CENTER ON BEHAVIORAL MEDICINE

ADDITIONAL MATERIAL

EFFECTIVE TREATMENTS

   Traditional Approaches-Psychopharmacology:  Background Material

Effective Treatments Index

Medication List


This information comes from: 
Helpguide, A project of the Rotary Club of Santa Monica and Center for Healthy Aging
http://www.helpguide.org

Depression
Anxiety
Bipolar
Schizophrenia
Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder


DEPRESSION

SSRIs (selective serotonin reuptake inhibitors)

SSRIs act on a chemical in the brain called serotonin. They are the most commonly prescribed class of antidepressants because the adverse effects are less severe than those of older antidepressants. Common side effects include nausea, drowsiness, sexual dysfunction, and agitation. The SSRIs also cause serious withdrawal symptoms if you stop taking them abruptly.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
Generic and Brand Drug Names
Most Common Side Effects
  • Nausea
  • Insomnia
  • Anxiety and restlessness
  • Decreased sex drive
  • Dizziness
  • Weight gain or weight loss
  • Tremors
  • Sweating
  • Drowsiness or fatigue
  • Dry mouth
  • Diarrhea or constipation
  • Headaches
Other Precautions and Warnings

SSRIs can cause an increase in suicidal thoughts and behaviors. SSRIs also carry a risk for increased hostility, agitation, and anxiety. SSRIs should not be taken at the same time as MAOIs. Taking an SSRI within two weeks of an MAOI can cause a fatal reaction.


Tricyclic Antidepressants

Tricyclics are an older class of antidepressants than the SSRIs. The tricyclics typically take around two weeks to provide symptom relief. They have many side effects, including weight gain and drowsiness. Drowsiness is particularly common in the first few weeks after starting the medication. The tricyclics can cause many withdrawal symptoms when discontinued abruptly.

TRICYCLIC ANTIDEPRESSANTS
Generic and Brand Drug Names

Most Common Side Effects

  • Dry mouth
  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Increased heart rate
  • Loss of sex drive and erectile failure
  • Increased sensitivity to the sun
  • Weight gain
  • Drowsiness
  • Dizziness and nausea

MAOIs (Monoamine oxidase inhibitors)

MAOIs are the oldest class of antidepressants. Common side effects include weight gain, dizziness, drowsiness, and loss of sex drive. MAOIs also have severe interactions with certain foods, drinks, and medications. If you choose to take an MAOI, you will have to carefully monitor what you eat and what drugs you take. Items that are restricted include many cheeses, chocolate, wine, and beer. For a more complete guide, read MAOI Diet Facts. If you have previously taken an SSRI, you should wait at least five weeks before taking an MAOI. Combining SSRIs and MAOIs can lead to a life-threatening condition called serotonin syndrome.

MONOAMINE OXIDASE INHIBITORS (MAOIs)

Generic and Brand Drug Names
Most Common Side Effects
  • Lightheadedness upon standing
  • Dizziness
  • Insomnia
  • Weight gain
  • Headaches
  • Insomnia
  • Sexual problems such as impotence
  • Sleepiness
Other Precautions and Warnings

When taking an MAOI, you must follow strict dietary restrictions, avoiding all foods and drinks containing tyramine. Combining MAO inhibitors with foods or drinks containing tyramine can cause dangerously high blood pressure, which can lead to a stroke or heart attack.

Atypical Antidepressants

There are a variety of newer atypical antidepressants which target other neurotransmitters either alone or in addition to serotonin. Some of the brain chemicals they affect include norepinephrine and dopamine. The side effects vary according to the specific drug. To learn more about the atypical antidepressants, visit How Newer Antidepressants Work.

Generic and Brand Drug Names
Most Common Side Effects
  • Nausea
  • Nervousness
  • Sexual dysfunction
  • Dry mouth
  • Fatigue
  • Sleepiness
  • Weight gain
  • Blurred vision



ANXIETY

Benzodiazepines

Benzodiazepines are fast-acting sedatives which work by slowing down the Central Nervous System. They typically relieve anxiety symptoms within 30 minutes to an hour. The rapid relief benzodiazepines provide makes them very effective when taken during a panic attack or another overwhelming anxiety episode. However, benzodiazepines are highly addictive. If taken regularly for more than a couple of weeks, physical and psychological addiction is likely to occur. Benzodiazepine tolerance is also common, with larger doses needed to achieve the same effect. Because of this drug dependency risk, the benzodiazepines are usually recommended only for short-term use. It can also be difficult to stop taking benzodiazepines. Serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. To minimize the withdrawal reaction, it is important to slowly taper off your medication.

