BETTER LIVING THROUGH CHEMISTRY

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BETTER LIVING THROUGH CHEMISTRY

• MAGNUS LAKOVICS, M.D.

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LATEST AND GREATEST OUTLINE

• Introduction
• B Antidepressants
• C Antipsychotics
• D Mood Stabilizers
• E Psychostimulants
• F Antianxiety Agents

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Psychiatric Medications

• ADHD
• Anorexiant / Stimulant
• Anxiolytic / Hypnotic
• Non BDZ
• BDZ, Short Mid Long Acting

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Psychiatric Medication

• Depression
• TCA
• SSRI
• MAO
• Others

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Psychiatric Medications

• Psychosis
• Low Pot
• Mid Pot
• High Pot
• Atypicals
• Others

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Psychiatric Medications

• Bipolar / Mania
• Prophylactic Agent
• Anticonvulsants

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Oldest and Wisest Rules for the Latest and
Greatest

• 8. Avoid PRNs (exception hospital)
• 9. Drugs treat symptoms, have target symptoms in
  mind
• 10. Know treatment time frames involved
• 11. Use latest and greatest only when they have
  substantial advantage, older drugs fail or for
  specific indications

• 1. Know your drugs
• 2. Choose a drug for its effectiveness
• 3. Side effects are king
• 4. One drug rule
• 5. Low and go slow
• 6. Inform the recipient
• 7. See them frequently to start out

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Optimal Treatment for Subtypes of Depressions

• Atypical Depression
• - MAOIs gt TCAs
• - SSRIs gt TCAs ?
• Anxious Depression
• - stimulating AD sedating antidepressants
• Irritable Depression
• - SSRIs gt Bupropion
• Depression with Comorbid OCD
• - SSRIs gt Bupropion

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Antidepressants are classified by mechanisms or
structure

• SSRIs
• Bupropion
• Mirtazapine
• Venlafaxine
• Trazodone and Nefazodone

• Tricyclics and Nefazodone
• Monoamine Oxidase Inhibitors
• Newer (and very old) antidepressants

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Low Potency Antipsychotics Thioridizine Mellaril
Chlorpromazine Thorazine Mid Potency
Antipsychotics Perphenazine Trilafon Loxapine
Loxitane High Potency Antipsychotics Trifluperaz
ine Stelazine Haloperidol Haldol Fluphenzine Pr
olixin
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Newer AntipsychoticDrugs
Clozapine Risperidone Olanzapine Sertindole Queti
apine Ziprasidone Aripiprazole
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• Typical antipsychotics like haloperidol are
  potent dopamine antagonists at the D2 receptor.
  These drugs are effective against the positive
  symptoms of schizophrenia, but minimally improve,
  and may potentially exacerbate negative symptoms.
  Moreover, typical antipsychotics are associated
  with EPS and potentially irreversible
  neurological side effects such as TD.

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Atypical antipsychotic medications (i.e.
clozapine, risperidone, quetiapine olanzapine and
ziprasidone) are all D2 receptor antagonists and
5HT 2A receptor antagonists, which distinguishes
them from typical antipsychotic agents. Atypical
medications alleviate the positive symptoms and
may also have a beneficial effect on the negative
and cognitive symptoms of schizophrenia. These
drugs represent an advance over typical
antipsychotics because they have minimal
potential for causing EPS.
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Although the atypical agents are an improvement
over typical antipsychotics, experience with
these drugs has shown that each of them has
potentially serious unwanted side effects.
Drug-specific side effects can include
agranulocytosis, weight gain, dyslipidemia,
dysregulation of glucose, QTc prolongation, and
prolactin elevation.
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Bipolar / Mania

• Prophylactic agent
• Lithium Carbonate Lithobid
• Anticonvulsants
• Valproic Acid Depakote
• Carbamazepine Tegretol
• Lamotragine Lamictal
• Tropiramate Topamax
• Antipsychotics
• Olanzapine Zyprexa
• BDZ
• Clonazepam Klonopin

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6. Sachs, Harvard Psychophaem Course 10/02
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Atomoxetine (Strattera) for Adult ADHD I

• Selective NE reuptake inhibitor
• Enhances DA function
• Effective in adults no controlled med
• Effective within days with increasing improvement
  over weeks
• Usual dose
• Start o.5 mg/kg/day, once daily in AM
• Final dose target up to 1.2 mg/kg/day
• Side effects
• Nausea, insomnia, dizziness, dry mouth, urinary
  hesitation, constipation, sexual side effects
• Pulse increases by 5BPM, BP negligible
  difference

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Short Acting BDZ Alprazolam Xanax Oxazepam Ser
ax
Mid Acting BDZ Tempaxepam Restoril Lorazepam
Ativan
Long Acting BDZ Chlordiazepocide Librium Diazep
am Valium Clonazepam Klonopin
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How Stress Affects Memory Ability

• Studies of Laboratory animals
• Chronic stress shrinks brain memory centers and
  impairs memory
• Studies of humans
• Several days of stress hormone exposure impairs
  memory
• Stress leading to depression / anxiety distracts
  us from learning and remembering.

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Keeping Our Brains Young

• Minimize stress
• Get regular physical exercise
• Eat a healthy brain diet
• Choose a lifestyle that protects your brain
• Remain Mentally active