M. Catalina Melo, M.D.. Antipsychotics: -first generation -atypical or second generation Antidepressants: -tricyclics -SSRI’s & SNRI’s -Others (wellbutrin,

M. Catalina Melo, M.D.

Antipsychotics: -first generation-atypical or second generation

Antidepressants: -tricyclics-SSRI’s & SNRI’s

-Others (wellbutrin, remeron, nefazodone, trazodone, viibryd)

-MAO InhibitorsMood Stabilizers:

-Lithium -Anticonvulsants

Anxiolytics and Hypnotics: -Benzodiazepines-Buspar-Antihistamines (benadryl, vistaril)-Sleep agents (ambien, lunesta, sonata,

melatonin)Stimulants and Cognitive enhancers:

-Amphetamines, methylphenidate, strattera, provigil

-Aricept, Namenda, Reminyl, Exelon

-> D2 Receptors Antagonists

* Chlorpromazine=Thorazine* Thioridazine=Mellaril* Fluphenazine=Prolixin (injection)* Perphenazine=Trilafon* Trifluoperazine=Stelazine* Thiothixene=Navane* Haloperidol=Haldol (inj)* Pimozide=Orap

* EPS, TD (haldol) * Sedation* Orthostatic hypotension* NMS* leukopenia (low white blood cell count)* Constipation* Urinary retention, dry mouth, blurry vision* Galactorrhea, breast enlargement * Skin pigmentation (mellaril)* Seizures (increases risk)

EPS (Extrapyramidal Symptoms): inability to move, akathisia (restlessness), acute dystonia, tremor, difficulty with gait, mouth/tongue tremor.

Tardive Dyskinesia : rapid repetitive movements.

* Neuroleptic Malignant Syndrome: confusion, fever, muscle rigidity.

->5HT2A and 5HT2C Serotonin Blockeade

Clozapine= ClozarilRisperidone= Risperdal (consta inj)Olanzapine= ZyprexaQuetiapine= SeroquelZiprasidone= GeodonAripiprazole= AbilifyPaliperidone= Invega (sustenna inj)Asenapine= SaphrisIloperidone= FanaptLurasidone= Latuda

Sedation (seroquel +++)Weight gain (zyprexa, clozaril+++)Metabolic changes (zyprexa, seroquel,

clozaril)EPS, TDRisks if pregnancyConstipation, dry mouthIrritabilityChanges in blood cells (clozaril needs blood

counts regularly)

Psychotic Disorders: Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, depression with psychosis, drug induced and other organic psychosis.

Acute maniaMaintenance of Bipolar IllnessTourette’s Syndrome and other tic disordersTreatment-Resistant Depression: Abilify and

SeroquelOther uses (not FDA): personality disorders,

chronic aggression, OCD.Psychosis and Bipolar illness in Children and

adolescents.

Lithium= Eskalith, LithobidValproic acid = Depakote, Depakene, ERCarbamazepine= Tegretol, Equetro,

Carbatrol, XRLamotrigine = LamictalOxcarbamazepine= TrileptalGabapentin= NeurontinTopiramate= Topamax

Thirst/ Increased UrinationTremorWeight gainNausea, diarrheaAcneFatigueThyroid abnormalitiesToxicity: severe tremor, confusion, seizuresInteractions with Diuretics, NSAID’s,

lisinopril

-> Increases GABA transmission

GastrointestinalLow platelet countTremorSedationWeight gainAlopecia

-> Blocks sodium channels

Dizziness, uncoordinationDouble visionG.I. upsetTremorDecreased white blood cellsRash* Interactions with other drugs

Lamotrigine : no weight gain. RASH.Neurontin: used for pain. Somnolence.Topiramate : migraine prophylaxis. Weight

loss, memory deficits, sedation, osteoporosis.

*ALL: Neonatal complications and fetal malformations. Neurological side effects.

Bipolar Illness type I and II (prophylaxis)Acute maniaCyclothymiaSchizoaffective DisorderAggressionPersonality Disorders with unstable affectAlcohol Abuse (+/-)AnxietyChronic pain syndromes

Fluoxetine= “Prozac”Paroxetine= “Paxil, Paxil CR, Pexeva”Citalopram= “Celexa”Sertraline= “Zoloft”Fluvoxamine= “Luvox” *Duloxetine= “Cymbalta”Venlafaxine= “Effexor, Effexor ER, XR”Desvenlafaxine= “Pristiq”Vilazodone= “Viibryd”

Nausea and decreased appetiteIncreased sweatingTremorHeadachesSleep changes (quantity, quality, dreams)Sexual dysfunction*Diarrhea/constipationBruxismHTN (SNRI’s)

Tricyclics: sedation, hypotension, dry mouth, blurry vision, constipation, cardiac toxicity.

Bupropion “Wellbutrin”: low appetite, headaches, seizures.

Mirtazapine “Remeron”: increased appetite, somnolence.

Nefazodone: Liver damage.Trazodone: somnolence, priapism.MAO (-): rarely used due to dietary limitations.Viibryd: newest antidepressant. No sexual side

effects?

Major Depressive DisorderDysthymic DisorderPanic DisorderSocial Anxiety DisorderGeneralized anxiety DisorderPTSD (zoloft)OCD (fluvoxamine), Impulse Control

DisordersBulimia NervosaPersonality Disorders (BPD)

Neuropathic Pain, FibromyalgiaInsomniaEnuresis (imipramine)ADHD (Wellbutrin)Smoking cessation (Wellbutrin)

Alprazolam= “xanax”Clonazepam= “Klonopin”Diazepam= “Valium”Lorazepam= “ativan”Temazepam= “restoril”Zolpidem= “Ambien”Eszopiclone= “Lunesta”Buspirone= “Buspar”Hydroxyzine= “Vistaril”

Side Effects: sedation, memory deficits, incoordination, dependence, coma in OD (BZD).

Atomoxetine= StratteraMethylphenidate = ritalin, focalin, concerta,

daytrana. Amphetamines = dexedrine, adderall, vyvanse.Modafinil = Provigil. (Narcolepsy).

*Uses: ADHD, narcolepsy, treatment resistant depression.

*Side Effects: Cardiac, insomnia, irritability, G.I.

-> Acethylcholinesterase inhibitorsDonepezil= “Aricept”Galantamine= “Reminyl”Memantine= “Namenda”Rivastigmine= “Exelon”

Side Effects: G.I., insomnia, mood changes.

“All things are poison, and nothing is without poison”

Patients with a psychiatric diagnosis have a higher incidence of co-existent medical problems, therefore are at higher risk of pharmacological interactions

Most patients do not take medications as prescribed

Providers forget to ask about the use of CAMBirth ControlSubstance AbuseEpocrates.comErowid.org

High risk of depression, anxiety and substance abuse: women

Attempted suicide: high rate in US Latino high school students

Higher rate of mental illness: US born and long-term residents

Less than 10% with a Dx seek servicesLargest uninsured group in the USResearch on Evidence based treatments

tested mainly on white populationsOver-reliance on family and religionLow socio-economic status: 2-3 times more

likely to have a mental illnessPoor Health overall

Stigma of mental illness and Psychiatry careBeing an “Illegal alien”Lost in Translation: 1% of APA members are

HispanicGender rolesDifferent Hispanic cultures/ countriesOver-representation in the criminal and

Juvenile justice systems