BENZODIAZEPINES
Generic and Brand Drug Names
Most Common Side Effects
  • Drowsiness
  • Impaired coordination
  • Fatigue
  • Confusion and disorientation
  • Dizziness
  • Decreased concentration
  • Short-term memory problems
  • Dry mouth
  • Blurred vision
  • Pounding or irregular heart beat
Other Precautions and Warnings

Because of their addictive potential, benzodiazepines are usually prescribed only for short periods of time. When going off benzodiazepines, it is important to gradually reduce the dosage amount to prevent withdrawal symptoms.

Azapirones

Azapirones are a newer type of anti-anxiety drug prescribed for generalized anxiety disorder (GAD) and obsessive compulsive disorder (OCD). Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief. However, they have several advantages over the benzodiazepines. The azapirones are not as sedating as benzodiazepines, they don’t impair memory and coordination, they aren’t as addictive, and withdrawal effects are minimal. Currently, buspirone is the only azapirone approved for medical use.

AZAPIRONES
Generic and Brand Drug Names
Buspirone (BuSpar)
Most Common Side Effects
  • Nausea
  • Headaches
  • Dizziness
  • Drowsiness
  • Upset stomach
  • Constipation
  • Diarrhea
  • Dry mouth
Other Precautions and Warnings

You should not take azapirones and MAO inhibitors at the same time, as combined use may cause an increase in blood pressure.



BIPOLAR

Mood stabilizers are medications that relieve both the symptoms of mania and depression. They are the cornerstone of bipolar disorder treatment, and are generally recommended for both the acute and preventive phase of the illness. Taken long-term, mood stabilizers can help prevent mood cycling and reduce the severity of episodes.

The primary drugs used as mood stabilizers are lithium, valproic acid, and several newer anticonvulsive medications. Lithium and valproic acid are the most widely prescribed mood stabilizers. Lithium is the treatment of choice for euphoric mania, while valproic acid is preferred for mixed episodes and rapid cycling.

Major Mood Stabilizers for Bipolar Disorder
Drug Brand Names Common Side Effects Special Precautions

Lithium

Eskalith, Lithobid

Weight gain, restlessness, tremor, nausea, stomach pain, excessive thirst, and increased urination.

Lithium can cause thyroid and kidney problems, so periodic blood tests are necessary to make sure they are functioning properly.

Valproic acid, (also known as valproate or   divalproex sodium)

Depakote, Depakene

Drowsiness, weight gain, dizziness, tremor, diarrhea, and constipation.

Valproic acid can cause liver damage and alter your body’s production of blood platelets. Periodic liver function tests and platelet counts are necessary.

Carbamazepine

Tegretol

Drowsiness, dizziness, upset stomach, vomiting, headache.

There is a rare but dangerous risk of liver inflammation and a decrease in your body’s production of blood cells. Blood tests are needed to monitor these functions.

Lamotrigine

Lamictal

Dizziness, loss of balance, headaches, and vision problems.

Lamotrigine can cause a serious rash. This risk can be reduced by increasing your dose very slowly and gradually.


There are also serious safety concerns regarding the use of antidepressants for bipolar disorder treatment. First, antidepressants can trigger mania in people with bipolar disorder. Second, there is evidence that antidepressants may worsen the course of bipolar disorder over the long-term. Many experts believe that over time, antidepressant use in people with bipolar disorder has a mood destabilizing effect, increasing the frequency of manic and depressive episodes.

Because of the risks, antidepressant therapy for bipolar disorder should be limited. If an antidepressant is prescribed for a severe episode of depression, it should be discontinued once symptoms are under control. Antidepressants are not recommended for maintenance therapy.

Antidepressants for Bipolar Disorder
Generic and Brand Names
Special Precautions

Because antidepressants can trigger mania or hypomania in people with bipolar disorder, they must always be combined with a mood stabilizer such as lithium or valproate. Tricyclic antidepressants should be avoided, because they can bring on rapid cycling.


Atypical antipsychotics are often used to control bipolar disorder when psychotic symptoms, such as delusions and hallucinations, are present. Typically, they are combined with a mood stabilizer such as lithium or valproic acid. In addition to their effectiveness in treating psychotic mania, the atypical antipsychotics have also been found to help with regular manic episodes. Because of this, this class of drugs is now considered to be a mood stabilizer as well as an antipsychotic. Atypical antipsychotics have also shown promise in the treatment of bipolar depression.

