Main drugs

EMSAM

selegiline patch, MAOI, low dose does NOT require tyramine concerns with food. ONLY MAOI that I might use especially if patients have issues swallowing pills. Used for MDD, MAJOR caution with SSRI use

prozac

Fluoxetine (SSRI) MDD, panic, OCD, PMDD, bulimia, max dose 80mg. Most common increase anxiety. If Zoloft or lexapro does not work, Prozac Is usually the next option.

Lexapro

Escitalopram , only used for MDD,GAD, off label panic SSRI 10-20mg (high sexual dysnfunction rate)

Zoloft

sertraline SSRI, MDD, panic, OCD, PTSD,

50-200mg usually, 25mg starting , 50 sweet spot. Most common nausea. Start in PM if you can, headache , nausea, upset stomach, typically goes away. flip to AM if you want. At 3 week mark, follow back to see progress. if already progressing well we can keep dose same

paxil

Paroxetine SSRI, MDD, GAD, OCD, PTSD, PMDD, 10mg , increase 10 per week to max of 50mg .(Autism )

Celexa

Citalopram SSRI, MDD, off label panic

20 start, 40mg max

Auvelity

(dextromethorphan/bupropion)-NMDA receptor that targets glutamine. N-methyl-D-aspartate has Wellbutrin in it, about 100mg per pill comes in weird 45/100 pills. Caution when using with prozac Paxil do to same receptor activation. can only use 1 pill not 2 . max dose 2 pills

ONLY FOR MDD

Trintellix

Atypical antidepressant SSRI like , really only good for MDD, minimal side effects compared to SSRI. weight neutral, labido not typically affected. 10mg start, 20mg max SSRI class

Cymbalta

Duloxetine

SNRI, depression, anxiety, fibromyalgia and chronic pain uses (Serotonin-norepinephrine reuptake inhibitors)

Effexor(XR)

Venlafaxine , MDD,GAD, panic ,

caution for serotonine syndrome (BP baseline, can increase in high doses over 225. Serotonin-norepinephrine reuptake inhibitor (SNRI)

Pristiq

Desvenlafaxine , MDD, do not use within MAOI use of 14 days.

Wellbutrin

Bupropion -max dose 450mg, used for increase labido uses, increases dopamine and norepinephrine. stimulant like, can worsen anxiety, helps with smoking cravings. IR dose sucks, can be used as boost for ADHD symptoms. Fewer side effects, great drug used a lot (NDRI-norepinephrine -dopamine reuptake inhibitor) used in combo a ton.

(Remeron),

Mirtazapine increases serotonin and norepinephrine while blocking histamine (H1) receptors, which induces drowsiness. and increased appetite. helps with sleep FDA off label . CAUTION weight gain. Oddly lower doses help more with sleep over high doses. 7.5-45mg /MDD, anxiety ex. (atypical)

trazodone

Desyrel, atypical, used for sleep super safe, low side effects 25mg to 200mg, 150mg usually most

common scales for anxiety

Zung anxiety GAD 7

scales for depression.mood

PHQ9, phq3 , RMS (rapid mood scale) , zung depression,

Campral

generic name:

acamprosate) taken 3x daily for alcohol, issues with taking 3x pills daily

safest usually

naltrexone

(REVIA),

alcohol and opioids induces vomitting if any alcohol used, caution with mouthwash even, Naltrexone binds to opioid receptors, preventing substances like heroin, morphine, oxycodone, and alcohol from activating them and releasing feel-good chemicals like dopamine.

baseline monitor labs (check on everyone)

magnesium, vitamin b complex, vitamin d, calcium

GeneSight test

help choose what meds to pick, analyzes CYP2d6 and CYP2c19

Effexor

Fluvoxamine

LUVOX , OCD , 25-100 IR, 100-150 ER SSRI

Risperdone or any other ending in "one" monitor for what

Prolactin

oxcarbazepine monitor for

SODIUM, (Trileptal,) . an anticonvulsant often used off-label as a mood stabilizer for bipolar disorder, particularly for managing mania, by affecting sodium channels and neurotransmitters like GABA and glutamate to stabilize nerve activity

lithium monitor for

LI level, TSH, bun/creatinine,

chantix

varenicline, smoking sensation, most effective , black box neuropsychiatric events like depression, suicidal thoughts even without psychiatric disease. Nicotine receptor partial agonist. dose .5mg titrate slowly, start 1 week before quick date.

zoloft, prozac, lexapro safe for what age group?

kids 4 and up, risperdone for mood/anager if severe.

