Medications for Medications for Mental IllnessesMental IllnessesThis presentation is designed to This presentation is designed to help understand how and why help understand how and why

drugs can be used as part of the drugs can be used as part of the treatment of mental health treatment of mental health

problems. problems.

IntroductionIntroduction DefinitionsDefinitions

psy·cho·phar·ma·col·o·gy psy·cho·phar·ma·col·o·gy n.n. - The branch of - The branch of pharmacology that deals with the study of pharmacology that deals with the study of the actions, effects, and development of the actions, effects, and development of psychoactive drugs.psychoactive drugs.

Psychotropic Drug – a drug that affects Psychotropic Drug – a drug that affects emotional stateemotional state. Psychotropics include . Psychotropics include antidepressants, antipsychotic medications, antidepressants, antipsychotic medications, sedatives, stimulants, and tranquillizers.sedatives, stimulants, and tranquillizers.

HistoryHistory Uses and BenefitsUses and Benefits

CategoriesCategories Anti-psychoticsAnti-psychotics (Haldol, Risperdal, Zyprexa) (Haldol, Risperdal, Zyprexa)

controls hallucinations (e.g., schizophrenia)controls hallucinations (e.g., schizophrenia)

AntidepressantsAntidepressants (Prozac, Zoloft, Lexapro) (Prozac, Zoloft, Lexapro) control feelings of sadness, feelings of control feelings of sadness, feelings of hopelessness, and suicidal thoughts (e.g., hopelessness, and suicidal thoughts (e.g., depression)depression)

Mood stabilizersMood stabilizers (Lithium, Depakote, Tegretol) (Lithium, Depakote, Tegretol) control mood swings (e.g., bipolar disorder)control mood swings (e.g., bipolar disorder)

Anti-anxiety drugsAnti-anxiety drugs (Xanax, Valium, Buspar) (Xanax, Valium, Buspar)

Antipsychotic Antipsychotic MedicationsMedications

Antipsychotic Antipsychotic medications, as medications, as their name their name suggests, act suggests, act against psychotic against psychotic symptoms. The symptoms. The principal form of principal form of psychosis is psychosis is schizophrenia.schizophrenia.

Dosing Dosing Myth. The higher Myth. The higher

the dose, the the dose, the better.better.

FormsForms EffectivenessEffectiveness

Maintenance TreatmentMaintenance Treatment

Some people may need to take medication for Some people may need to take medication for an extended period of time, or even an extended period of time, or even indefinitely.indefinitely. usually have chronic (long-term, continuous) usually have chronic (long-term, continuous)

schizophrenic disorders, or schizophrenic disorders, or have a history of repeated schizophrenic episodes, have a history of repeated schizophrenic episodes,

and are likely to become ill again.and are likely to become ill again. Medication may be continued in as low a Medication may be continued in as low a

dosage as possible to maintain control of dosage as possible to maintain control of symptoms. symptoms. Prevents relapsePrevents relapse Reduces side effectsReduces side effects

Commonly Prescribed Commonly Prescribed Antipsychotic MedicationsAntipsychotic Medications

OldOld 1952 – 1952 –

chlorpromazine chlorpromazine ((Thorazine)Thorazine)

1950-60s1950-60s Haloperidol Haloperidol

((Haldol)Haldol) TThioridizine hioridizine

(Mellaril)(Mellaril)

New New 1989 – Clozopine 1989 – Clozopine

((Clozaril)Clozaril) 1994 - Risperidone 1994 - Risperidone

(Risperdal)(Risperdal) 1996 - Olanzapine 1996 - Olanzapine

(Zyprexa)(Zyprexa) 1997 - Quetiapine 1997 - Quetiapine

(Seroquel)(Seroquel)

Commonly Prescribed Commonly Prescribed Antipsychotic MedicationsAntipsychotic Medications

21st Century 21st Century 2001 - ziprasidone 2001 - ziprasidone

(Geodon)(Geodon) 2002 – aripiprazole 2002 – aripiprazole

(Abilify)(Abilify) 2006 - paliperidone 2006 - paliperidone

(Invega)(Invega)

DevelopmentsDevelopments Some of these Some of these

medications have medications have become available in become available in dissolvable, or dissolvable, or injectable forms, injectable forms, which makes can which makes can reduce non-reduce non-compliance.compliance.

Side EffectsSide Effects It is well recognized that many people (around It is well recognized that many people (around

two-thirds in controlled drug trials) two-thirds in controlled drug trials) discontinue antipsychotics, partly due to discontinue antipsychotics, partly due to adverse effects.adverse effects.

A continuous problem for mental health A continuous problem for mental health professionals is mental health patients not professionals is mental health patients not adhering to their medication regimen. This adhering to their medication regimen. This deviation is the primary cause of crisis deviation is the primary cause of crisis concerns.concerns.

