Contact Hours: 3
This educational activity is credited for 3 contact hours at completion of the activity.
Course Purpose
The purpose of this course is to provide healthcare providers with an overview of psychotropic medications, focusing on the five standard classes of drugs extensively used in psychiatric care.
Overview
Psychotropic medications are a category of drugs used to treat various mental health disorders and are integral components of effective treatment and long-term therapy This course aims to provide an overview of psychotropic medications, focusing on the five standard classes of drugs extensively used in psychiatric care commonly prescribed medications within the classifications, typical diagnoses, associated side effects, and black box warnings.
Course Objectives
Upon completion of this course, the learner will be able to:
- Review the physiology associated with the neurotransmitter systems within the central nervous system (CNS).
- Review the five common classes of psychotropic medications used to treat mental health conditions, the medications within the classes of psychotropic medications, and their side effects.
- Understand the importance of the black box warning as an alert for significant risk and potentially life threatening adverse reaction when it is issued by the Food and Drug Administration (FDA).
- Identify the black box warnings for medications within the five classes of common psychotropic medications.
- Review nursing considerations for a patient undergoing a treatment regimen for mental health.
Policy Statement
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Disclosures
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
To access Psychotropic Medications, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
To access Psychotropic Medications, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
Definitions
| Acetylcholine | A neurotransmitter that plays a role in memory, learning, attention, arousal and involuntary muscle movement. |
| Anticonvulsants | Medications that are used to treat epilepsy and other seizure disorders. |
| Antidepressants | A type of medicine used to treat clinical depression or prevent it recurring. |
| Antipsychotics | A type of psychiatric medication which are available on prescription to treat psychosis. |
| Autism Spectrum Disorder (ASD) | A neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. |
| Axon | Also known as a nerve fiber is a long, slender projection of a nerve cell, or neuron in vertebrates that typically conducts electrical impulses known as action potentials away from the nerve cell body. |
| Black Box Warning | A serious warning given by the federal drug association for drugs or drug classes that may cause serious harm or death. |
| Bradykinesia | Slowness of movement and speed as movements are continued. |
| Bulimia Nervosa | An eating disorder characterized by regular, often secretive bouts of overeating followed by self-induced vomiting or purging, strict dieting, or extreme exercise, associated with persistent and excessive concern with body weight. |
| Cataplexy | A sudden loss of muscle tone while a person is awake that leads to weakness and a loss of voluntary muscle control. |
| Cognitive Behavioral Therapy (CBT) | A form of psychotherapy that focuses on modifying dysfunctional emotions, behaviors, and thoughts by interrogating and uprooting negative or irrational beliefs. |
| Delusions | A false belief or judgment about external reality, held despite incontrovertible evidence to the contrary, occurring especially in mental conditions. |
| Dendrite | A short, branched extension of a nerve cell, along which impulses received from other cells at synapses are transmitted to the cell body. |
| Dialectical Behavior Therapy (DBT) | A structured program of psychotherapy with a strong educational component designed to provide skills for managing intense emotions and negotiating social relationships. |
| Disorganized Thinking | One of the primary symptoms of schizophrenia. |
| Dopamine | Acts on areas of the brain to give you feelings of pleasure, satisfaction and motivation. |
| Dopamine D2 Receptor | A receptor that plays a role in reward pathways and inhibits the formation of camp by inhibiting adenylate cyclase. |
| Endorphins | Help relieve pain, reduce stress and improves a sense of well-being. |
| Enzymatic Degradation | A method more often used to release particles encapsulated in the droplets or hydrogels. |
| Extrapyramidal Symptoms (EPS) | Symptoms that are archetypically associated with the extrapyramidal system of the brain’s cerebral cortex. |
| Gamma-Aminobutyric Acid (GABA) | The chief inhibitory neurotransmitter in the developmentally mature mammalian central nervous system. |
| Glutamate | An amino acid that acts as a neurotransmitter in the brain. |
| Hallucinations | To hear, see, smell, taste or feel things that appear to be real but only exist in the mind. |
| Histamine | A compound which is released by cells in response to injury and in allergic and inflammatory reactions, causing contraction of smooth muscle and dilation of capillaries. |
| Intellectual Developmental Disorders | A neuro-developmental disorder that causes problems with intellectual tasks. |
| Metabolic Syndrome | A cluster of conditions that occur together, increasing the risk of heart disease, stroke and type 2 diabetes. |
| Monoamine Oxidase Inhibitors (MAOIs) | A class of antidepressants that help treat depression symptoms. |
| Mood Stabilizers | A class of medications used in the management and treatment of bipolar disorder. |
| Narcolepsy | A chronic neurological disorder that affects the brain’s ability to control sleep-wake cycles. |
| Neuron | Nerve cells that send messages all over the body to allow the body to do everything from breathing to talking, eating, walking, and thinking. |
| Neurotransmitter | Endogenous chemicals that allow neurons to communicate with each other throughout the body. |
| Norepinephrine | Also called noradrenaline, is both a neurotransmitter and a hormone. |
| Norepinephrine Reuptake Inhibitors (SNRIs) | Stop or delay substances called serotonin and norepinephrine from being reabsorbed in the brain, which leaves more of them available for the brain to use. |
| Panic Disorder | A sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. |
| Parkinson’s Disease | A progressive disorder that affects the nervous system and the parts of the body controlled by the nerves. |
| Receptor Agonism | A chemical that activates a receptor to produce a biological response. |
| Receptor Antagonism | A drug that binds to a receptor and produces no biologic effect. |
| Refractory Psychosis | Can be present from the first episode, or it can develop after years of prolonged response to antipsychotic treatment with periods of remission. |
| Reuptake Inhibition | Stop or delay the body from reabsorbing a substance called serotonin, which leaves more of it available for the body to use. |
| Schizoaffective Disorder | A mental health problem where you experience psychosis as well as mood symptoms. |
| Schizophrenia | A serious mental health condition that affects how people think, feel and behave. |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | A class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. |
| Serotonin | Sends signals between nerve cells. |
| Severe Depression | A mood disorder that causes a persistent feeling of sadness and loss of interest. |
| Stimulants | A class of drugs that speed up messages travelling between the brain and body. |
| Synapse | A structure that permits a neuron (or nerve cell) to pass an electrical or chemical signal to another neuron or to the target effector cell. |
| Synaptic Cleft | Also known as the synaptic gap, is the space in between the axon of one neuron and the dendrites of another and is where the electrical signal is translated to a chemical signal that can be perceived by the next neuron. |
| Tardive Dyskinesia | A condition affecting the nervous system, often caused by long-term use of some psychiatric drugs. |
| Tricyclic Antidepressants (TCAS) | Medications that are FDA-approved to treat symptoms of major depressive disorder. |
Psychotropic medications are a category of drugs used to treat various mental health disorders. Not only do they offer relief from debilitating symptoms, but they also improve the overall quality of life for millions of individuals worldwide. Despite their once controversial reputation, increased awareness and understanding of mental health issues have transformed their perception.