Depakote

(valproic acid), monitor for thrombocytopenia , best for acute manic episode. hard on liver, used for bipolar disorder (acute mania), effective serum level 50mcg-125mcg, start 250-500mg for acute QHS, 1000mg-1500mg day target, max 4000mg

lithium (gold standard drug)

lithobid, used for acute mania, bipolar maintenance, target serum level .8mcg-1.2 acute, .6-1 for maintenance, , check TSH, lithium levels, can cause fine tremors, add propranolol to counteract, hypothyroidism, , NSAIDS, and ace drugs alter Lithium levels can increase levels, excreted by urine. 5 days roughly for lithium levels to level back out if elevated ex. Checked 3 months or so once levels reached, checked 7 days after initiation, change

Lamictal

lamotrigine, bipolar maintenance, start 25mg max 200mg, used for prophylaxis of depressive episodes associated with it. black box skin reaction!, Steven-johnson syndrome, also used for treatment resistant anxiety (add in for anxiety) Also issues with balance in elder patients

Abilify

Aripiprazole

Antipsychotic, atypical second generation

Schizophrenia, bipolar disorder, acute treatment of manic and mixed episodes. most common AKATHISIA especially if used in kids, sedation,

Rexulti

Brexpiprazole, schizophrenia, depression adjunct, akathisia, weight gain, similar to Abilify , ABILIFY better for most part,

Vraylar

Variprazaine, schizophrenia, bipolar disorder manic or mixed, similar to Abilify, newest drug, treats bipolar all which is nice, atypical

Haldol

haloperidol, treat schizophrenia, acute psychosis, and delirium , tourettes, prolactin elevation caution, good injectable, high potency which can cause more EPS

Latuda

lurasidone, schizophrenia and bipolar depression, must ge given with food. weight neutral, no need for titration, once daily dosing, EPS and akathisia,

Seroquel

Quetiapine, schizophrenia, bipolar mixed, major depression adjunct, insomnia off use label, low risk for EPS, good first choice, sedation and weight gain issues, causes LOW BP, second gen atypical

Risperdal

risperidone

antipsychotic

schizophrenia, bipolar disorder mixed, irritability symptoms autisms >5, EPS, somnolence in children, Othostatic hypotension, rare hyperprolactinemia like galactorrhea (milk production) or amenorrhea

Geodon

Generic: Ziprasidone

Drug Class: Atypical Antipsychotic

Indication: Schizophrenia, bipolar disorder, acute treatment mixed, maintenance of bipolar disorder, acute agitation with Schizophrenia IM only, akathisia, dizziness, rare QT prolongation, high cost hard to justify, less weight gain.

Invega Sustenna

monthly injection Shizophrenia, schizoaffective disorder

Schizoaffective disorder vs schizophrenia

Schizoaffective disorder

combines schizophrenia symptoms (hallucinations, delusions) with significant,, concurrent mood episodes (depression or mania), whereass schizophrenia primarily features psychosis without consistent, major mood disturbances.

Ambien

Zolpidem sedative hypnotic, 5-10mg . sleep walking . potential for abuse and dependence.

Lunesta

(eszopiclone)- insomnia, fall asleep faster and wake up fewer times during the night. belongs to a drug class called sedative-hypnotics, and it's a controlled substance so there are restrictions on how it can be filled and refilled at the pharmacy.

hydroxyzine

vistaril, is used for anxiety, sleep. 10-20mg ish , can be drying

a prescriptionfirst-generation antihistamine

Temazepam

(Restoril)- sleep aid, prescription benzodiazepine used for the short-term treatment of insomnia, typically for 7 to 10 days. used long term though

3 drug classes for stimulants

methylphenidate, amphetamines, non stimulants

Strattera

Atomoxetine, add use ./can be combined with adderall of better effect. works especially well with prozac, same receptor site. instead of 40mg starting, 25mg instead. off label treatment resistant depression original purpose but actually for ADHD , non stim, SNRI, children over 6

Vyvance

Lisdexamfetamine

ADHD, amphetamine start 10-20mg, max 70mg, fewer side effects compared to other amphetamines, pro drug meaning must be broken down by GI acids, avoid antacids,

approved drug for binge eating

vyvance

ritalin

methylphenidate, adhd , narcolepsy, start 5mg max 60mg, amphetamine based. Concerts or Ritalin SR is extended release,

methylphenidate transdermal

daytrana

adhd, patch, 9 hour patch, high cost, not recommended, issues with patch,

Xanax

Alprazolam

Anxiety, .25mg -2mg, max 4mg

benzo

GAD, Panic,

buspirone

buspar, GAD, 5mg to 30mg, benzo like, not as robust response, dizziness and nausea as SS though, some do not tolerate well or its like water, doesn't do jack

Clonazepam

klonopin, seizure, panic, anxiety off use, .5mg to 2mg, max 6mg, insomnia off use label, lower doses like other benzos in elderly, Benzos=ehances gaba

Valium

Diazepam, benzo, GAD, alcohol withdrawal, muscle spasms, used off label for CATATONIA, 2mg to 1-mg, max 40mg, controlled like other benzos,LONG ACTING,

lorazepam

Ativan, gAD , .5mg-2mg, max 6mg, shorten them use best first line agent as benzo drug,

propranolol

inderal, anxiety off label, essential tremors, 10-80mg, common 10-20mg for anxiety use, non selective beta 1 and beta 2 adrenergic receptor antagonist, helps with physical symptoms of anxiety like tremor, sweating, flushing, tachy, used when benzos can't be used because of sedation effect.

catatonia

a severe neuropsychiatric syndrome characterized by an inability to move normally, stupor, mutism, and waxy flexibility, often occurring alongside psychiatric (depression, schizophrenia) or medical disorders

3 types of tremors

rest tremors (when muscles are relaxed, common in Parkinson's), postural tremors (when holding a position against gravity), and action/kinetic tremors (during voluntary movement).

