The Neurological System Drugs for Mood and Behavioral Disorders 2025.pptx Lecture 10/9/25 NURS-3100-Clinical Science I-SEC001-1258The Neurological System Drugs for Mood and Behavioral Disorders

Selective Serotonin Reuptake Inhibitors:

citalopram (Celexa)

escitalopram (Lexapro)

fluoxetine(Prozac)

fluvoxamine (Luvox)

paroxetine(Paxil/Pexeva)

Sertraline (Zoloft)

Common Side Effects SSRI

Nausea, dry mouth, sleep disturbance, headache, GI upset, dizziness, fatigue, sexual dysfunction.

Serotonin Norepinephrine Reuptake
Inhibitors (SNRIs)

duloxetine (Cymbalta, Drizalma Sprinkle)

venlafaxine (Effexor, Effexor XR)

and desvenlafaxine (Pristiq, Khedezla).

SNRIs prevent reuptake of

both serotonin and norepinephrine SNRIs prevent norepinephrine uptake, associated with dose dependent hypertension and may
require longer titration periods

Serotonin modulators are

are selective serotonin reuptake inhibitors that also partially
agonize/antagonize serotonin 5-HT receptors.

These drugs are not considered first
line therapy for depression. They may be used for treatment resistant depression;

Serotonin modulators include

some older drugs such as trazodone:

(Oleptro) and nefazodone (Serzone),

which are FDA approved for depression and insomnia but are
used at this time for insomnia only.

Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)

bupropion hydrochloride (Budeprion, Forfivo XL, Wellbutrin).

(NDRIs) Drugs in this class include

stimulants used for the treatment of attention deficit-
hyperactivity disorder (ADHD).

Common side effects of NDRIs

insomnia »» nausea» dry mouth, constipation,

increased BP/heart rate, sweating, fatigue, HA, tremor, appetite change, orthostatic hypotension, sexual dysfunction

Serious Adverse Events NDRIs

Suicidal ideation, serotonin syndrome, decreases
seizure threshold

Which of the following drugs is an SNRI?

Tricyclic Antidepressants (TCAs) Mechanisms:

Inhibiting the presynaptic reuptake of both norepinephrine and serotonin.
 Competitive antagonists on postsynaptic cholinergic, muscarinic, and histamine receptors (H1

Medications TCAs

amitriptyline (Elavil, Limbitrol)

clomipramine (Anafranil)

imipramine (Tofranil, Tofranil-PM)

nortriptyline (Pamelor)

mirtazapine (Remeron)

Tricyclic Antidepressants (TCAs) FDA approved for..

FDA approved for depression, diabetic neuropathic pain, post-herpetic neuralgia, migraine headache prophylaxis, and fibromyalgia.

Tricyclic Antidepressants (TCAs) side effects

Significant anticholinergic side effects.

Cardiac toxicity is a serious consequence of TCA overdose

Common Side Effects: Sedation, orthostatic hypotension, dizziness, dry mouth, urinary retention, constipation-highly anticholinergic

Tricyclic Antidepressants (TCAs) Adverse Events:

Serious Adverse Events: Suicidal ideation, serotonin syndrome, agranulocytosis, seizures, heart block/MI, angioedema

Monoamine Oxidase Inhibitors (MAOIs)

Phenelzine (Nardil)

tranylcypromine (Parnate)

selegiline transdermal (Emsam)

isocarboxazid (Marplan)

(MAOIs) approved only for…

approved only for depression; have many dangerous drug-food and drug-drug interactions which can cause a hypertensive crisis.

Common Side Effects (MAOIs)

drowsiness, orthostatic hypotension, visual changes nausea,
constipation, dry mouth, urinary retention, sexual dysfunction.

Serious Adverse Events (MAOIs)

Suicidal ideation, respiratory/circulatory collapse, hypertensive
crisis, serotonin syndrome

Bipolar Disorder used to be called…

Used to be called manic depression.
a mood disorder characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression).

To distinguish bipolar disorder from
depression, use

DIGFAST to assess symptoms: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness.

DIGFAST Norepinephrine, glutamate and gamma-aminobutyric

up»» Norepinephrine, glutamate
down»» gamma-aminobutyric acid [GABA]

Treatment of Bipolar Disorder

»»»»Nonpharmacologic and antidepressant treatments in
combination with mood stabilizers (3)

Lithium, Antiseizure medications, Atypical antipsychotic medications

Lithium:

common side effects include GI upset, tremor,
fatigue, HA. Serious adverse events include peripheral
circulatory collapse; toxicity is a frequent issue

Antiseizure medications:

valproic acid (Depakote),
carbamazepine (Tegretol),

lamotrigine (Lamictal)

Atypical antipsychotic medications

aripiprazole (Abilify),
olanzapine (Zyprexa),

quetiapine (Seroquel),

risperidone (Risperdal),

ziprasidone (Geodon)

Attention Deficit Hyperactivity Disorder (ADHD)

..Classified as a behavioral disorder; affects about 5% of school-aged children.
..1/3 children diagnosed with ADHD need treatment into adulthood
..Most children with ADHD are treated with medication in the US (about 70%)

ADHD medication 

CNS Stimulants-D- and L-amphetamine (Adderall)

lisdexamfetamine (Vyvanse)

methylphenidate (Ritalin, Concerta)

ADHD Non-CNS Stimulants

Non-CNS Stimulants include atomoxetine (Strattera),

clonidine,

bupropion