Psychotropic medications are integral components of effective mental health treatment and long-term therapy. As such, their use has risen drastically. An estimated 20% of adults have received mental health treatment involving medication.1 This course aims to provide an overview of psychotropic medications, focusing on the five standard classes of drugs extensively used in psychiatric care: antianxiety medications, antidepressants, antipsychotics, mood stabilizers, and stimulants. Each category is to be explored, with a focus on commonly prescribed medications, typical diagnoses, associated side effects, and black box warnings. This course will also highlight nursing considerations to ensure the safe administration of these medications and optimize patient outcomes.
Mental health disorders are a significant global concern, with one in every eight people worldwide affected.2 Among these disorders, the most prevalent are:3
- Anxiety
- Bipolar disorder
- Depression
- Disruptive behavior and dissocial disorders
- Eating disorders
- Neurodevelopmental disorders
- Post-traumatic stress disorder (PTSD)
- Schizophrenia
In the United States, it is estimated that at some point in their lives, approximately 31% of adults will experience an anxiety disorder.4 Anxiety disorders are characterized by excessive fear, worry, and related behavioral disturbances that cause significant distress or impairment in functioning. These disorders encompass various conditions, such as generalized anxiety disorder, marked by excessive worry; panic disorder, defined by panic attacks; social anxiety disorder, which is excessive fear in social situations; and separation anxiety disorder, an intense fear of separation from emotionally significant individuals. Depression is another major mental health issue, affecting 280 million people globally.5 In the United States 8% of the adult population and 15% of youth (ages 12-17) are affected by major depression.6 Depression differs from usual mood fluctuations and short-lived emotional responses to everyday challenges. During a depressive episode, individuals experience a persistent depressed mood or a loss of interest in activities for most of the day, nearly every day, for at least two weeks. Additional symptoms may include poor concentration, excessive guilt or low self-worth, hopelessness, disrupted sleep, changes in appetite or weight, chronic fatigue, and thoughts of death or suicide. People with depression are also at an increased risk of suicide.
Individuals with bipolar disorder go through alternating depressive episodes and periods of manic symptoms. During depressive episodes, they may feel persistently sad, irritable, or empty and lose interest or pleasure in most activities for most of the day, nearly every day. On the other hand, manic episodes are characterized by elevated or irritable mood, increased activity or energy, and symptoms such as heightened talkativeness, racing thoughts, inflated self-esteem, reduced need for sleep, distractibility, and impulsive or reckless behavior. These fluctuating episodes significantly increase the risk of suicide.
An expected 3% of the global population has experienced post-traumatic stress disorder (PTSD).9 Among these are 6% of the US population, who have been affected at some point in their lives.10 Post-traumatic stress disorder is characterized by three main symptoms:9
- Re-experiencing the traumatic event through flashbacks, intrusive memories, or nightmares.
- Avoidance of thoughts, memories, or reminders of the event.
- Persistent feelings of heightened current threat.
To meet the criteria for PTSD, these symptoms must continue for several weeks and cause significant impairment to daily functioning. Schizophrenia is believed to affect an estimated 24 million people worldwide, or approximately 1 in 300 people.2 In the US, 1% of the population aged 18 or older are believed to be affected.11 Schizophrenia is characterized by significant impairments in perception and behavior, with symptoms that may include persistent delusions, hallucinations, disorganized thinking, highly disorganized behavior, and extreme agitation. In addition to struggling with persistent cognitive difficulties, those with schizophrenia may have a life expectancy that is 10-20 years shorter than that of the general population.
Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating behaviors and an intense preoccupation with food, body weight, and shape. These disorders result in significant health risks, distress, and impairment in functioning. Anorexia nervosa typically arises during adolescence or early adulthood and is associated with a high risk of premature death due to medical complications or suicide. Bulimia nervosa significantly increases the risk of substance use, suicide, and various health complications.
