Comprehensive Guide to Psychotropic Medications: Benzodiazepines, Antidepressants, Mood Stabilizers, and Antipsychotics

Lorazepam

A benzodiazepine used to treat anxiety and insomnia.

Temazepam

A benzodiazepine used primarily for the treatment of insomnia.

Triazolam

A short-acting benzodiazepine used for the treatment of insomnia.

Alprazolam

A benzodiazepine commonly prescribed for anxiety and panic disorders.

Midazolam

A benzodiazepine used for sedation and anesthesia.

Oxazepam

A benzodiazepine used to relieve anxiety and manage alcohol withdrawal.

Diazepam

The most familiar benzodiazepine, used for anxiety, muscle spasms, and seizures.

Zolpidem

A non-benzodiazepine used for the short-term treatment of insomnia.

Zaleplon

A non-benzodiazepine used for the treatment of insomnia.

Eszopiclone

A non-benzodiazepine used for the treatment of insomnia.

Ramelteon

A melatonin receptor agonist used for the treatment of insomnia.

Venlafaxine

An antidepressant used to treat major depressive disorder and anxiety disorders.

Duloxetine

An antidepressant used to treat major depressive disorder and generalized anxiety disorder.

Trazadone

An antidepressant used primarily for depression and insomnia.

Bupropion

An antidepressant used to treat major depressive disorder and to help with smoking cessation.

Mirtazapine

An antidepressant used to treat major depressive disorder.

Vortioxetine

An antidepressant used to treat major depressive disorder.

Lithium

A mood stabilizer used to treat bipolar disorder.

Valproic Acid

An anticonvulsant used to treat epilepsy and bipolar disorder.

Carbamazepine

An anticonvulsant used to treat epilepsy and bipolar disorder.

Lamotrigine

An anticonvulsant used to treat epilepsy and bipolar disorder.

Anxiolytic

Drugs that relieve anxiety.

Hypnotics

Drugs that promote sleep.

CNS Depression

Drowsiness, incoordination, and difficulty concentrating caused by depressants.

Anterograde Amnesia

Impaired recall of events that take place after dosing.

Paradoxical Effects

Insomnia, excitation, or euphoria that can occur as rare side effects.

Respiratory Depression

Rare when given orally but can cause severe respiratory depression when given intravenously.

Abuse

Benzodiazepines are classified as Schedule IV and can lead to dependence.

Teratogenic

Substances that can cause fetal harm when used during pregnancy.

Hypotension

Low blood pressure that can occur with benzodiazepine use.

Benzodiazepines

A class of drugs that act as CNS depressants and are used for anxiety, insomnia, and seizure disorders.

CNS Depressants

Substances that can cause profound respiratory depression, coma, and death when combined with other CNS depressants.

Tolerance

The phenomenon where the body becomes less responsive to a drug, requiring higher doses to achieve the same effect.

Physical Dependence

A condition where withdrawal symptoms occur when a drug is discontinued.

Overdose Symptoms (PO)

Lethargy, drowsiness, confusion.

Overdose Symptoms (IV)

Profound hypotension, respiratory arrest, cardiac arrest.

Flumazenil (Romazicon®)

A benzodiazepine receptor antagonist that blocks GABA and reverses sedative effects.

Benzodiazepine Withdrawal

Occurs after treatment for more than 8 weeks, requiring a gradual dose reduction.

Zolpidem (Ambien)

A sedative-hypnotic used for short-term management of insomnia.

Zaleplon (Sonata)

A short-acting hypnotic used primarily to help fall asleep.

Eszopiclone (Lunesta)

A drug for sleep onset or maintenance with no limitation on duration of use.

Melatonin Agonist

A relatively new hypnotic that activates melatonin receptors, approved for chronic insomnia.

Barbiturates

A class of drugs that bind to GABA receptors and enhance the actions of GABA.

Barbiturates - Ultrashort acting

Thiopental, used for induction of anesthesia.

Barbiturates - Short-Intermediate Acting

Secobarbital, not commonly used; for migraine abortion.

Barbiturates - Long-acting

Phenobarbital, used for epilepsy.

CNS Depression (Barbiturates)

A pharmacological effect that can lead to modest reductions in blood pressure and heart rate.

Adverse Effects of Barbiturates

Includes respiratory depression, hangover effects, and increased sensitivity to pain.

Drug Interactions (Barbiturates)

Intensified effects when combined with other CNS depressants.

Overdose Symptoms (Barbiturates)

Respiratory depression, coma, pinpoint pupils, hypotension, and hypothermia.

Treatment for Barbiturate Overdose

Includes gastric lavage, dialysis, and maintaining oxygen to the brain.

Patient Teaching for Eszopiclone

Effective teaching is indicated if the patient states they should take the drug 1 hour before bedtime.

Patient Understanding of Triazolam

Indicated if the patient states that the medication will not affect their breathing.

