What Psychotherapists Should Know About PsychotropicKnow About Psychotropic
Medication
Daniel B. Martinez, M.D.Medical Director
Pilsen Wellness Center, Inc.
The Medical Model
BiologicalP h l i lPsychologicalSociologicalSociological
CulturalCulturalSpiritual
Si l Ph E i i T hSingle Photon Emission Tomography
Images (c) Dr. Amen
N lNormal
Images (c) Dr. Amen
Images (c) Dr. Amen
ENCOURAGE COMPLIANCE!!!ENCOURAGE COMPLIANCE!!!
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source
D iDopamine
RewardsAttentionMotivationDrivePleasure
Strahl 2000Strahl, 2000
N i h iNorepinephrine
MoodI t tInterestMotivationEnergy
S t iSerotonin
SexConcentrationConcentrationHungerInterestInterestMoodPainSleepp
Cl f M di tiClasses of MedicationsClass: Neurotransmiter: Affects:
Antipsychotics Dopamine Psychosis
Antidepressants SerotoninNorepinephrine
MoodNorepinephrine
Antimanic Polarization of neuron
Mood
Benzodiazepines GABA Anxiety
Have you decided for yourself?
Cl f M di tiClasses of MedicationsClass: Neurotransmiter: Affects:
Antipsychotics Dopamine Psychosis
Antidepressants SerotoninNorepinephrine
MoodNorepinephrine
Antimanic Polarization of neuron
Mood
Benzodiazepines GABA Anxiety
Antipsychotic therapy:Antipsychotic therapy:Historical perspective in the United States
ReserpineChlorpromazine
FluphenazineQuetiapine
Clozapine
ThioridazineHaloperidol
RisperidoneOlanzapine
Quetiapine
Ziprasidone
Aripiprazole
19 0 1960 19 0 1980 1990 2000 20021950 1960 1970 1980 1990 2000 2002
Kaplan HI et al. Kaplan and Sadock’s Synopsis of Psychiatry. 7th ed.1994.Black DW et al. Introductory Textbook of Psychiatry. 2001.
AAntipsychotics
-Major Tranquilizers-Block Dopamine-Block Dopamine -Decrease Psychosis
d k-Induce Parkinsonism
Atypicals and Reported Dangers
Clozaril -Agranulocytosis, SeizuresRespirdal -EPS HyperprolactinemiaRespirdal -EPS, HyperprolactinemiaZyprexa -Weight, Diabetes
d blGeodon -EKG problemsSeroquel -CataractsAbilify -Deaths
A ti h tiAnti-psychotics
Typical (e.g. Haldol)Anticholinergic side effects (thorazine)Anticholinergic side effects (thorazine)Extrapyramidal side effects
Atypical (e.g. Zyprexa and Respirdal)S d ti i ht i di iSedation, weight gain, dizziness, orthostatic hypotension
A tid tAntidepressants
Multimechanism Serotonin
EffexorWelbutrin
ProzacPaxile but
TCARemeron
aZoloftLuvoxRemeron
CymbaltaLuvoxLexaproCelexaCelexa
Selective Serotonin Reuptake Inhibitors
ProzacPaxil
The most common side effects of SSRI medications are: Nausea, diarrhea, Paxil
Zoloftheadache, restlessness, insomnia, anxiety, sexual dysfunction, perspiration, tremor, insomnia,
LuvoxCelexa
perspiration, tremor, insomnia, sleepiness, dry mouth.
Lexapro
A i t Di dAnxiety Disorders
Serotonin Benzodiazepines
ProzacPaxil
ValiumAtivanPaxil
ZoloftLuvox
AtivanXanaxKlonopinLuvox
CelexaLexapro
KlonopinLibrium
Lexapro
Bipolar Disorder MedicationsLithium .6-1.2 mEq/L tremor, N/V, kidney,
thyroid, acne,y , ,sedation
Depakote 50-120ug/ml N/V, wt,sedation,hair loss
Tegretol 6-12 ug/ml sedation, N/V, rash
L k t fLook out for:
Coma, kidney, Heart -Lithium
Liver, Pancreas, Skin, Ovary, Blood-Depakote
Blood, Skin, Liver -Tegretol
Benzodiazepines’ p5 Dangerous Ds
DependenceDependenceDisinhibitionDizzinessDepressionDeficits in Memory
ADHD Treatments
NorepinepherineAnd Dopamine
AdderallVyvanse
DopamineRitaline
ConcertaFocalin VyvanseFocalin
NorepinephrineStrattera
a2-agonist Intunive
Attention Deficit Hyperactivity yp yDisorder
Stimulants (Ritalin, Dexedrine, Adderall, Concerta, Cylert)Cylert)
Blood Pressure Medication (clonidine and Tenex))
WellbutrinTricyclic Anti-Depressants (ImipramineTricyclic Anti-Depressants (Imipramine, Desipramine)
Strattera (atomoxetine)Strattera (atomoxetine)
HHOW ABOUT NATURAL MEDS?
Omega-3DHEADHEASt. John's Wort
lMelatonin
Sun-Times 6/04
Multi-mechanism AntidepressantsEffexor -weight loss, insomnia, nausea, sleepiness, anxiety, decreased appetite. Other side effects include: blurry vision, dizziness, constipation, seizures, changes in blood pressure, decreased energy, sweating, sexualseizures, changes in blood pressure, decreased energy, sweating, sexual dysfunction, dry mouth, yawning.Welbutrin -Nausea, vomiting, sweating, dry mouth, nervousness, constipation dizziness Other side effects include: seizure insomnia motorconstipation, dizziness. Other side effects include: seizure, insomnia, motor tics, rash.Tricyclic Antidepressants -weight gain, weight loss, sleepiness, irritability and aggression dizziness sexual dysfunction changes in breast sizeand aggression, dizziness, sexual dysfunction, changes in breast size, nightmares, stuttering, sensitivity to the sun. Severe side effects include: seizures, irregular heart beats, rash, hallucinations.
R b f l i h i h iRemeron- be careful with weight gain
Serzone – be careful with liver failure
Child Issues
Diagnostic nosology difficult to apply to childrenDiagnostic nosology difficult to apply to children and adolescents.Symptom/Syndrome treatment should be theSymptom/Syndrome treatment should be the focus when there is diagnostic uncertainty.Reconsider the intervention every 6-12 months.Reconsider the intervention every 6 12 months.Start low and go slow.
Figiuring out Prescriptions
Pharmacy Abbreviations
p.o. By mouthi m Intramuscularlyi.m. IntramuscularlyTab tablet
lCap CapsuleLiq LiquidElix Elixer
More Pharmacy Abbreviations
Am morningPm evening (afternoon)Pm evening (afternoon)Hs at bedtimeQ everyPrn as needed
Even more Abbreviations
qD once dailyBid twice dailyBid twice dailyTid three times daily
d f d lQid for times dailyQ6h every six hoursQod every other dayTsp teaspoon (5ml)Tbsp tablespoonTsp teaspoon (5ml)Tbsp tablespoon
(15ml)
MedicationSig. (Directions)Sig. (Directions)
#NumberNumber