Also known as conduct disorder, conduct-dissocial disorder is one of the two primary disruptive behavior and dissocial disorders.12 Disruptive behavior and dissocial disorders are characterized by persistent behavior problems, ranging from defiance and disobedience to actions that consistently violate the rights of others or societal norms, rules, or laws. These disorders typically manifest during childhood, although this is not always the case. Neurodevelopmental disorders are a group of behavioral and cognitive disorders that occur during the developmental period, significantly impacting the acquisition and execution of specific intellectual, motor, language, or social functions.13 The disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual developmental disorders, among others. Attention deficit hyperactivity disorder is primarily characterized as a persistent pattern of inattention, hyperactivity-impulsivity, or both, which negatively affects academic, occupational, or social functioning. In the United States, the overall prevalence of ADHD is 4.%.14 Autism spectrum disorder (ASD) is marked by challenges in social communication and reciprocal social interaction, along with restricted, repetitive, and inflexible patterns of behavior, interests, or activities. Intellectual developmental disorders involve significant limitations in intellectual functioning and adaptive behavior, encompassing difficulties with everyday conceptual, social, and practical skills. Effective interventions and treatments are available for neurodevelopmental disorders, aiming to support and improve the quality of life for affected individuals.
Statistical Data on Psychotropic Medications Use
In 2020, the prevalence of mental health treatment among adults in the United States saw a notable rise. Approximately 20% of the adult population (age 18 and older) has been prescribed some form of mental health therapy.15 This includes those who have taken prescription medication for their mental health and those who also obtained counseling or therapy from a mental health professional. This reflects a steady continuation of both mental health issue diagnoses and medication prescriptions.
There are significant disparities in mental health treatment across different demographic groups. By gender, women tended to receive more mental health treatment when compared to men. When broken down by ethnicity, non-Hispanic white adults (24%) were more likely to have received mental health treatment compared to non-Hispanic black (15%), Hispanic (12%), and non-Hispanic Asian (7%) adults.15 The usage of psychotropic medications has seen a significant upward trend over the years. Measured using a defined daily dose (DDD) per 1000 inhabitants/day, it is estimated that the overall sales of psychotropic medicines increased from 28.54 DDD to 34.77 DDD per 1000 inhabitants/day in recent years.15
Antidepressant use had the most significant increase, with an average annual increase of 3%.15 Among antidepressants, selective serotonin reuptake inhibitors (SSRIs) use saw an annual rise of 0.26 DDD per 1000 inhabitants/day. The use of antipsychotic medications also increased, with an average yearly increase of 2%.15 In contrast, there was an overall annual decrease in the use of tranquilizers (-0.99%) and sedatives or hypnotics (-0.91%). However, it is important to note that these are overall assessments. The use of psychotropic medicines varies significantly across countries with different income levels. Due to better access to mental health care, high-income countries have the highest use of these medications (123.61 DDD per 1000 inhabitants/day), followed by upper-middle-income countries (13.52 DDD), and lower-middle-income countries at (6.77 DDD per 1000 inhabitants/day).15 However, in high-income countries, the sales of tricyclic antidepressants, typical antipsychotics, tranquilizers, and sedatives or hypnotics are decreasing, while SSRIs and SNRIs use is steadily increasing. These trends in antidepressant consumption in high-income countries largely mirrored those of middle-income countries. Yet, there is a notable increase in the sales of tranquilizers (0.14 DDD per 1000 inhabitants/day) and sedatives or hypnotics (0.04 DDD per 1000 inhabitants/day) in these regions, contrasting with the trends observed in high-income countries.
To understand how psychotropic medications work, it is crucial to grasp the neurotransmitter systems within the central nervous system (CNS). The CNS, the brain and spinal cord, is responsible for processing and transmitting information throughout the body.16 It does so through a complex network of neurons, the fundamental units of the system. A CNS neuron consists of a soma (cell body), an axon, and dendrites.17 Dendrites receive signals from other neurons. The axon carries electrical impulses from the cell body to other neurons, muscles, or glands. The junction where the axon of one neuron meets the dendrite or cell body of another neuron is called a synapse. There is a small gap at the synapse called the synaptic cleft, and neurons communicate at this junction.
Whenever a neuron is activated, it generates electrical impulses that move down its axon to the synapse. The electrical impulse is then converted into a chemical signal through the release of neurotransmitters, which move across the synaptic cleft to the receptor sites on the next neuron. Each neurotransmitter has a specific role and affects different aspects of brain function and behavior. The neurotransmitters particularly relevant to mental health disorders include serotonin, dopamine, norepinephrine, gamma-aminobutyric acid (GABA), glutamate, acetylcholine, endorphins, and histamine.
Serotonin promotes feelings of well-being and happiness, and regulates mood, appetite, sleep, memory, and learning.18 Imbalances in serotonin levels are linked to depression, anxiety disorders, and other mood disorders.
Dopamine plays a central part in the reward and pleasure systems of the brain, and is involved in regulating movement, motivation, and emotional responses. Abnormal dopamine levels are associated with several mental health conditions. For example, high levels of dopamine are linked to schizophrenia and psychosis. In contrast, low levels are associated with Parkinson’s disease and depression.
Norepinephrine, also known as noradrenaline, affects attention, arousal, and mood.18 It is involved in the body’s fight-or-flight response and helps regulate stress responses. Low levels of norepinephrine correlate to depression, while high levels can contribute to anxiety and hyperactivity.
Gamma-aminobutyric acid (GABA) is the chief CNS inhibitory neurotransmitter.18 It reduces neuronal excitability and helps calm nervous activity. Gamma-aminobutyric acid plays a significant role in regulating anxiety and preventing over-excitation of neurons.
