- there is poverty of speech content, poor self-
care, and social withdrawal
- tend to be more chronic and persistent

36.  Are divided into 2:
› Typical Antipsychotics
 Division of typical antipsychotics
 Phenotiazines
 Nonphenotiazine
> Atypical Anti Psychotics -

37.  Antipsychotics block the action of dopamine and
thus may be classified as dopaminergic
antagonists. There are five subtypes of
dopaminergic antagonists.
 There are five subtypes of dopamine receptors. D1
through D2. All antipsychjotics block the D1
(dopaminergic) receptor, which in turn promotes
the presence of EPS, resulting in
pseudoparkinsonism. Atypical antipsychotics have
a weak affinity to D2 receptors, a stronger affinity
to D4 receptors and they block the serotonin
receptor.

38. Extrapyramidal Syndrome
Pseudoparkinsonism, which resembles symptoms of
Parkinson’s disease is a major side effect of typical
antipsychotic drugs.
Symptoms:
 stooped posture
 masklike facies
 rigidity
 tremors at rest,
 shuffling gait,
 pill-rolling motion of the hand, a
 and bradykinesia.

39. Contraindications to Antipsychotic Treatment
Narrow angle glaucoma is an absolute
contraindication to the use of
antipsychotics. Antipsychotic treatment
while a patient is suffering from glaucoma is
inadvisable. Glaucoma must be treated
before a patient can continue with an
antipsychotic treatment.
Prostatic hypertrophy is a relative
contraindication to the use of
antipsychotics. Bethanechol at 25 to 50
mg/day can be used throughout treatment
to offset the obstruction, but patients must
be carefully monitored.

40. Acute dystonia
 Symptoms usually occur in 5% of clients within days
of taking typical antipdsychotics
 This condition is treated with
anticholinergic/antiparkinsonism drugs such as
benztropine (Cogentin).
 The benzodiazepine lorazepam (Atrivan) may also
be prescribe.
 Characteristics of the reaction include:
› muscle spasms of face, tongue, neack, and back;
› facial grimacing;
› abnormal or involuntary upward eye-movement;
› and laryngeal spasms that can impair respiration

41. Akathisia
 Incidence occurs in approximately 20% of
clients who take a typical psychotic drug.
 is best treated with a benzodiazepine 9e.g
lorazepam) or beta-blocker (e.g
propranolol)
Characteristics:
› trouble standing still,
› is restless,
› paces the floor,
› and is in constant motion

42. Tardive dyskinesia
 is a later phase of extrapyramidal reaction to
antipsychotics
 is a serious adverse rection occulting in clients who have
taken a antipsychotic drug for more than a year
 The likelihood of developing tardive dyskinesia depends
on the dose and duration of the antipsychotic factor
Characteristics:
› protrusion and rolling of the tongue,
› sucking and smacking movements of the lips in
chewing motion,
› and involuntary movement of the body and
extremities.

43. Neuroleptic Malignant Syndrome
 is a rare but potentially fatal condition associated with antipsychotic
drugs.
 Treatment of NMS involves immediate withdrawal of antipsychotics,
adequate hydration, benzodiazepines, and muscle relaxants such as
dantolene (Dantrium).
Symptoms:
 involve muscle rigidity,
 sudden high fever,
 altered mental status,
 blood pressure fluctuations,
 tachycardia,
 dysrhythmias,
 seizures,
 rhabdomyolysis,
 acute renal failure,
 respiratory failure,
 and coma

45.  In 1952 chlorpromazine hydrochloride
(Thorazine) was the first phenothiazine
introduced for treating psychotic behavior in
clients in psychiatric hospitals
 are subdivided into three groups:
› aliphatic,
› piperazine,
› and piperidine

46.  produce a strong sedative effect, decreased
blood pressure, and may cause moderate
effect of EPS (pseudoparkinsonism).
 Chlorpromazine (Thorazine) is in the aliphatic
group and may produce pronounced
orthostatic hypotension ( low blood pressure
that occurs when an individual assumes an
upright position from a supine position).

47.  produce a low sedative and strong
antiemetic effect but have little effect on
blood pressure.
 They cause more EPS than other
phenothiazines. examples of piperazine
phenothiazines are fluphenazine (Prolixin) and
perphenazine (Trilafon).

48.  have a strong sedative effect, cause few EPS,
have a low to moderate effect on blood
pressure , and have no antiemetic effect
 Thioridazine ( MEllril ) is an example of
piperidine phenothiazines.

50.  Includes
› Butyrophenone
› Dibenzoxazepines
› Dihydroindolone
› Thioxanthene

51.  Drowsiness
 Dry mouth
 Increased heart rate
 Urinary retention
 Constipation
 Decrease blood pressure

52.  Dosage adjustment of an anticonvulsant may be
necessary
 If either aliphatic phenotiazine or the thioxanthene group
is administered, a higher dose of anticonvulsant may be
necessary
 Antipsychotics interact with alcohol, hypnotics, sedatives,
narcotics and benzodiazepines to potentiate the
sedative effects of antipsychotics
 Antipsychotics should not be given with other
antipsychotic or antidepressant drugs except to control
psychotic behavior for selected individuals who are
refractory to drug therapy.
 When discontinuing antipsychotics, the drug dosage
should be reduced gradually

53.  Older adults usually require smaller doses of
antipsychotics – from 25% to 50% less than
young middle-aged adults
 Dosage amount need to be individualized
according to the client’s age and physical
status

55.  A new category of antipsychotics that was
marketed in the US in the early 1990s
 Differs from the typical/ traditional antipsychotics
2 advantages of the atypical agents
 They are effective in treating negative symptoms
 They are not likely to cause EPS or tardive
dyskinesia

56. Atypical drugs available
 clozapine (Clozaril)
 risperidone (Risperdal)
 olanzapine (Zyprexa)
 quetiapine (Seroquel)
 paliperidone (Invega)