Antidepressants, Antimanic & Antipsychotic

Antidepressants, Antimanic &
Antipsychotics
By: Dr.Urwah Ali
 Depression is commonly treated with antidepressant medications.
 Antidepressants work on neurotransmitters such as serotonin,

norepinephrine & dopamine
 Older antidepressant medications include;
1) Tricyclics & Tetracyclics (TCA's)

2) Monoamine Oxidase Inhibitors (MAOI's)
3) Selective Serotonin Reuptake Inhibitors (SSRI's)
Commonly Rx Tetracyclics/Tricyclics
Tricyclic & tetracyclic antidepressants, also called cyclic antidepressants
 Elavil – (Amitriptyline)
 Anafranil – (Clomipramine)
 Norpramine – (Desipramine)
 Tofranil – (Imipramine)
MAOIs
 Nardil - Phenelzine
 Parnate - Tranylcypromine
 People taking MAOIs need to be careful about the foods they eat & the
medicines they take
 If you take an MAOI & you eat high-tyramine foods, tyramine can quickly
reach dangerous levels. This can cause a serious spike in blood pressure &
require emergency treatment.
 Tyramine is found in some cheeses, wines & pickles. The chemical is also
in some medications, including decongestants & over-the-counter cold
medicine
 People taking MAOIs should ask their doctors for a complete list of foods,
medicines & other substances to avoid
 An MAOI skin patch has recently been developed and may help reduce
some of these risks
Selective Serotonin Reuptake Inhibitors (SSRI's)
 The most popular types of antidepressants are called Selective Serotonin
Reuptake Inhibitors (SSRIs) These include:
 Prozac – (Fluoxetine)
 Celexa – (Citalopram)
 Zoloft – (Sertraline)
 Paxil – (Paroxetine)
 Lexapro – (Escitalopram)
 Luvox – (Fluvoxamine)
SNRI’s
 Other types of antidepressants are serotonin & norepinephrine reuptake
inhibitors (SNRIs). These include;
 Effexor – (Venlafaxine)
 Cymbalta – (Duloxetine)
FDA Warning on Antidepressants
 In 2005, the FDA decided to adopt a “black box” warning label—the most
serious type of warning—on all antidepressant medications
 The warning says there is an increased risk of suicidal thinking or attempts

in children & adolescents taking antidepressants. The warning also says
that patients of all ages taking antidepressants should be watched closely,
especially during the first few weeks of treatment
 Finally, FDA has warned that combining the newer SSRI or SNRI
antidepressants with one of the commonly-used “triptan” medications used
to treat migraine headaches could cause a life-threatening illness called
“serotonin syndrome ”
 A person with serotonin syndrome may be agitated, have hallucinations,

have a high temperature, or have unusual blood pressure changes
 Serotonin syndrome is usually associated with the older antidepressants
called MAOIs, but it can happen with the newer antidepressants as well, if
they are mixed with the wrong medications
Medications to treat Bipolar Disorder
 Bipolar disorder, also called manic-depressive illness, is commonly treated
with mood stabilizers, antidepressants & antipsychotics
Mood Stabilizers
 Lithium is a very effective mood stabilizer. It was the first mood stabilizer
approved by the FDA in the 1970’s for treating both manic & depressive
episodes
 Eskalith – (Lithium Carbonate)
 Anticonvulsant medications also are used as mood stabilizers. They were
originally developed to treat seizures, but they were found to help control
moods as well
 Anticonvulsants used as mood stabilizers are;

 Tegretol – (carbamazepine)
 Lamictal – (lamotrigine)
 Depakote – (Valproic acid)
 Depakene – (Valproate)
Atypical Antipsychotics
 Atypical antipsychotic medications are sometimes used to treat symptoms

of bipolar disorder
 The newer antipsychotics usually act quickly & can help pts avoid the
reckless & impulsive behaviors associated with mania. More normal
thinking often is restored within a few weeks
 Antipsychotics used to treat bipolar disorder include:

 Abilify (aripiprazole)
 Clozaril (clozapine)
 Zyprexa (olanzapine)
 Risperdal (risperidone)
 Combination antipsychotic & antidepressant

 Symbyax (Prozac & zyprexa) – (fluoxetine & olanzapine)
Antipsychotics
Medications to treat Schizophrenia
 Antipsychotic medications are used to treat schizophrenia
 Some of these medications have been available since the mid-1950’s They
are also called conventional “typical” antipsychotics
 Conventional & typical antipsychotics are effective for positive symptoms

of schizophrenia
 Some of the more commonly used typical antipsychotics medications
include:
 Thorazine (Chlorpromazine)
 Haldol (Haloperidol)
 Loxitane (loxapine)
 Orap (pimozide)
 Navane (thiothixene)
 Mellaril (thioridazine)
 Stelazine (trifluoperazine)
 In the 1990’s, new antipsychotic medications were developed
 These new medications are called second generation, or “atypical”

antipsychotics.
 One of these medications was Clozaril (clozapine). It is a very effective

medication that treats psychotic symptoms, hallucinations & breaks with
reality, such as when a person believes he or she is the president. But
clozapine can sometimes cause a serious problem called agranulocytosis,
(which is a loss of the white blood cells that help a person fight infection)
 Therefore, people who take clozapine must get their white blood cell
counts checked every week or two. Still, clozapine is potentially helpful
for people who do not respond to other antipsychotic medications
 Other atypical antipsychotics were developed. All of them are effective, &
none cause agranulocytosis These include:
 Risperdal (Risperidone)
 Zyprexa (Olanzapine)
 Abilify (Aripiprazole)

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Antidepressants, Antimanic &

 Antidepressants work on neurotransmitters such as serotonin,

 Older antidepressant medications include;

1) Tricyclics & Tetracyclics (TCA's)

 The warning says there is an increased risk of suicidal thinking or attempts

 A person with serotonin syndrome may be agitated, have hallucinations,

 Anticonvulsants used as mood stabilizers are;

 Atypical antipsychotic medications are sometimes used to treat symptoms

 Antipsychotics used to treat bipolar disorder include:

 Combination antipsychotic & antidepressant

 Conventional & typical antipsychotics are effective for positive symptoms

 These new medications are called second generation, or “atypical”

 One of these medications was Clozaril (clozapine). It is a very effective

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