Wellbutrin xl vs Sr

XL 1 dose, used for depression, pick me up. SR is for smoking sensation, last 12 hours, needs to be dosed 2x

trichotillomania

eye lash pulling ,first like supplement NAC , 1000mg or so x2

Excessive need for admiration, lack of empathy, grandiosity

narcistic

Intense fear of abandonment, impulsive actions, fragile self-image.

BPD

BPD first line treatment

DPT therapy

good drug class in place of SSRI for anxiety driven

SNRI like EFFEXOR , money drug for anxiety

GuanfacinePM

taken PM, treat ADHD, non stimulant, centrally acting alpha-2A adrenergic receptor agonists. EXPENSIVE, no generics 400 plus if no insurance even with Goodrx

topamax

makes carbonated drinks taste weird

Clozapine

Clozaril, atypical antidepressant for treatment resistant schizophrenia. can cause agranulocytosis, strict blood work with WBC monitoring required. watch for weight gain, blood sugar, cholesterol. Anticholinergic Effects: like drooling, dry mouth, constipation

Modafinil

Provigil, cns stimulant. used for daytime sleepiness, narcolepsy., fatigue management in depression off label adhd

Ativan works well in what population

elderly not metabolized by liver.

3 benzo drugs not metabolized by the liver (OTL)

temazepam (restoril), oxazepam not common, Ativan (lorazepam)

Viibryd

vilazodone. 5-HT1A receptor partial agonist ex of this is buspirone.. plus ssri, for MDD. known as a SPARI- serotonin partial agonist-reuptake inhibitor. It is used in the treatment of major depressive disorder (MDD) and can enhance serotonin effects. off label anxiety

TCA vs atypical 2ndgen drug for OCD

anafranil (Clomipramine) TCA has more side effects compared to resperidol 2nd gen atypical used for OCD low dose 1-2mg combined with SSRi as add on drug if anafranil doesnt work.

celexa vs lexapro drug profile and improvements

lexapro is a newer version of celexa, less GI upset, doesn’t share QT prolongation profile like celexa . Newer and better essentially with less side effects

must be taken with 350 calories of food

Latuda (Lurasidone)

helpful to add zofran to which particular non sim med

Strattera

BP 2 meds, tips and tricks . med for highs of manic episodes and meds better for lows w/depression

depakote helps with the acute , highs , (monitor LFTS can affect liver 6 month labs or so ) lamictal targets more lowsl

list of meds for bipolar 2

aplyta, vraylar, lamictal, latuda, depakote, lithiium, valporic acid, seroquil add in

BP med with minimal side effect profile, also works well for resistant treatment anxiety.

Lamictial( Lamotrigine)

supplementation for brain zaps and antidepressants

omega 3

drugs for appetite stimulation

cyproheptadine 1st gen antihistamine number 1 , or Remeron possibly

another Adderall equivalent like drug, same family of amphetamine

dexedrine (Dextroamphetamine:) , or vyvance (Lisdexamfetamine)

MTHFR mutation dose with what

methylated folate (vitamin b9) 7.5mg starting to 15mg

MSE 30 questions

Depression causes issues with sleep how sleep cycle.

Phase shift or phase advance, lack of neurotransmitters, less serotonin, less epinephrine, less actyticoline

inflammation and its effects on mood

 

Inflammation causes vegas nerve to not fire correctly, gut and biome linked to mood possibly.

depression/anxiety on memory loss

Depression/anxiety causing memory loss, lack of glutamate (Excitatory transmitter, less of that equals memory, up to 40%). Pseduo dementia, false appearance of dementia.

How thoughts are processed, intrusive to obsessive.

Obsessive start in front cortex and goes back to basal ganglia, pathway is activated there is a worry, inhibitory pathway activities and it goes back front cortex and inhibits it.

Obsessive thought disorder, there’s overactivation of that pathway back to the front cortex and under activation of the inhibitory pathway.  CBT can be used or exposure therapy (hierarchy of fears)

serotonin vs dopamine

Serotonin and dopamine are neurotransmitters; they transport messages in the brain.

Serotonin equals mood and anxiety, think what SSRI does

Dopamine=pleasure and joy

how ketamine works

How ketamine works, helps block where glutamate binds and it causes glutamate to increase 2-3 days lasting.

Psychopathy checklist

25 and over =psychopath, Closest dsm5 is antisocial personality disorder, breaks lots of rules

Not every psychopath has this though.

Focalin dosing

focalin max dose 30mg kids, 40mg for adults

OCD treatment if SSRI is not enough

IF Luvox is not enough, seroquil can be added as conjuct treatment for treatment resistant ocd. 100mg up helps with augmentation, helps quiet thoughts by working on serotonin and dopamine receptors . remember seroquil also has histamine effects to help quiet racing thoughts, sedating effects

therapy for OCD

ERP therapy, exposure response therapy.