Psychiatric Medications Milwaukee Police Crisis Intervention Team Psychiatric Medications

Major Mental Illness Mood Disorders Thought Disorder Depression Bipolar Disorder Thought Disorder Schizophrenia Psychosis Personality Disorder Anxiety Disorders Obsessive Compulsive Disorder

Holistic Approach

Some medications can work can work differently for different people. Effectiveness Bipolar Disorder 80% Major Depression 65% Schizophrenia 60% Some medications can work can work differently for different people.

Neurotransmitters Dopamine- pleasure and rewards Serotonin – feelings of well being Norepinephrine – stress hormone feelings of arousal

Antidepressants Take 4 to 6 weeks to work Suicide risk increases in first few weeks Can precipitate a manic episode

Selective Serotonin Reuptake Inhibitors (SSRI’s) Celexa Prozac Luvox Paxil Lexapro Zoloft

SSRI’s Less lethal in overdose Can cause sleepiness or insomnia (30xdaily dose – minimal or no symptoms, tremor, nausea, vomiting, drowsiness) (>75xdaily dose – decreased LOC, EKG changes, seziures) Most fatalities occurred when combined with other medications or alcohol Can cause sleepiness or insomnia Side effects include: weight gain, tremors, sexual dysfunction Serotonin Syndrome: Too high a dose or a combination with other meds (St. John’s Wort, migraine meds)

Atypical Antidepressants Wellburtrin Desyrel Effexor Remeron Cymbalta

Tricyclic Antidepressants (TCA’s) Older Medications Side effects include dry mouth, blurred vision, constipation, urinary retention High lethality in overdose (30 day supply) – cardiac problems 2 weeks supply enough to cause considerable toxicity. Imipramine (Tofranil), amitriptyline (Elavil), doxepin (Senequan)

Monoamine oxidase inhibitor (MAOI’s) Monoamine oxidase deactivates the neurotransmitters Used for treatment resistant depression Nardil, Parnate Problems with certain foods containing tyramine (sausage, cheeses, imported beers, sauerkraut) can cause very high blood pressure and stroke

MAOI Patch Emsam (selegiline) At lowest strength (6mg), can be used without dietary restrictions Patch changed once per day

Mood Stabilizers (Lithium) Treatment of choice for bipolar disorder Naturally occurring salt 10-21 days to take effect, 1 to 2 weeks to reach therapeutic levels 10% have no response Small window between therapeutic dose and toxic

Lithium (cont.) Long term risk of kidney impairment and hypothyroid disorder Side effects include weight gain, acne, tremors. SE’s increase with toxicity levels, which can lead to death. Caution with vomiting, diarrhea, dehydration, exercise

Mood stabilizers – Anticonvulsants Tegretol, Depakote, Lamictal Side effects include insomnia, drowsiness, dizziness

Antipsychotic Older medications: Cheap Low potency (more sedating and less movement disorders): Thorazine, Mellaril High potency (less sedating and more movement disorders): Haldol, Prolixin

Intramuscular injection medications for schizophrenia Haldol Prolixin Risperdal Zyprexa Geodon

Movement Disorders Involuntary movements Lack of movements Parkinson-like symptoms Tardive Dyskinesia

Atypical Antipsychotics Newer, more expensive, works on more symptoms, better side-effect profile Clozaril, Risperdal, Zyprexa, Seroquel, Abilify, Geodon Some cause weight gain and diabetes

Neuroleptic Malignant Syndrome Potentially fatal Can occur in the first week of drug therapy Severe muscle rigidity, catatonia, fever, altered consciousness Requires emergency treatment

Other antipsychotics side effects Problems with temperature regulation (risk for heat stroke) Sun sensitivity

Anxiety Disorders Generalized Anxiety Disorder: excessive worry, discomfort Panic Disorder Obsessive Compulsive Disorder

Anxiety Medications Can sometimes be treated with antidepressants Short acting Benzodiazepines: Xanax, Valium, Librium, Ativan Buspar: Longer acting anxiety med

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