 is a psychiatric medication used to

alleviate mood disorders, such as

major depression and dysthymia.
 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
 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.
 St.John’s wort – can decrease
reuptake of the neurotransmitters
serotonin, norepinephrie, and
dopamine.

 Gingko biloba- can be used for

memory enhancement and dementia
St. John’s wort

Gingko biloba
Four groups (4):
 tricyclic antidepressants (TCAs)
 selective serotonin reuptake
inhibitors (SSRIs)
 atypical antidpressants that affect
various neurotransmitters
 monoamine oxidase inhibitors
(MAOIs)
 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.
 This group 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.
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.
 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)
 
Contraindications
All antidepressants are
contraindicated in patients
with a history of
hypersensitivity to any
component.
 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
 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.
 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 )
 Dry mouth
 Blurred vision
 Insomnia
 Headache
 Nervousness
 Anorexia
 Nausea
 Diarrhea
 Suicidal ideation
 Some clients may experience sexual dysfunction
 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.
Examples:
 amoxapine (Asendin)
 bupropion (Wellbrutin)
 maprotiline (Ludiomel)
 nefazodone (Serzone)
 trazodone (Desyrel)
 mirtazipine (Remeron)
 venlafaxine (Effexor)
 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.)
 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
 MAO- A – inactivates dopamine in
the brain

MAO- B
– inactivates
norepinephrine and serotonin
1. tranyclypromine sulfate
(Panate)
2. isocarboxazid (Marplan)
3. phenelzine sulfate (Nardil)
Orthostatic hypotension
CNS stimulation (agitation,
restlessness, insomnia)
Anticholinergic effects
 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
 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.
 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
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
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
 “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
 Are divided into 2:
› Typical Antipsychotics
 Division of typical antipsychotics
 Phenotiazines
Nonphenotiazine

> Atypical Anti Psychotics -

 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.
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.
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.
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
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
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.
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
 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
 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).
 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).
 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.
 Includes
› Butyrophenone
› Dibenzoxazepines
› Dihydroindolone
› Thioxanthene
 Drowsiness
 Dry mouth
 Increased heart rate
 Urinary retention
 Constipation
 Decrease blood pressure
 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
 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
 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
Atypical drugs available
 clozapine (Clozaril)
 risperidone (Risperdal)
 olanzapine (Zyprexa)
 quetiapine (Seroquel)
 paliperidone (Invega)