Lecture 5 - Psychotropic Medication

Question 1

Psychotropic Medications

Answer 1

Theories behind the use of psychotropic drugs focuses on neurotransmitters and receptors.

used to relieve or decrease symptoms, prevent or delay relapse. Not a cure and cannot be used as the sole treatment for psychopathology. Informed consent required. Broad spectrum and have effects on a large number of symptoms. Tolerance can be an issue.

• All medications have side effects, and each individual will have a unique reaction to a given drug.
• Method of action is more or less unknown.
• Combinations of medications can be unpredictable. Recreational drugs such as alcohol can have interaction effects.

Question 2

Antidepressants

Answer 2

drugs that increase the central serotonin, noradrenaline, and dopamine concentration. Usually take 2-4 weeks to come into effect. Types: TCAs, SSRIs, MAOIs, SNRIs, and alternatives such as St John’s Wort.

• Used in treatment of depression, anxiety, phobias, SAD, PD, eating disorders, ADHD in adults, migraine, autism, OCD, and irritability in PTSD.
• TCAs – not ideal. Slow to take effect, greater side effects, and hazardous in overdose. Cardiovascular problems, sedation, hormonal effects. Risk of ventricular dysrhythmias. Can interact with grapefruit juice.
• SSRIs – OD risk reduced. Equivalent efficacy, greater safety, improved tolerability, and ease of dosing compared to TCAs. Can cause nausea, insomnia, sexual dysfunction, anorexia, increased risk of gastrointestinal bleeding. Increase in suicidal thoughts following commencement in children and adolescents.
• SNRIs and Atypical – augmenting agents or second line treatment. Greater efficacy at increased doses. Augmenting SSRIs.
• MAOIs – third or fourth line treatment. Drug-drug and drug-food interactions. Treatment of depression in the elderly.

Question 3

Anti-Anxiety Agents

Answer 3

can use SSRIs or anti-psychotics (improve efficacy other medication). Buspirone (2-4 weeks), Barbituates. Many cause sedation. Most commonly used is benzodiazepines.

• Benzodiazepines – anxiety and insomnia. Can result in dependency and can have severe withdrawal symptoms. Tapered and discontinued. Excessive sedation, impairment of physical and mental activities, and respiratory repression – not to be used for those with respiratory disorders, severe liver or kidney damage, or those with a history of alcohol or drug abuse. Withdrawal symptoms of anxiety, psychomotor agitation, insomnia, irritability, tremors, palpitations.

Question 4

Mood stabilisers

Answer 4

preventing extreme mood swings, taken long term by bipolar clients. Combination of lithium and antipsychotics is more effective than lithium alone. Can achieve mood stabilisation through establishment of good circadian and exercise routines. Weight gain common to these medications

• Lithium – works for 60% of people. Preventing manic episodes. Closely monitored. GI distress, sedation, cognitive deficits, weight gain, poor concentration, skin problems. Renal, hyperthyroidism, psoriasis, cardiac, and toxicity in severe cases.
• Valproate – better tolerated than Lithium during bipolar depression.

Question 5

Medication - effectiveness, individual differences & adherence

Answer 5

• Effectiveness – weak effects allowing for placebo possibility. 30-40% fail to show any improvement.
  
  • Individual differences due to genetic factors, metabolism, receptors.
  • Elderly – should use SSRIs because of low drug interactions, and avoid benzodiazepines and TCAs.
• Pregnancy – teratogenic or neurobehavioural effects. Risks need to be weighed against benefits. TCAs and fluoxetine are the safest.
• Adherence – motivational interviewing. We are not doctors. Need to work with risk management and psychoeducation, and address cognitions and behaviours and barriers to treatment. Help manage and tolerate side-effects.