Glutamate is the dominant excitatory neurotransmitter in the brain and is connected to vital cognitive functions such as learning and memory. While essential for normal brain function, excessive glutamate activity can lead to excitotoxicity, which can damage or kill neurons. Dysregulation of glutamate is implicated in several mental health conditions, including schizophrenia, depression, and bipolar disorder.
Acetylcholine is involved in arousal, attention, memory, and motivation. It is crucial for cognitive function and is often associated with the parasympathetic nervous system. Disruptions in acetylcholine levels are linked to cognitive decline and conditions such as Alzheimer’s disease.
Endorphins are neuropeptides that serve as natural painkillers and mood elevators. They are normally released in response to stress or discomfort and can produce feelings of euphoria. Low levels of endorphins relate to depression and chronic pain conditions.
Histamine is a part of regulating sleep-wake cycles, appetite, and cognition. It also plays a part in the body’s immune response. Histamine imbalances can affect mood and cognitive function.
Psychotropic medications primarily exert their effects on neurotransmitter systems.15 They increase or decrease the concentrations of brain chemicals, either through reuptake inhibition, enzymatic degradation, or direct receptor agonism or antagonism. In reuptake inhibition, medications prevent neurotransmitters from being reabsorbed, thereby increasing their concentration and activity. Enzymatic degradation causes psychotropic medications to inhibit the enzymes that break down neurotransmitters, again increasing their concentration and activity. Psychotropic medications that are direct receptor agonists bind to receptors and activate them, mimicking the action of natural neurotransmitters to produce therapeutic effects. Direct receptor antagonists also bind to receptors but do not activate them. Instead, they block the receptors, preventing natural neurotransmitters from binding and activating them. The goal of psychotropic medications is to restore neurochemical homeostasis to mitigate the pathological symptoms of various psychiatric disorders, ultimately regulating mood, perception, behavior, and cognition. Standard types of psychotropic medications include antianxiety medications, antidepressants, antipsychotics, mood stabilizers, and stimulants.
Antianxiety Medications
Antianxiety medications, also known as anxiolytics, are a category of drugs for treating anxiety disorders, which include generalized anxiety disorders (GADs), panic disorders, social anxiety disorders, and specific phobias.19 These medications primarily target GABA or serotonin levels in the brain to reduce symptoms of anxiety, such as excessive worry, restlessness, and physical tension. The primary classes of antianxiety medications include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and certain off-label medications. Benzodiazepines, such as diazepam, alprazolam, and lorazepam, are among the most prescribed medications for acute anxiety relief.20 They bind to distinct sites on the GABA receptor, which increases the receptors’ affinity for GABA. This enhances the effect of GABA, resulting in a tranquilizing effect that relaxes muscles and reduces anxiety.
While highly effective for short-term use, benzodiazepines have a high potential for dependence and tolerance, making them less suitable for long-term treatment. They are generally prescribed as a short-term solution or for use in acute situations where immediate relief from severe anxiety symptoms is necessary.
Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are typically considered first-line treatments for chronic anxiety disorders due to their efficacy and relatively favorable side effect profile. Selective serotonin reuptake inhibitors such as fluoxetine, sertraline, and escitalopram, work by boosting serotonin availability in the brain, thereby reducing anxiety and regulating mood. Serotonin-norepinephrine reuptake inhibitors, such as venlafaxine and duloxetine, increase both serotonin and norepinephrine levels, offering a dual mechanism of action that can be especially beneficial for patients with anxiety and comorbid depression.
Certain off-label medications are used to manage anxiety. For example, buspirone, a non-benzodiazepine anxiolytic, also modulates serotonin receptors but has a lower risk of dependence compared to benzodiazepines. This makes it a preferable alternative for treating generalized anxiety disorder. Additionally, certain antihistamines, such as hydroxyzine and beta-blockers like propranolol can be used to treat the physical manifestations of anxiety symptoms, such as rapid heartbeat and trembling. While antianxiety medications can be relatively tolerable, they are not without potential side effects and risks. Benzodiazepines can cause drowsiness, dizziness, and cognitive impairment, and long-term use can result in dependence and withdrawal symptoms. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may cause nausea, insomnia, sexual dysfunction, and, in some cases, increased anxiety during the initial weeks of treatment.
Antidepressants
Antidepressants are primarily used to treat major depressive disorder. However, they have also proven effective in managing other mental health diagnoses, such as obsessive-compulsive disorder (OCD), anxiety disorder, and post-traumatic stress disorder (PTSD).21 The most commonly prescribed classes of antidepressants include:22
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine and dopamine reuptake inhibitors (NDRIs)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs) are typically the first line of treatment for depression due to their relatively favorable side effect profile and safety compared to older antidepressants. Selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, and escitalopram, increase the availability of serotonin in the brain. This enhances feelings of well-being, alleviating depressive symptoms and anxiety. Selective serotonin reuptake inhibitors are generally well-tolerated, but common side effects can include nausea, weight gain, insomnia, sexual dysfunction, and, initially, an increase in anxiety. Serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine and venlafaxine, increase the brain levels of both serotonin and norepinephrine. The dual mechanism of action can be especially beneficial for those who do not respond well to SSRIs. These medications are also used to treat chronic pain conditions like fibromyalgia and neuropathy. Side effects are like SSRIs and may also include increased blood pressure in some patients. Norepinephrine and dopamine reuptake inhibitors (NDRIs), like bupropion, multiply the levels of norepinephrine and dopamine in the brain. They are used to treat depressive disorders, seasonal affective disorder, attention deficit disorder and to help people stop smoking. Side effects include insomnia, dry mouth, headache, dizziness, sweating, and an increased risk of seizures, especially at higher doses.
