Monday, October 19, 2009

Psychoactive/Psychotropic drugs

A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior. These drugs may be used recreationally to purposefully alter one's consciousness, as entheogens for ritual or spiritual purposes, or therapeutically as medication.


There are 6 major classes of psychiatric medications:

1. Antidepressants, which are used to treat disparate disorders such as clinical depression, dysthymia, anxiety, and eating disorders and affect dysregulation, colloquially termed 'mood stabilization' in borderline personality disorder.
2. Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.
3. Antipsychotics, which are used to treat psychoses such as schizophrenia and mania.
4. Mood stabilizers, which are used to treat bipolar disorder and schizoaffective disorder.
5. Anxiolytics, which are used to treat anxiety disorders.
6. Depressants, which are used as hypnotics, sedatives, and anesthetics.


1. Antidepressants
Most Anti-Depressants are blood level medications, meaning they take some time to build up in the system and then they must be taken every day to keep that level maintained.  Often these medications are titrated up from small doses to begin with and also titrated down to discontinue their use.  Do NOT stop these medications on your own suddenly due to withdrawal symptoms.  Most of these take 3-6 weeks to be effective and you will notice side effects during the first 7-10 days or so.  It is possibly that you will feel some anxiety getting on to these medications at first, but it should resolve.  If the early side effects are not tolerable, notify your doctor and you can try something else.

Average doses of different Anti-Depressants
http://www.globalrph.com/antidepressants.htm

Selective serotonin reuptake inhibitors (SSRIs one neutrotransmitter, Seratonin):
Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressants considered to be the current standard of drug treatment. This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro, Esipram), citalopram (Celexa), and sertraline (Zoloft).
Serotonin-norepinephrine reuptake inhibitors (SNRIs) :

Serotonin-norepinephrine reuptake inhibitors (SNRIs, two neurotransmitters) such as venlafaxine (Effexor) and duloxetine (Cymbalta) are a newer form of antidepressant that works on both norepinephrine and 5-HT. They typically have similar side effects to the SSRIs, although there may be a withdrawal syndrome on discontinuation that may necessitate dosage tapering.

Noradrenergic and specific serotonergic antidepressants (NASSAs ) form a newer class of antidepressants which purportedly work to increase norepinephrine (noradrenaline) and serotonin neurotransmission by blocking presynaptic alpha-2 adrenergic receptors while at the same time minimizing serotonin related side-effects by blocking certain serotonin receptors. The only example of this class in clinical use is mirtazapine (Avanza, Zispin, Remeron).

Norepinephrine (noradrenaline) reuptake inhibitors (NRIs)
Norepinephrine (noradrenaline) reuptake inhibitors (NRIs) such as reboxetine (Edronax) act via norepinephrine (also known as noradrenaline). NRIs are thought to have a positive effect on concentration and motivation in particular, though they have been known to increase aggression.
Norepinephrine-dopamine reuptake inhibitors

Norepinephrine-dopamine reuptake inhibitors (2 neurotransmitters) such as bupropion (Wellbutrin, Zyban) inhibit the neuronal reuptake of dopamine and norepinephrine (noradrenaline).[21]

Tricyclic antidepressants (TCAs)
Tricyclic antidepressants are the oldest and include such medications as amitriptyline and desipramine. Tricyclics block the reuptake of certain neurotransmitters such as norepinephrine (noradrenaline) and serotonin.

Monoamine oxidase inhibitor (MAOIs)
Monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil)


2. Stimulants / Amphetamines which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.
Many children and teens with ADHD take a medication called methylphenidate, better known by the brand name Ritalin. But although methylphenidate drugs are the medications that are most frequently prescribed to manage ADHD, lots of children take other medicines to control their ADHD symptoms.

In addition to methylphenidate drugs, doctors often prescribe other types of medication to help people with ADHD. Like Ritalin, amphetamines (such as Adderall) and dexamphetamines (such as Dextrostat or Dexedrine) treat ADHD by stimulating the brain's attention centers.
Non-Stimulants for ADHD and other Disruptive Behavior Disorders
Other types of medications that are prescribed for ADHD are nonstimulating and work differently. These include atomoxetine (like Strattera) and certain antidepressants (such as Wellbutrin). Alpha-2 Agonists are also used: Clonidine or Tenex.
Risperidone – Atypical antipsychotic used in the management of schizophrenia. It has also found use in the treatment of Tourette’s syndrome, bipolar disorder, autism, and aggressive behavior (12).


3. Antipsychotics which are used to treat psychoses such as schizophrenia and mania.
Typical antipsychotics
Phenothiazines:
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin) - Available in decanoate (long acting) form
Perphenazine (Trilafon)
Prochlorperazine (Compazine)
Thioridazine (Mellaril)
Trifluoperazine (Stelazine)
Mesoridazine
Promazine
Triflupromazine (Vesprin)
Levomepromazine (Nozinan)
Thioxanthenes:
Chlorprothixene
Flupenthixol (Depixol and Fluanxol)
Thiothixene (Navane)
Zuclopenthixol (Clopixol and Acuphase)
Butyrophenones:
Haloperidol (Haldol) - Available in decanoate (long acting) form
Droperidol
Pimozide (Orap) - Used to treat Tourette syndrome
Melperone

These are more commonly used, and can be used for other purposes than just psychosis, such as enhancing the benefit of anti-depressant.

