A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at least naturally derived.
Prescription psychiatric medications, like all prescription medications, require a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner, PMHNP, before they can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology.
Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs, and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactives drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions with the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology.
Psychiatric medications sometimes have adverse effects that may reduce patients' drug compliance. Some of these adverse effects can be further treated by using other medications such as anticholinergics (antimuscarinics). Some adverse effects, including the possibility of a sudden or severe re-emergence of psychotic features, may appear when the patient stops taking the drug, particularly if a drug is suddenly discontinued instead of slowly tapered off.
There are six main groups of psychiatric medications.
- Antidepressants, which treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.
- Stimulants, which treat disorders such as attention deficit hyperactivity disorder and narcolepsy, and suppress the appetite.
- Antipsychotics, which treat psychoses such as schizophrenia and mania.
- Mood stabilizers, which treat bipolar disorder and schizoaffective disorder.
- Anxiolytics, which treat anxiety disorders.
- Depressants, which are used as hypnotics, sedatives, and anesthetics.
Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or schizophrenia. Antipsychotics are also used as mood stabilizers in the treatment of bipolar disorder, even if no symptoms of psychosis are present. Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers".
- Chlorpromazine (Thorazine), typical antipsychotic
- Haloperidol (Haldol), typical antipsychotic
- Perphenazine (Trilafon), typical antipsychotic
- Thioridazine (Mellaril), typical antipsychotic
- Thiothixene (Navane), typical antipsychotic
- Trifluoperazine (Stelazine), typical antipsychotic
- Aripiprazole (Abilify), atypical antipsychotic
- Olanzapine (Zyprexa), atypical antipsychotic
- Quetiapine (Seroquel), atypical antipsychotic
- Risperidone (Risperdal), atypical antipsychotic
- Ziprasidone (Geodon), atypical antipsychotic
Antidepressants are drugs used to treat clinical depression, and they are also often used for anxiety and other disorders. Most antidepressants will restrain the metabolism of serotonin or norepinephrine or both. Such drugs are called selective serotonin reuptake inhibitors (SSRIs), and they actively prevent these neurotransmitters from dropping to the levels at which depression is experienced. SSRIs will often take 3–5 weeks to have a noticeable effect: the brain struggles to process the flood of serotonin, and reacts by downregulating the sensitivity of the autoreceptors, which can take up to 5 weeks. Bi-functional SSRIs are currently being researched, which will occupy the autoreceptors instead of 'throttling' serotonin. Another type of antidepressant is a monoamine oxidase inhibitor, which is thought to block the action of MAO, an enzyme that breaks down serotonin and norepinephrine. MAOIs are typically only used when tricyclic antidepressants or SSRIs exacerbate or fail to prevent depression.
- Citalopram (Celexa), SSRI
- Escitalopram (Lexapro), SSRI
- Paroxetine (Paxil), SSRI
- Fluoxetine (Prozac), SSRI
- Sertraline (Zoloft), SSRI
- Duloxetine (Cymbalta), SNRI
- Venlafaxine (Effexor), SNRI
- Bupropion (Wellbutrin), NDRI
- Mirtazapine (Remeron), NaSSA
- Isocarboxazid (Marplan), MAOI
- Phenelzine (Nardil), MAOI
In 1949, the Australian John Cade discovered that lithium salts could control mania, reducing the frequency and severity of manic episodes. This introduced the now popular drug lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. Food & Drug Administration. Many antipsychotics are used as mood stabilizers, though first resort remains a mood stabilizer such as lithium carbonate. Many mood stabilizers, with the exception of lithium, are anticonvulsants. The mechanism of action of mood stabilizers is not well elucidated nor understood.
Common mood stabilizers:
- Lithium Carbonate (Carbolith), Regular mood stabilizer
- Carbamazepine (Tegretol), anticonvulsant mood stabilizer
- Valproic acid (Valproate), anticonvulsant mood stabilizer
- Valproate semisodium (Depakote), anticonvulsant mood stabilizer
- Lamotrigine (Lamictal), Atypical anticonvulsant mood stabilizer
- Gabapentin, atypical GABAergic anticonvulsant mood stabilizer
- Pregabalin, atypical GABAergic anticonvulsant mood stabilizer
- Oxcarbazepine, anticonvulsant mood stabilizer
- Topiramate, atypical sulfamate-substituted saccharide anticonvulsant mood-stabilizer
Stimulants are some of the most widely prescribed drugs today. A stimulant is any drug that stimulates the central nervous system. Adderall, a collection of amphetamine salts, is one of the most prescribed pharmaceuticals in the treatment of attention-deficit hyperactivity disorder (ADHD). Stimulants can be addictive, and patients with a history of drug abuse are typically monitored closely or even barred from use and given an alternative. Discontinuing treatment without tapering the dose can cause psychological withdrawal symptoms such as anxiety and drug craving. Stimulants are not physiologically addictive.
- Caffeine, typical stimulant found in many edibles worldwide
- Methylphenidate (Ritalin, Concerta), atypical stimulant
- Dexmethylphenidate (Focalin), D-isomer of methylphenidate
- Dextroamphetamine (Dexedrine), D-Amphetamine-based stimulant
- Dextroamphetamine & levoamphetamine (Adderall), D,l-Amphetamine salt mix
- Methamphetamine (Desoxyn), D-methamphetamine-based stimulant
- Modafinil (Provigil)
Anxiolytics & hypnotics
Barbiturates were first used as hypnotics and as anxiolytics, but as time went on, benzodiazepines (Lowell Randall and Leo Sternbach, 1957) were developed in the 1960s and 1970s. Eventually they led to billions of doses being consumed annually. Originally thought to be non-dependence forming in therapeutic doses, unlike barbiturates, as prescriptions increased, problems with addiction and dependence came to light. Benzodiazepines have widely supplanted barbiturates for treatment of almost all conditions in developed countries due to a much greater therapeutic ratio and less proclivity for overdose and toxicity.
Common anxiolytics & hypnotics:
- Diazepam (Valium), benzodiazepine derivative
- Nitrazepam (Mogadon), benzodiazepine derivative
- Zolpidem (Ambien, Stilnox), an imidazopyridine
- Chlordiazepoxide (Librium), benzodiazepine derivative
- Alprazolam (Xanax), benzodiazepine derivative
- Temazepam (Restoril), benzodiazepine derivative
- Clonazepam (Klonopin), benzodiazepine derivative
- Lorazepam (Ativan), benzodiazepine derivative
- Murray, Bridget (October 2003). "A Brief History of RxP". APA Monitor. Retrieved 4/11/2007. Check date values in:
- Moncrieff, Joanna (23 March 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatrica Scandinavica. John Wiley & Sons A/S. 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. ISSN 1600-0447. PMID 16774655. Retrieved 3 May 2009.
- Schatzberg, A.F. (2000). "New indications for antidepressants". Journal of Clinical Psychiatry. 61 (11): 9–17. PMID 10926050.
- "Tardive dyskinesia".
- "Monoamine Oxidase Inhibitors".
- Stephen M. Stahl, M.D., Ph.D.; et al. (2004). "A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor" (pdf). Journal of Clinical Psychiatry; 6(04) 159-166 2004 PHYSICIANS POSTGRADUATE PRESS, INC. Retrieved 2006-09-02.