Tricyclic antidepressants (TCAs) are a previous class of antidepressants that were commonly used before the advent of SSRIs and SNRIs. Tricyclic antidepressants, such as amitriptyline, nortriptyline, and imipramine, also inhibit norepinephrine and serotonin uptake but are linked with a higher incidence of side effects.22 These include dry mouth, constipation, urinary retention, blurred vision, and sedation. Tricyclic antidepressants can also be toxic in overdose, making them a less desirable option for patients at risk of suicide. However, TCAs are still prescribed in cases where patients do not respond to other classes of antidepressants.
Monoamine oxidase inhibitors (MAOIs) are another older class of antidepressants and include phenelzine and tranylcypromine. Unlike other antidepressants that inhibit the uptake of neurotransmitters, MAOIs inhibit the enzyme monoamine oxidase, which is responsible for breaking down serotonin, norepinephrine, and dopamine. By blocking the action of this enzyme, MAOIs effectively increase the availability of these “feed good” neurotransmitters. While highly effective, MAOIs are typically reserved for patients who do not respond to other antidepressants because of severe interactions with certain foods and medications. Patients taking MAOIs must adhere to dietary restrictions to avoid tyramine, a substance found in certain aged and fermented foods that reacts with the medication and can cause hypertensive crises. In addition to the primary class of antidepressants, there are other medications with unique mechanisms of action that are used to treat depression. For instance, the drug bupropion blocks the reabsorption of dopamine and norepinephrine. This makes it a suitable alternative for patients who do not respond to other antidepressants, or who experience aggravated side effects. Another example is mirtazapine, which antagonizes specific serotonin receptors and is known for its sedative effects, making it useful for patients with insomnia.
Antipsychotics
Antipsychotics are used to manage psychosis, a disassociation from reality. They are also used to treat symptoms of bipolar disorder, schizophrenia, and severe depression with psychotic features. Antipsychotics are categorized into two main classes: 23
- Typical (first-generation) antipsychotics
- Atypical (second-generation) antipsychotics
Both classes of antipsychotics aim to reduce or eliminate symptoms such as hallucinations, delusions, and disorganized thinking, but they differ in their pharmacological profiles and side effect risks.
Typical antipsychotics were the first generation of antipsychotic drugs developed. They include medications like haloperidol and chlorpromazine.23 These drugs block dopamine D2 receptors in the brain, which helps reduce psychotic symptoms. However, because dopamine plays a vital role in many brain functions, blocking the receptors can lead to significant side effects, including extrapyramidal symptoms (EPS) such as tremors, rigidity, bradykinesia, and tardive dyskinesia, a condition characterized by repetitive, involuntary movements. Atypical antipsychotics, or second-generation antipsychotics, also block dopamine receptors, antagonizing serotonin receptors. Antagonizing the serotonin receptor prevents serotonin from binding and exerting its usual effects, which can modulate the overactive serotonin pathways known to contribute to symptoms of psychosis. Not only does this dual action help to control psychotic symptoms, but it also reduces the risk of extrapyramidal side effects. Atypical antipsychotics, which include medications like risperidone, olanzapine, and clozapine, are generally preferred due to their more favorable side effect profile. However, they still cause significant issues such as metabolic syndrome, weight gain, and a higher risk of diabetes. It is important to note that clozapine is considered a unique atypical antipsychotic because of its effectiveness in treating treatment-resistant schizophrenia. It is often reserved for patients who do not respond to other antipsychotics. Clozapine has a complex pharmacology, affecting multiple neurotransmitter systems, including dopamine, serotonin, and glutamate receptors. However, it carries a risk of agranulocytosis, a potentially life-threatening reduction in white blood cells, requiring regular blood monitoring. Despite its risks, clozapine is invaluable for patients with severe, refractory psychosis.
Mood Stabilizers
Mood stabilizers are predominantly used to treat mood disorders, particularly bipolar disorder, which is characterized by intense mood swings that oscillate between emotional highs (mania) and lows (depression).24 Mood stabilizers are also used in the treatment of other conditions, such as schizoaffective disorder and severe depression that has not responded to other treatments. The main goal of mood stabilizers is to prevent the occurrence of mood episodes and to help maintain a stable emotional state. The most well-known mood stabilizer is lithium, which has been used for decades and remains the foundation of bipolar disorder treatment.25 Lithium’s exact mechanism of action is not fully understood. Still, it is believed to modulate neurotransmitter levels, enhance the function of serotonin, and stabilize neuronal membranes. Lithium has been shown to be effective in reducing the frequency and severity of manic episodes as well as suicidal ideations, making it an essential option for many patients. However, lithium requires regular blood monitoring because of this extremely narrow therapeutic window and potential for toxicity.
Other classes of mood stabilizers include anticonvulsants, such as valproate, carbamazepine, and lamotrigine.26 Initially developed to treat epilepsy, anticonvulsants have been shown to effectively stabilize mood in varying capacities. For example, valproate reduces the intensity of manic episodes and prevents future episodes. Lamotrigine, on the other hand, is better at preventing depressive episodes. While the exact mechanism by which anticonvulsants stabilize mood is not entirely understood, it is believed to be through the stabilization of neuronal activity and modulation of neurotransmitter systems. Note, atypical antipsychotics such as olanzapine, quetiapine, and aripiprazole are also prescribed as mood stabilizers, either alone or in combination with other medications. As these drugs block dopamine and serotonin receptors, they also assist in stabilizing mood and reducing the psychotic symptoms that can accompany severe mood episodes. 26 Atypical antipsychotics are most helpful in treating acute manic or mixed episodes and in maintenance therapy to prevent recurrence. Common side effects of mood stabilizers vary depending on the specific medication. Lithium can cause gastrointestinal upset, weight gain, tremors, increased thirst, and potential kidney and thyroid issues. Anticonvulsants can lead to side effects such as dizziness, drowsiness, weight gain, and, in rare cases, severe skin reactions (Stevens-Johnson syndrome with lamotrigine). Valproate may also cause liver damage and requires regular monitoring of liver function tests.
