Selegiline

GENERAL Preparations Brand name Eldepryl only. Class Selective MAOI (type B inhibitor). Used in Bulimia, depression, panic disorder (other anxiety disorders). Mechanism of action Inhibits monoamine oxidase, the protein enzyme responsible for the breakdown of dopamine, epinephrine, norepinephrine, and serotonin, resulting in elevated levels of these neurotransmitters. PRECAUTIONS Warnings At doses over 10 mg day, selegiline can cause a hypertensive crisis in which your blood pressure rises...

Yohimbine

GENERAL Preparations Brand name Yocon only. Class Aphrodisiac. Used in Medication-induced sexual dysfunction. Mechanism of action Unknown effects in the brain. In the peripheral nervous system, it changes the muscle tone of blood vessels, resulting in enhanced blood flow to the genitals during sexual activity. PRECAUTIONS Warnings Yohimbine is found in rubacae and related trees. It has been used as an aphrodisiac for many years in many cultures. It has been helpful in some people to reverse the...

Treatment Options in Bipolar Disorder

The treatment of bipolar disorder has two phases. One goal is the restoration of a normal mood during an acute exacerbation of either mania or depression. Equally important is the maintenance of a normal mood, by preventing recurrences of either mania or depression. Treatment of Acute Mania Mania may require an emergency evaluation by your psychiatrist or a visit to a hospital emergency room if you don't have a psychiatrist. It can be a medical emergency if the symptoms impair your perception...

Establish the Presence of a Specific Psychiatric Syndrome

The most important issue is to determine whether there is a psychiatric disorder present, and if so, which one. This is a complex issue, and it generates considerable disagreement. Some people believe any deviation from normal behavior is part of a psychiatric syndrome, while others believe that even the most extreme forms of thought and behavior are normal variations. It is important to educate yourself about what disorder you may or may not have so that you can make the best use of treatment....

Preliminary Guidelines

Pregnancy and Breastfeeding You need to be careful about the use of psychiatric medications if you are pregnant or breastfeeding. If you are unsure whether or not you are pregnant it is important to get a pregnancy test prior to beginning any psychiatric medications. Neither pregnancy nor breastfeeding precludes medications, but they must be used with extra caution. This is discussed in more detail in chapter 4. Driving or Operating Heavy Machinery Your ability to operate a car or heavy...

Methamphetamine

GENERAL Preparations Generic and brand name Desoxyn Gradumet (longrelease) tablets. Class Amphetamine stimulant. Used in ADD (developmental disorders). Mechanism of action Releases dopamine and norepinephrine from presynaptic neurons. PRECAUTIONS Warnings Abuse potential Amphetamines have been extensively abused for their stimulant effects of euphoria and increased energy. Ex treme psychological dependence has occurred in some individuals, who may exhibit insomnia, irritability, hyperactivity,...

Chlordiazepoxide

GENERAL Preparations Generic and brand name Librium. Class Benzodi-azepine. Used in Alcohol withdrawal, anxiety disorders, bipolar disorder (Alzheimer's disease, antipsychotic-induced akathisia restlessness , insomnia). Mechanism of action Intensifies the effects of gamma-aminobutyric acid (GABA). PRECAUTIONS Warnings It is habit-forming. Chlordiazepoxide, like all benzodiazepines, is physically and psychologically habit-forming. People who have experienced traumatic events in their lives and...

Nicotine

Thirty percent of the U.S. population smokes cigarettes and a small percentage in addition to that use pipes, cigars, and smokeless tobacco. Regular use of tobacco causes heart disease, lung cancer, mouth cancer, emphysema, and bronchitis, and causes several hundred thousand deaths each year. Dependence on tobacco is partly due to the presence of nicotine, which produces slight changes in awareness and attention that some people find pleasing. Nicotine produces physical dependence. If smoking...

The Three Components of a Diagnosis

The word diagnosis derives from the Greek language and means, literally, to know through, or to know fully. Three aspects of an illness need to be understood before one can say that an illness is fully understood. The etiology is the cause of the illness. The pathogenesis is the process by which the etiology produces the symptoms of the illness. The syndrome is the set of symptoms that occur in the individual. These three aspects are most easily seen in the understanding and description of a...