Would Would YOUYOU take a medication that caused… take a medication that caused…

Side EffectsSide Effects

Restlessness Restlessness Dry Mouth – Can Dry Mouth – Can

result in result in deterioration of teeth deterioration of teeth due to a lack of due to a lack of saliva.saliva.

Constipation or Constipation or DiarrheaDiarrhea

NauseaNausea SunburnSunburn Skin rashesSkin rashes

ShakinessShakiness TremorsTremors Weight GainWeight Gain Lethargy/SedationLethargy/Sedation Increased heart rateIncreased heart rate Lowered blood Lowered blood

pressurepressure DiabetesDiabetes Heart ProblemsHeart Problems

Side EffectsSide Effects

SeizuresSeizures Muscle contractionsMuscle contractions StiffnessStiffness Infertility/ImpotenceInfertility/Impotence Production of breast Production of breast

milk in womenmilk in women Protruding tongueProtruding tongue Eyes rolled backEyes rolled back

Repetitive, Repetitive, involuntary, involuntary, purposeless purposeless movements often of movements often of the lips, face, legs, or the lips, face, legs, or torso.torso.

Failure of temperature Failure of temperature regulation centers -- regulation centers -- resulting in a medical resulting in a medical emergency, as the emergency, as the person's temperature person's temperature suddenly increases to suddenly increases to dangerous levelsdangerous levels

What about….What about….

Side EffectsSide Effects

Some of these side effects are Some of these side effects are permanent, even after the permanent, even after the medications have been stoppedmedications have been stopped

Many of these medications are also Many of these medications are also lethal when taken in excess lethal when taken in excess

Desirable side effectsDesirable side effects

Anti-Manic MedicationsAnti-Manic Medications

Referred to as Mood StabilizersReferred to as Mood Stabilizers Commonly associated with bipolar Commonly associated with bipolar

disorderdisorder Treat a manic “high”Treat a manic “high” Can decrease aggressive behaviorsCan decrease aggressive behaviors

LithiumLithium UseUse EffectivenessEffectiveness Regular blood tests Regular blood tests

are an important part are an important part of treatment with of treatment with lithium lithium

Side EffectsSide Effects

Lithium is a salt Lithium is a salt (lithium carbonate). (lithium carbonate). It is naturally It is naturally occuring, and found occuring, and found in rock formations.in rock formations.

Anything that lowers Anything that lowers the level of sodium the level of sodium in the body may in the body may cause a lithium cause a lithium buildup and lead to buildup and lead to toxicity toxicity

Signs and Symptoms Signs and Symptoms of lithium toxicityof lithium toxicity

Anti-convulsantsAnti-convulsants

Not all patients with symptoms of Not all patients with symptoms of mania benefit from lithium. mania benefit from lithium.

Some patients respond to anti-Some patients respond to anti-convulsant medications that are usually convulsant medications that are usually used to treat seizures/epilepsy. used to treat seizures/epilepsy.

Commonly prescribed anti-convulsantsCommonly prescribed anti-convulsants DepakoteDepakote TegretolTegretol LamictalLamictal

Antidepressant Antidepressant MedicationsMedications

UsesUses DepressionDepression AnxietyAnxiety InsomniaInsomnia

EffectivenessEffectiveness

Antidepressant Antidepressant MedicationsMedications

OlderOlder

Tricyclic medicationsTricyclic medications MAOIs (MMAOIs (Monoamine onoamine

Oxidase InhibitorsOxidase Inhibitors))

NewerNewer

Some commonly Some commonly prescribed SSRIs are:prescribed SSRIs are: fluoxetine (Prozac)fluoxetine (Prozac) Escitalopram (Lexapro)Escitalopram (Lexapro) paroxetine (Paxil)paroxetine (Paxil)

also used to treat also used to treat Panic DisordersPanic Disorders

sertraline (Zoloft). sertraline (Zoloft). fluvoxamine (Luvox) fluvoxamine (Luvox)

also used to treat also used to treat Obsessive Obsessive Compulseive Compulseive DisorderDisorder

Where does depression Where does depression hurt?hurt?

SNRIs (serotonin and SNRIs (serotonin and norepinephrinenorepinephrine reuptake inhibitors) are a reuptake inhibitors) are a newer classnewer class of of medications. medications.

EffexorEffexor Wellbutrin or ZybanWellbutrin or Zyban CymbaltaCymbalta

Anti-Anxiety MedicationsAnti-Anxiety Medications

XanaxXanax KlonopiKlonopi

nn LibriumLibrium ValiumValium AtivanAtivan BuSparBuSpar VistarilVistaril InderalInderal

Anti-Anxiety MedicationsAnti-Anxiety Medications

A non-benzodiazepine, buspirone A non-benzodiazepine, buspirone (BuSpar),(BuSpar), is used for generalized is used for generalized anxiety disorders. anxiety disorders.