Stimulants
Stimulants are a class of psychotropic medications primarily prescribed for ADHD and narcolepsy, a sleep disorder marked by excessive daytime sleepiness, sudden episodes of muscle weakness (cataplexy), and disrupted nighttime sleep.27 In some cases, stimulants may be prescribed off-label for other concerns, such as treatment-resistant depression and certain types of cognitive dysfunction. Stimulants primarily enhance the activity of neurotransmitters dopamine and norepinephrine, which play critical roles in attention, focus, and impulse control. By increasing the levels of neurotransmitters, stimulants help improve concentration, reduce hyperactive and impulsive behaviors, and manage the excessive daytime sleepiness associated with narcolepsy.
Several stimulant medications are widely used in clinical practice. Methylphenidate, amphetamine, and dextroamphetamine are all commonly used to manage ADHD symptoms.27 Lisdexamfetamine is another popular choice, particularly for its longer duration of action and lower risk for abuse compared to other stimulants.
While stimulants are quite well tolerated, there are several possible side effects. Individuals may experience insomnia, loss of appetite, weight loss, increased heart rate, and elevated blood pressure. Other possible side effects include anxiety, irritability, and gastrointestinal concerns such as nausea and stomach pain. In rare cases, stimulants can lead to more severe side effects, including cardiovascular problems and mental health issues such as psychosis or mania.
Psychotropic medications are essential tools in the treatment of mental health disorders because they directly influence brain chemistry, helping to alleviate symptoms associated with mental health conditions. However, adherence is vital for effective management.28 When patients follow the medication regimen prescribed, they ensure that therapeutic levels of the drugs are consistently maintained in the body. This consistency is crucial for psychotropic medications to effectively regulate brain chemistry and manage symptoms. For example, individuals with depression who take their antidepressants regularly are more likely to experience sustained relief from depressive symptoms. Adherence to medication regimens also helps prevent the recurrence of severe depressive episodes. Consistent use of psychotropic medications leads to better symptom control, allowing patients to experience improved mood stability and reduced severity of symptoms. For patients with bipolar disorder or schizophrenia, adherence to medication schedules can significantly decrease the frequency and intensity of manic or psychotic episodes, enabling individuals to engage more fully in work, relationships, and daily activities without the disruptive impact of unmanaged symptoms, thus enhancing their overall quality of life.
Adherence to psychotropic medication regimens can prevent the need for hospitalizations and emergency interventions related to mental health crises.29 By maintaining stability and reducing the risk of symptom exacerbation, patients are less likely to require acute care or emergency psychiatric services. Not only does this minimize the emotional and practical disruptions associated with hospital stays or urgent interventions, but it also reduces healthcare costs. Psychotropic medications often complement psychotherapeutic interventions by providing a stable foundation from which patients can engage more effectively in therapy. When symptoms are well-managed through medication adherence, individuals can better participate in cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or other therapeutic modalities aimed at addressing underlying issues, improving coping skills, and enhancing overall mental wellness. When patients do not adhere to their prescribed medication regimen, it can lead to a deterioration in their mental health.29 Symptoms that were previously well-managed may worsen, causing distress and impairment in daily functioning. For example, those with schizophrenia or bipolar disorder who stop taking their antipsychotic medications abruptly may experience a reappearance of psychotic symptoms such as hallucinations, delusions, and disorganized thinking. These symptoms can severely disrupt their ability to maintain relationships, hold jobs, or deal with daily responsibilities. Non-adherence increases the risk of developing treatment-resistant conditions, where symptoms become more challenging to manage with standard therapeutic approaches.
This phenomenon is particularly concerning in conditions like depression or anxiety disorders, where inadequate treatment can lead to a chronic condition and a diminished response to subsequent pharmacological interventions, resulting in treatment resistance. Treatment resistance often necessitates more intensive medications, such as higher doses, combination therapies, or alternative treatment strategies that may have more significant side effects or require more extended periods to achieve symptom relief. Stopping psychotropic medications without medical guidance can also precipitate withdrawal symptoms and other health complications.30 Many psychotropic medications, including antidepressants and benzodiazepines, require gradual tapering to minimize withdrawal effects such as nausea, headaches, insomnia, and mood disturbances. Abrupt discontinuation can intensify these symptoms and potentially lead to medical emergencies in severe cases. In addition to physical discomfort, withdrawal may exacerbate underlying mental health symptoms and contribute to psychological distress, further complicating the recovery process. Non-adherence to a medication regimen not only affects individual symptom management, but it also undermines the overall effectiveness of treatment plans. Poor medication adherence can diminish the therapeutic alliance between patients and healthcare providers, reducing opportunities for collaborative treatment decision-making and support. The breakdown in care coordination may result in missed opportunities to adjust medications, explore alternative therapies, or address underlying barriers to adherence, ultimately hindering long-term recovery and wellness.