Alternative Treatments for Psychiatric Problems

Medication is most helpful when it is used in conjunction with other things you do to help yourself. Try to get the most out of any medication you take by augmenting it with other sensible aids. Some things you can do on your own, while others require the expertise of others. Specific aids for each disorder will be described in part III. Diet affects your physical health. Deficiencies of vitamins and minerals cause illnesses. The best-known example is the development of scurvy among British...

Zaleplon

GENERAL Preparations Brand name Sonata only. Class Hypnotic (sleeping aid). Used in Insomnia. Mechanism of action Intensifies the effects of gamma-aminobutyric acid (GABA). PRECAUTIONS Warnings It may be habit-forming. Zaleplon is different structurally from benzodiazepines but has similar pharmacological properties, and may share their tendency to be physically and psychologically habit-forming. This issue is not resolved. Use with extra caution if you have Liver damage, as the metabolic...

Clorazepate

GENERAL Preparations Generic and brand name Tranxene. Class Benzodi-azepine. Used in Anxiety disorders, bipolar disorder (alcohol withdrawal, Alzheimer's disease, antipsychotic-induced akathisia restlessness , insomnia). Mechanism of action Intensifies the effects of gamma-aminobutyric acid (GABA). PRECAUTIONS Warnings It is habit-forming. Clorazepate, like all benzodiazepines, is physically and psychologically habit-forming. People who have experienced traumatic events in their lives and have...

Mesoridazine

GENERAL Preparations Brand name Serentil only in pills and liquid form. Class Standard antipsychotic of the phenothiazine group. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety). Mechanism of action Blocks postsynaptic dopamine receptors. PRECAUTIONS Warnings All antipsychotics can cause neuroleptic malignant syndrome, a rare, but severe and potentially fatal reaction consisting of fever, muscle rigidity, mental status changes, and alterations in pulse and...

Children

Because of their smaller size, limited cognitive skills, and dependence on others, adults protect them from harm and exploitation in myriad ways. These issues are relevant to the prescription of psychiatric medications to children. As a parent, you have the legal authority to decide whether your child should receive any medical treatment. Although you will likely discuss the issue of medication with your child, the decision is essentially yours. If you are a parent...

Protriptyline

GENERAL Preparations Generic and brand name Vivactil. Class Tricyclic antidepressant. Used in Anxiety disorders, bulimia, and depression. Mechanism of action Blocks the reuptake of norepinephrine and serotonin into presynaptic neurons. PRECAUTIONS Don't use if you have Heart block (an abnormal heart rhythm) or if you recently had a heart attack, as protriptyline may worsen heart block and dangerously affect heart function. Use extra caution if you have Bipolar disorder, as protriptyline may...

Psychiatric Drugs Poison or Panacea

Unhappy all her life, a thirty-one-year-old woman has felt good, alive, normal, only in the last few months since she's been taking Prozac. A middle-aged man feels trapped in a cycle of anxiety and addiction to Xanax. The parents of a teenage boy with hallucinations think their son is calmer on clozapine, but he feels like a zombie. Teachers are thrilled with the effects of Ritalin on a fourth-grader, but his mother worries about how it affects his personality. The daughter of an elderly woman...

The Side Effects

If you notice a side effect not described here, contact your physician. If you experience a side effect that is listed, but not associated with the drug you take, it is wise to contact your physician to ensure your safety. Boldface type indicates side effects described elsewhere in this section. Abdominal Pain Nefazodone, phenothiazines, tacrine, and valproate (3) can cause liver damage and failure. If you experience abdominal tenderness, especially if it is accompanied by yellow eyes or skin...

Flurazepam

GENERAL Preparations Generic and brand name Dalmane. Class Benzodi-azepine. Mechanism of action Intensifies the effects of gamma-aminobutyric acid (GABA). Used in Insomnia. PRECAUTIONS Warnings It is habit-forming. Flurazepam, like all ben-zodiazepines, is physically and psychologically habit-forming. People who have experienced traumatic events in their lives and have chronic anxiety are especially prone to developing dependence. Prolonged use is associated with a range of problems. Use for...

Amoxapine

GENERAL Preparations Generic and brand name Asendin. Class Tricyclic antidepressant. Used in Bulimia, depression. Mechanism of action Blocks the reuptake of norepinephrine and serotonin into presynaptic neurons. It also blocks the response of dopamine receptors to dopamine on postsynaptic neurons. PRECAUTIONS Warnings Although amoxapine is used as an antidepressant, its action of blocking dopamine gives it antipsychotic-like activity, and the potential to cause side effects common to other...