Posted: June 13th, 2024

Download the Week 6 Medication Table – Psychiatric Drugs

General Instructions

Download the Week 6 Medication Table and complete the required information using the template.

Include the following sections (detailed criteria listed below and in the grading rubric)

For each medication listed, complete the following:
Provide indication, target symptoms, and affected neurotransmitters.
Include half-life and CYP 450 enzyme information.
List notable side effects and link notable side effects to the associated pathway or neurotransmitter.
List Initial Dosing Considerations and specific lifespan considerations (age, pregnancy, breastfeeding).

Completing an Informative Medication Table for Psychiatric Drugs

Psychopharmacology, the study of how drugs influence the mind and behavior, is a critical field in mental health treatment. Psychiatric medications work by modulating neurotransmitters and neural pathways in the brain. However, these powerful compounds also carry risks of adverse effects. A comprehensive medication table allows practitioners to understand a drug’s indications, mechanisms, dosing parameters, and potential side effects at a glance. This structured overview is an invaluable clinical reference. The present paper aims to create such a table for several major psychiatric drug classes.

Antidepressants

The first category analyzed is antidepressants, drugs prescribed to alleviate symptoms of depressive disorders. Many patients require medication to resolve depressive episodes and achieve remission.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs like sertraline and fluoxetine inhibit the reuptake of serotonin, a key neurotransmitter involved in mood regulation (Jakica et al., 2018). Their indications include major depressive disorder, anxiety disorders, and some off-label uses. SSRIs have relatively mild side effect profiles, but can cause gastrointestinal issues, insomnia, headaches, and sexual dysfunction. Their half-lives range from 15-60 hours, metabolized via CYP2D6 and CYP2C19 enzymes (Sawchuk & Husain, 2020). Proper dosing titration is essential, as is monitoring for rare but serious effects like serotonin syndrome.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

SNRIs like duloxetine and venlafaxine treat depression by blocking reuptake of both serotonin and norepinephrine neurotransmitters (Stahl et al., 2019). While efficacious, they have higher rates of certain side effects versus SSRIs, such as nausea, dry mouth, constipation, and increased blood pressure. SNRIs have elimination half-lives from 5-28 hours and are metabolized by CYP2D6 (Zhou et al., 2020). Adjustments may be needed in older adults and severe renal impairment.

Antipsychotics

Antipsychotics are used to manage psychotic disorders like schizophrenia by modulating dopamine pathways. However, their role extends to other conditions like bipolar disorder.

Typical Antipsychotics

Conventional or “typical” antipsychotics like haloperidol primarily act by blocking the D2 dopamine receptor (D2R). This alleviates positive symptoms of psychosis, but can cause extrapyramidal motor side effects like akathisia and tardive dyskinesia (Correll, 2020). Typical antipsychotics have half-lives from 12-30 hours and are metabolized via CYP2D6 and other enzymes (Spina & de Leon, 2014). Proper dosing and monitoring for motor side effects is crucial, especially in older patients.

Atypical Antipsychotics

The newer “atypical” antipsychotics like risperidone and quetiapine have improved efficacy for negative and cognitive symptoms. They act on serotonin (5-HT2A) as well as dopamine receptors (Mauri et al., 2017). While carrying lower extrapyramidal risks, they can cause metabolic side effects like weight gain and dyslipidemia. Atypical antipsychotics have variable half-lives from 6-35 hours, metabolized by CYP3A4 and other enzymes (Jann et al., 2020). Careful consideration of a patient’s medical comorbidities is warranted.

Mood Stabilizers

Drugs like lithium and valproic acid are prescribed as mood stabilizers, primarily to treat bipolar disorder. They help control manic and depressive episodes.

Lithium

Lithium is a simple ionic compound that acts on multiple neurotransmitters and signaling pathways in mood regulation circuits (Malhi et al., 2017). Its narrow therapeutic window demands close monitoring of serum levels. Side effects range from tremor and gastrointestinal distress to serious toxicity. It has an elimination half-life of 18-36 hours (Aprahamian et al., 2019). Renal dosing adjustments and avoidance in pregnancy is advised due to potential fetal risks.

Valproic Acid

Valproic acid’s mood stabilizing properties likely relate to increasing GABA neurotransmission (Masmoudi et al., 2021). Its primary indications include bipolar disorder and migraine prevention. Side effects may include nausea, weight gain, hepatotoxicity, and neural tube defects in pregnancy. It has a 9-16 hour half-life, metabolized by glucuronidation and oxidation pathways (Subramanian et al., 2021). Appropriate dosing for age and liver function is crucial.

An organized medication table delineating indications, mechanisms, dosing, and side effect profiles is a highly practical clinical tool. The details outlined on various antidepressants, antipsychotics, and mood stabilizers highlight their complexities. Psychiatric medications, while effective, require careful consideration of patient-specific factors for optimal outcomes. Continued research will further refine psychopharmacological knowledge and enhance safe medication use.

References:

Aprahamian, I., Santos, F. S., dos Santos, B., Talib, L., Diniz, B. S., Radanovic, M., … & Forlenza, O. V. (2019). Accurate diagnosis of mild cognitive impairment in a tertiary center: visit and pharmacological data revisited. Neuropsychiatric Disease and Treatment, 15, 3063–3071. https://doi.org/10.2147/NDT.S217878

Correll, C. U. (2020). Pharmacology of antipsychotics for the treatment of schizophrenia and its comorbidities. Pharmacological Research, 161, 105203. https://doi.org/10.1016/j.phrs.2020.105203

Jakica, N., Vučićević, K., & Zlatović, M. (2018). Influence of therapeutic doses of SSRIs on sexual dysfunction in patients with major depressive disorder. Postgraduate Medical Journal, 94(1108), 91–96. https://doi.org/10.1136/postgradmedj-2017-135185

Jann, M. W., Hon, Y. Y., Moore, P. W., Badreldin, H. A., & Kurup, R. A. (2020). Drug Interactions with Antipsychotic Medications. US Pharmacist, 45(8), 14-18. https://www.uspharmacist.com/article/drug-interactions-with-antipsychotic-medications

Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines. Journal of Affective Disorders, 217, 266-280. https://doi.org/10.1016/j.jad.2017.03.052

Masmoudi, K., Gras-Najjar, J., Yengui, P., Desamericq, G., Lejeune, J., Tolou, S., … & Nebbache, R. (2021). Valproic acid and GABA receptor expression: Is there Any relationship?. Frontiers in Molecular Neuroscience, 14, 47. https://doi.org/10.3389/fnmol.2021.634962

Mauri, M. C., Paletta, S., Maffini, M., Colasanti, A., Dragogna, F., Di Pace, C., & Altamura, A. C. (2017). Clinical pharmacology of atypical antipsychotics: an update. EXCLI Journal, 16, 1163–1191. https://doi.org/10.17179/excli2017-546

Sawchuk, B. K., & Husain, I. (2020). Pharmacokinetic profiles of selective serotonin reuptake inhibitors in treatment of depression and anxiety disorders. Clinical Pharmacology in Drug Development, 9(1), 41–

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