Alprazolam Overdose Treatment

The nurse should prepare to administer Flumazenil.

Protamine sulfate

Acetylcysteine [Acetadote]

Naloxone [Narcan]

Flumazenil [Romazicon]

Depression

Most common psychiatric disorder

Incidence of depression in the U.S.

30% of the U.S. population will experience some form during their lifetime

Depression in adults

Approximately 1 in every 8 adults in the United States is depressed

Gender incidence of depression

Incidence in women twice as high as that in men

Suicide risk with depression

Risk of suicide is high with depression

Clinical features of depression

Symptoms must be present most of the day, nearly every day, for at least 2 weeks

Pathogenesis of depression

Complex and incomplete

Possible contributing factors to depression

Genetic heritage, Difficult childhood, Chronic low self-esteem

Monoamine hypothesis of depression

Depression is caused by the functional insufficiency of monoamine neurotransmitters: Norepinephrine, serotonin, or both

Pharmacotherapy

Primary therapy for depression

Electroconvulsive therapy

Used when drugs and psychotherapy have not worked, when a rapid response is needed, for severely depressed patients, for suicidal patients, for elderly patients at risk of starving

Transcranial magnetic stimulation

Time course of response to treatment

Symptoms resolve slowly; Initial responses develop after 1 to 3 weeks; Maximal responses may not be seen for 12 weeks

Suicide risk with antidepressants

May increase suicidal tendencies during early treatment

Monoamine oxidase inhibitors (MAOIs)

Block the enzyme responsible for the breakdown of catecholamines.

Available MAOIs in the US

Phenelzine and Tranylcypromine

Foods to avoid with MAOIs

Avoid foods high in tyramine- can cause HTN crisis

Drug interactions with MAOIs

Avoid over-the-counter sympathomimetics; Do not combine with any other antidepressants

Transdermal MAOI

Selegiline [Emsam] is the first transdermal treatment for depression

Selective serotonin reuptake inhibitors (SSRIs)

Selectively inhibit the reuptake of 5-HT, resulting in increased 5-HT concentrations in the synapse.

FDA approved SSRIs for depression

Fluoxetine (Prozac®), Sertraline (Zoloft®), Paroxetine (Paxil®), Citalopram (Celexa®), Escitalopram (Lexapro®), Fluvoxamine (Luvox®), Vilazodone

Side effects of SSRIs

Gastrointestinal complaints, CNS stimulation, Headache, Sexual dysfunction

Serotonin syndrome

Begins 2-72 hours after initiation of treatment, most likely if SSRI combined with MAOI

Desvenlafaxine

An antidepressant similar to Venlafaxine with negligible effects at other receptors that cause anticholinergic or antihistaminic side effects.

Side effects of Venlafaxine, Desvenlafaxine, and Duloxetine

Nausea, Headache, Nervousness (more stimulatory), can increase blood pressure (diastolic), and weight loss.

Extended-release formulation

Available for some antidepressants, may have fewer gastrointestinal side effects.

Trazodone (Desyrel)

A serotonin reuptake inhibitor that also blocks 5-HT2a receptors, used more for sleep than depression.

Side effects of Trazodone

Sedating, orthostatic hypotension, dry mouth.

Bupropion (Wellbutrin)

An inhibitor of dopamine and norepinephrine reuptake with minimal effects on 5-HT, associated with a low risk of seizures.

Side effects of Bupropion

Increase seizure risk, agitation, weight loss, constipation, tremor, headache, insomnia.

Norepinephrine-Dopamine Reuptake Inhibitor (NDRIs)

A class of antidepressants that inhibit dopamine and norepinephrine reuptake with minimal effects on serotonin.

Mirtazepine (Remeron)

An antidepressant that antagonizes presynaptic receptors preventing norepinephrine and 5-HT release.

Side effects of Mirtazepine

Sedation and weight gain (increased appetite).

Dose effect of Mirtazepine

30 mg and below = Sedation; Above 30 mg = Stimulating.

Esketamine (Spravato)

An NMDA receptor antagonist approved for use in conjunction with an oral antidepressant for treatment-resistant depression.

Black Box Warning for Esketamine

Includes sedation, dissociation, respiratory depression, abuse and misuse, suicidal thoughts and behaviors.

Bipolar Disorder

A chronic condition characterized by recurrent fluctuations in mood, including episodes of mania and depression.

Mainstays of therapy for Bipolar Disorder

Lithium and valproic acid, often combined with an antipsychotic.

Characteristics of Bipolar Disorder

Cyclic disorder with episodes of mania and depression persisting for months without treatment.

Types of mood episodes in Bipolar Disorder

Pure manic episode (euphoric mania), hypomanic episode (hypomania), major depressive episode (depression), mixed episode.

Manic Episode

At least 1-week period of an abnormal and persistent elevated mood.

Inflated self-esteem

A significant degree of an exaggerated sense of self-worth.