Black box warnings, also referred to as boxed warnings, are the highest warning issued by the FDA for prescription medications.31 Prominently displayed on the package insert or label of a medication, a black box warning is used to alert healthcare providers and patients on the significant risks and potentially life-threatening adverse effects associated with the medication. Black box warnings are intended to ensure all parties are aware of the serious nature of the risks and to encourage informed decision-making regarding use of a medication with a black box warning. For healthcare providers, adherence to black box warnings is a matter of patient safety and a regulatory requirement. It is essential for prescribers to be familiar with the warnings and to educate patients on the associated risks and precautions. Failure to heed black box warnings can result in adverse patient outcomes and potential legal ramifications in cases where harm occurs due to inadequate consideration of these warnings. While black box warnings highlight serious risks, they are not intended to deter appropriate use, especially when the benefits outweigh potential harms. Instead, they serve as tools for informed consent and collective decision-making between healthcare professionals and patients.
Antianxiety Medications
Benzodiazepines, a class of antianxiety medications, carry significant risks that must be carefully considered. Benzodiazepines are notorious for their potential to cause psychological and physical dependence, even when taken at therapeutic doses and for short periods.32 Prolonged use or high doses can increase dependence risk, making it challenging for individuals to discontinue the medication without experiencing withdrawal symptoms. Abrupt discontinuation of benzodiazepines can trigger a range of withdrawal symptoms, which may include severe anxiety, insomnia, irritability, muscle spasms, and, in severe cases, seizures. For this reason, it is recommended that benzodiazepines are tapered gradually under medical supervision to mitigate withdrawal effects.
Another significant concern with benzodiazepines is their potential to impair cognitive and motor functions.33 This is typically seen in older adults and individuals taking higher doses who may experience heightened drowsiness, dizziness, confusion, and slowed reaction times. Combined, these issues can lead to an increased risk of falls, accidents, and injuries. Benzodiazepines also have an additive effect when taken with CNS depressants such as opioids, alcohol, or certain antidepressants. When taken together, sedative effects are highly elevated, increasing the risk of respiratory depression, coma, or even fatal overdose.
Antidepressants
Antidepressants such as SSRIs and SNRIs carry a black box warning due to their tendency to increase suicidal thoughts and tendencies in children, adolescents, and young adults under the age of 25.34 Studies suggest this may be because individuals are more vulnerable to mood fluctuations caused by the medications. Therefore, during adjustment periods, most notably during the first stages of treatment or when the dose is changed, individuals may spiral further into depressive episodes. Vigilant and open communication is vital during any adjustments in medications to monitor for any signs of worsening depression or emerging suicidal thoughts.
In addition to the risk of suicidal thoughts, some antidepressants can also increase the risk of serotonin syndrome. Serotonin syndrome is a potentially life-threatening concern and occurs when there is an excessive accumulation of serotonin in the brain. Symptoms of serotonin syndrome include confusion, agitation, rapid heart rate, elevated body temperature, sweating, shivering, muscle rigidity, tremors, and in critical cases, seizures, or loss of consciousness. This condition is particularly likely to occur when antidepressants are taken in combination with other medications that also increase serotonin levels, such as other antidepressants, certain pain medications, or supplements like St. John’s Wort.
Antipsychotics
All antipsychotic medications come with a black box warning as they increase the risk of mortality in elderly patients with dementia-related psychosis.35 Clinical studies have shown that these individuals may experience an increased risk of death when treated with antipsychotics, often due to cardiovascular events such as heart failure or sudden death, as well as infections like pneumonia.36 Consequently, antipsychotics are not approved for the treatment of dementia-related psychosis.
In addition to the mortality risk in elderly patients, antipsychotics are associated with several metabolic side effects, including significant weight gain, dyslipidemia (abnormal lipid levels in the blood), and hyperglycemia (elevated blood sugar levels), all of which further increase cardiovascular risk factors.
Long-term use of antipsychotic medications relates to movement disorders, the most notable being tardive dyskinesia. This condition is characterized by involuntary, repetitive movements, generally involving the face, tongue, and limbs. Tardive dyskinesia can be irreversible and significantly impact a patient’s quality of life. Other movement-related side effects include parkinsonism (symptoms similar to Parkinson’s disease), akathisia (a state of restlessness and an urgent need to move), and dystonia (continual muscle contractions leading to abnormal postures or twisting movements).
Mood Stabilizers
The mood stabilizer lithium carries a black box warning because of its risk of lithium toxicity.37 Even though it is a cornerstone treatment for bipolar disorder, lithium’s therapeutic range is relatively narrow. This means the difference between a therapeutic and a toxic dose is slight. If not monitored closely, Lithium toxicity can lead to severe renal and thyroid complications. Symptoms include tremors, excessive thirst, frequent urination, confusion, and, in severe cases, seizures and coma. To prevent such complications from arising, patients on lithium need to have regular blood tests to ensure lithium levels remain within the therapeutic range. Lithium should not be taken with non-steroidal anti-inflammatory drugs (NSAIDs) or certain blood pressure medications, as the combined effects increase lithium levels, heightening the risk of toxicity.
Other mood stabilizers, particularly anticonvulsants like valproate, carbamazepine, and lamotrigine, carry black box warnings related to potential suicidal thoughts or behaviors.38 The FDA has highlighted that these medications, while effective in stabilizing mood and preventing episodes of mania and depression, may increase the risk of suicide in certain individuals. Mood stabilizers may also interact with other drugs, such as antibiotics, oral contraceptives, and anticoagulants buy altering the metabolism and effectiveness of them and cause an increase in the potential for side effects, including sedation, gastrointestinal disturbances, and cognitive impairment.