Antidepressants are also effective for Antidepressants are also effective for panic attacks and some phobias and are panic attacks and some phobias and are often prescribed for these conditions.often prescribed for these conditions.

The medications approved by the FDA The medications approved by the FDA for use in OCD are the antidepressants for use in OCD are the antidepressants Anafranil, Prozac, and Paxil. Anafranil, Prozac, and Paxil.

Antianxiety MedicationsAntianxiety Medications Benzodiazepines have a very strong potential for Benzodiazepines have a very strong potential for

the development of tolerance and dependence the development of tolerance and dependence Side EffectsSide Effects Interaction with AlcoholInteraction with Alcohol Withdrawal reactionsWithdrawal reactions

Anti-anxiety MedicationsAnti-anxiety Medications

Occasionally, for specific reasons, one Occasionally, for specific reasons, one of the following medications may be of the following medications may be prescribed:prescribed: antipsychotic medicationsantipsychotic medications antihistamines (such as antihistamines (such as Atarax, Vistaril,Atarax, Vistaril,

BenadrylBenadryl)) barbiturates such as phenobarbitalbarbiturates such as phenobarbital beta-blockers such as propranolol beta-blockers such as propranolol

(Inderal, Inderide) – normally used to (Inderal, Inderide) – normally used to treat heart conditionstreat heart conditions

Medications used to treat Medications used to treat insomniainsomnia

Over-the-Counter Over-the-Counter Sleep Aids:Sleep Aids: Most of these sleeping Most of these sleeping

pills are pills are antihistamines. antihistamines.

Benadryl, and Benadryl, and antihistamine, is the antihistamine, is the sleep aid in Tylenol sleep aid in Tylenol PM.PM.

They generally work They generally work well but can cause well but can cause some drowsiness the some drowsiness the next day. next day.

Benzodiazepines – Benzodiazepines – RestorilRestoril

Antidepressants – Antidepressants – Trazodone Trazodone (Desyrel)(Desyrel)

LunestaLunesta RozaremRozarem SonataSonata AmbienAmbien

Ambien And DrivingAmbien And Driving In March 2007, the FDA issued warnings In March 2007, the FDA issued warnings

for prescription sleep aids, alerting patients for prescription sleep aids, alerting patients that they can cause complex sleep-related that they can cause complex sleep-related behaviors, including “sleep driving.”behaviors, including “sleep driving.”

New research indicates that misuse of New research indicates that misuse of Ambien could be contributing to accidents Ambien could be contributing to accidents on the roads. on the roads.

A lot of people are not just taking Ambien – A lot of people are not just taking Ambien – they are mixing it with other drugs, or they they are mixing it with other drugs, or they are taking alcohol – and when you combine are taking alcohol – and when you combine all those things together, that's trouble. all those things together, that's trouble.

Reasons patients do not Reasons patients do not take theirtake their

medications as prescribed medications as prescribed Side effectsSide effects They start feeling better and think they no They start feeling better and think they no

longer need the medicationslonger need the medications The stigma associated with being mentally ill The stigma associated with being mentally ill

-- they don’t want people to know they have a -- they don’t want people to know they have a mental illness.mental illness.

Unawareness of illness – some experts Unawareness of illness – some experts estimate that up to ½ of those with serious estimate that up to ½ of those with serious mental illnesses are unable to perceive that mental illnesses are unable to perceive that they are ill.*they are ill.**Amador XF, David AS, eds. Insight and Psychosis: Awareness of Illness in Schizophrenia and Related Disorders. 2nd ed. New York, NY: Oxford University Press; 2004:177 93.

The Right to Refuse The Right to Refuse TreatmentTreatment

A person may not administer a A person may not administer a psychoactive medication to a psychoactive medication to a patient who refuses to take the patient who refuses to take the medication voluntarily unlessmedication voluntarily unless the patient is in need of a medication the patient is in need of a medication

related to an emergency, or related to an emergency, or the patient is under an order the patient is under an order

authorizing the administration of the authorizing the administration of the medication regardless of the patient’s medication regardless of the patient’s refusal.refusal.

Symptom Relief, Not CureSymptom Relief, Not Cure Medications help relieve the symptoms associated Medications help relieve the symptoms associated

with mental illness, but they usually do not provide a with mental illness, but they usually do not provide a cure. cure.

Many people may need medication for a single Many people may need medication for a single period (perhaps for several months) and then never period (perhaps for several months) and then never have to take it again. have to take it again.

For some conditions, such as schizophrenia or For some conditions, such as schizophrenia or bipolar disorders, medication may have to be taken bipolar disorders, medication may have to be taken indefinitely. indefinitely.

Psychotherapeutic medications do not produce the Psychotherapeutic medications do not produce the same effect in everyone -- all factors must be same effect in everyone -- all factors must be consideredconsidered