Atypical antipsychotics
Abilify (aripiprazole), an atypical antipsychotic, may enhance the response to antidepressants in people who have treatment-resistant major depression.
Clozapine (Clozaril) - Requires weekly to biweekly CBC (FBC) because of risk of agranulocytosis (a severe decrease of white blood cells).
Olanzapine (Zyprexa) - Used to treat psychotic disorders including schizophrenia, acute manic episodes, and maintenance of bipolar disorder.
Risperidone (Risperdal) - Dosing 0.25 to 6 mg per day and is titrated upward; divided dosing is recommended until initial titration is completed at which time the drug can be administered once daily.
Quetiapine (Seroquel) - Used primarily to treat bipolar disorder and schizophrenia, and "off label" to treat chronic insomnia and restless legs syndrome; it is a powerful sedative (if it's used to treat sleep disorders and is not effective at 200 mg, it is not going to be effective in this regard).
Ziprasidone (Geodon) - Now (2006) approved to treat bipolar disorder. Dosing 20 mg twice daily initially up to 80 mg twice daily.
Amisulpride (Solian) - Selective dopamine antagonist.
Paliperidone (Invega) - Derivative of risperidone. Approved in December 2006.


4. Mood Stabilizers which are used to treat bipolar disorder and schizoaffective disorder.
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by rapid and unstable mood shifts. The most common is bipolar disorder, where mood stabilizers suppress swings between mania and depression, and these drugs are also used in borderline personality disorder. Most mood stabilizers are anticonvulsants, with the important exception of lithium, which is the oldest and best known mood stabilizing drug.
Mood stabilizers include:
Lithium Lithium carbonate —- Lithium is the 'classic' mood stabilizer. The first Food and Drug Administration-approved mood stabilizer, and still popular in treatment. Therapeutic drug monitoring required. Monitor blood lithium levels (therapeutic range: 0.6 or 0.8-1.2 mEq/L) and look for signs and symptoms of toxicity (such as nausea, vomiting, diarrhea, ataxia). See also lithium orotate, another lithium salt.
Depakote Valproic acid (Depakene divalproex sodium (Depakote), and sodium valproate (Depacon) — Available in extended release form. Can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC should be monitored. Therapeutic drug monitoring is required.
Lamictal Lamotrigine (Lamictal) — Particularly effective for bipolar depression. Monitor for signs and symptoms of Stevens-Johnson syndrome, very rare but can be fatal.
Tegretol Carbamazepine (Tegretol) — CBC should be monitored; can lower white blood cell count. Therapeutic drug monitoring is required. Not FDA-approved for bipolar disorder, but widely used for many years.
Neurontin Gabapentin (Neurontin) — Not FDA approved for bipolar disorder. Recent scientific studies suggest it is not an effective treatment, however many psychiatrists continue to use it.
Trileptal Oxcarbazepine (Trileptal) — Not FDA approved for bipolar disorder.
Topamax Topiramate (Topamax) — Not FDA approved for bipolar disorder.
Sometimes mood stabilizers are used in combination, such as lithium with one of the anticonvulsants.


5. Anxiolytics which are used to treat anxiety disorders.
Benzodiazepines (tend to be addictive and can cause rebound anxiety)
Benzodiazapenes can be taken PRN (as needed) or regularly, depending on the prescription and can be habit forming.

Average Dose of Benzodiazepines
http://www.globalrph.com/benzodiazepine_calc.htm
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium). Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder.

Non-benzodiazepines (nonaddictive)
Buspirone (Buspar) is a serotonin 1A agonist. It lacks the sedation and the dependence associated with benzodiazepines and causes much less cognitive impairment. It may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as the medication does not provide the sedation that these patients may expect or equate with anxiety relief.

Vistaril (hydroxyzine pamoate) is used for symptomatic short-term relief of anxiety and tension, as well to treat allergic reactions. A typical adult dosage for Vistaril is 50 to 100 mg up to four times a day. Dosages for children under 6 years old are 2 mg per kilogram per day in divided dosages, not to exceed 50 mg per day.

Alpha-2 Agonists "Alpha or Beta Blockers" are also used:
Alpha or Beta Blockers can be taken PRN (as needed) or regularly, depending on the prescription.
Alpha 2 Agonists, Catapres (Clonidine) or Guanfacine (Tenex) reduce the anxiogenic effects of circulating Norepeneprhine NE. Beta blockers protect against social anxiety. Beta blockers, like Propranolol/Inderal, block the receptors for the physical effects of a person's natural fight or flight response. They are not sedatives, and they can't help anxiety of a purely psychological nature. Can be used for PTSD related sleep disturbance and Panic Attacks.
Clonidine average dose
http://www.drugs.com/dosage/clonidine.html
Guanfacine/Tene dose
http://www.drugs.com/ppa/guanfacine-hydrochloride.html
Beta Blocker average doses
http://www.globalrph.com/beta.htm


Miscellaneous Information


Medication Interactions: whenever you being taking a new prescribed medication OR natural supplement, you should check everything you are taking for interactions

Drug Interaction Checker - WebMD


Jane Rekas

LCSW, CHt

Jane Rekas is a Licsensed Clinical Social Worker at Turtle Dove Counseling and Hood River DBT, Certified Hypnotist at Hood River Hypnosis, Reiki Master at Rekas Reiki, Astrologer at Astrological Counsel, and Seasonal Color Analyst at Expressing Your Truth.

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