Atypical Antipsychotic Medications for Bipolar Disorder
Generic and Brand Drug Names
Common Side Effects
  • Drowsiness
  • Weight gain
  • Sexual dysfunction
  • Dry mouth
  • Constipation
  • Blurred vision
Special Precautions

The FDA requires all atypical antipsychotics to carry a warning about the risks of diabetes and hyperglycemia. These medications raise your risk of developing adult-onset diabetes. They also exacerbate preexisting Type 1 and 2 diabetes conditions.


SCHIZOPHRENIA

According to the American Psychiatric Association's Guideline for the Treatment of Patients with Schizophrenia, "antipsychotic medications are indicated for nearly all acute psychotic episodes in patients with schizophrenia." The two main groups of medications for the treatment of schizophrenia are the older or “typical” medications, and the newer, “atypical” medications.

Typical medications (neuroleptics)

The older types of medications for schizophrenia work by blocking dopamine receptors in the brain. They are sometimes referenced by their potency—low, medium, or high—which is related to strength, not effectiveness. These medications were a major step forward in reducing the “positive” symptoms of schizophrenia. There are approximately 30 of these first generation medications. Some brand names include:

Neuroleptic Types of Medications
  • Haldol
  • Stelazine
  • Thorazine
  • Compazine
  • Mellaril
  • Orap

“Atypical” medications

The second generation of antipsychotic medications generally affects specific dopamine receptors as well as serotonin re-uptake. Because their target is more limited, the muscular and sedative side effects are usually less severe. In addition, the atypical neuroleptics can address the “negative” symptoms of schizophrenia. However, since each formulation addresses different areas of the brain, finding the right combination of medications for a particular person may require more patience. Some of the brand names of these newer medications are:

"Atypical" types of Medications
  • Clozaril
  • Risperdal
  • Zyprexa
  • Seroquel
  • Abilify


ATTENTION DEFICIT HYPERACTIVITY DISORDER


What are the medications for treating ADHD?

Stimulants

The most common medications for treating ADHD are stimulants. Stimulants have been the longest in use for treatment of ADHD, and have the most research studies on their effects. Although some have been used on children as young as age 3, most are recommended for age 6 or older. Long-term studies on the use of stimulants for the treatment of ADHD lean toward the discontinuation during adolescence, due to possible growth inhibition.

Stimulants for the treatment of ADHD may be shorter or longer acting formulations. Short/intermediate acting stimulants require dosages 2-3 times a day, while long acting stimulants last 8-12 hours, and can be taken once a day, thus not requiring a dose at school.

There are four main types of stimulants used for treatment of ADHD:

  • amphetamines (Adderall)
  • methylphenidate (Ritalin, Concerta, Metadate)
  • dextroamphetamine (Dexedrine, Dextrostat)
  • pemoline (Cylert - less commonly prescribed because can cause liver damage)

Non-stimulant

The newest medication for treatment of ADHD is Strattera. This medication is a reuptake inhibitor that acts on the neurotransmitter norepinephrine (which affects blood pressure and blood flow) in the same way that antidepressants act on the neurotransmitter seratonin, allowing the natural chemical to remain longer in the brain before being drawn back up. Because it is a non-stimulant, it may be less objectionable to some families. Nevertheless, it has similar side effects as other medications used for ADHD.

Antidepressants and anti-anxiety medications

In some cases, antidepressants or anti-anxiety medications may be prescribed either in addition to or instead of stimulants for the treatment of ADHD. Most often, this determination is based on other symptoms, beyond those typical of ADHD alone. Antidepressants most commonly affect the neurotransmitters seratonin or norepinephrine. There have been recent concerns regarding the safety of some antidepressants, such as Paxil and Zoloft, particularly for adolescents or children. See Helpguide’s Medications for Treating Depression and Anxiety: Making Informed Choices for a discussion of antidepressants.

Antipsychotic or mood-stabilizing medications

For certain conditions that include symptoms of ADHD, other medications may be prescribed. With a few exceptions for seizure disorders, antipsychotic medications are not prescribed for children and most mood stabilizers are not recommended for children or adolescents.

What are some of the side effects of medications for ADHD?

Side effects most commonly include:

  • decreased appetite or weight loss
  • headaches
  • upset stomach, nausea or vomiting
  • insomnia or sleep difficulties
  • jitteriness, nervousness, or irritability
  • lethargy, dizziness, or drowsiness
  • social withdrawal

All medications have side effects, and sometimes a change in dosage, brand or type of medication will allow for the usefulness of the medication while reducing the side effects. One problem with medications for ADHD is that they are most often prescribed for young children, who usually will not be able to accurately report side effects. This is one of the concerns about prescribing any medications for children.