Stimulants
Stimulant medications carry a black box warning because of their high potential for abuse and dependence.39 Their stimulating properties can create a euphoric effect when taken in higher-than-prescribed doses, leading to misuse and addiction. For this reason, stimulants are also classified as Schedule II controlled substances. Even when used in the short term, stimulant medications pose significant cardiovascular risks. They can increase heart rate and blood pressure, which may be dangerous for those with pre-existing heart conditions or hypertension. There have been reports of sudden death, stroke, and myocardial infarction in adults taking stimulant medications at usual doses.
Stimulant medications can also exacerbate underlying psychiatric conditions. For individuals with a history of anxiety disorders, stimulants can increase anxiety and agitation. Similarly, in those with pre-existing psychotic disorders or a family history of psychosis, stimulants can exacerbate symptoms or trigger new episodes of psychosis, including hallucinations and delusions.
Stimulants have also been shown to affect growth in children and adolescents. There is evidence suggesting that these medications may slow growth rates, potentially affecting both weight and height.
Given the complex interactions and effects of psychotropic medications, several nursing considerations must be made before including psychotropic medications in treatment plans. Before initiating any medication, it is crucial for nurses to conduct a thorough patient assessment.19 This includes obtaining a detailed medical history, including any past psychiatric history, current medications, and any known allergies. Understanding the patient’s baseline physical and mental health status is essential for identifying any pre-existing conditions that may be exacerbated by psychotropic medications. This assessment should also encompass an evaluation of the patient’s lifestyle, dietary habits, and potential for substance abuse, as these factors can influence medication efficacy and safety. Once treatment commences, dosages should start low and be gradually titrated upwards.21 Patients must be monitored closely for side effects and adverse reactions. This includes regularly assessing vital signs, weight, and laboratory values to detect early signs of metabolic effects, cardiovascular risks, or organ toxicity.
Nurses should be vigilant for common side effects associated with specific classes of psychotropic medications.22 The nurse must assess for signs of dependence, withdrawal symptoms, and cognitive or motor impairment. The nurse must assess for the following:
- Antidepressants – Increased suicidal thoughts, particularly in children, adolescents, and young adults, as well as signs of serotonin syndrome.
- Antipsychotics – Metabolic effects, such as weight gain and dyslipidemia, and movement disorders like tardive dyskinesia.
- Mood stabilizers – Signs of lithium toxicity and adverse effects from anticonvulsants, including suicidal thoughts and behaviors.
- Stimulants-Potential abuse, cardiovascular effects, and impact on growth in children and adolescents.
Educating patients and their families about psychotropic medications is a crucial nursing responsibility. Patients should be informed about the purpose of the medication, the expected benefits, and the potential side effects.20 Emphasizing the importance of adherence to prescribed dosages and schedules is crucial to prevent relapse or worsening of symptoms. Patients should also be educated on the risks of abrupt discontinuation and the necessity of consulting healthcare professionals before any changes to their medication regimen. If conducive, family members should be included in the education process, particularly when caring for children, adolescents, or elderly patients. Family members should be aware of the signs and symptoms of adverse reactions and understand the importance of monitoring and supporting the patient’s treatment plan. Providing written materials and resources can enhance understanding and retention of information. As psychotropic medications often interact with other drugs, nurses must carefully review all medications the patient is taking, including over-the-counter medicines and supplements, to identify potential interactions.20 Coordinating with other healthcare providers to manage polypharmacy is essential to ensure safe and effective treatment. Nurses should also educate patients on the importance of disclosing all medications and supplements they are taking to their healthcare providers. Encouraging and supporting medication adherence is a critical aspect of nursing care for patients on psychotropic medications. Nurses can assist by developing tailored strategies that help patients take their medications regularly, such as using pill organizers, setting reminders, or establishing a routine. Regular follow-up appointments provide opportunities to discuss any challenges the patient may experience with adherence to a medication regimen, and to make necessary adjustments to the treatment plan, as necessary.
The importance of psychotropic medications in treating mental health disorders cannot be overstated. By targeting neurotransmitter systems, psychotropic medications aim to restore neurochemical balance, thereby alleviating symptoms to improve the quality of life for those struggling with mental health concerns. The diversity of psychotropic drug, ranging from antianxiety medications and antidepressants to antipsychotics, mood stabilizers, and stimulants, allows for personalized treatment plans based on the precise needs of patients. However, it is critical to understand the mechanisms of action, therapeutic uses, and potential side effects of these medications. Psychotropic medications must be carefully managed and monitored by healthcare professionals to ensure accurate dosing and modulation. The effectiveness of medications also hinges on consistent use. Adherence to prescribed medication regimens is central to maintaining therapeutic drug levels and ensuring symptom control. Non-adherence can lead to worsening symptoms, increased hospitalizations, and treatment resistance. Before initiating treatment, black box warnings must be thoroughly considered, as many psychotropic medications carry serious risks. This adds another layer of complexity that healthcare professionals must weigh for informed decision-making and careful monitoring. Nursing considerations, which revolve around comprehensive patient assessments, vigilant monitoring for side effects, and thorough patient education, are essential to ensuring adherence and safety. With a patient-centered approach, healthcare professionals can optimize treatment results and improve the overall well-being of patients with mental health disorders.
- Brauer, R., Alfageh, B., Blais, J. E., Chan, E. W., L Chui, C. S., Hayes, J. F., C Man, K. K., Y Lau, W. C., C Yan, V. K., Beykloo, M. Y., Wang, Z., Wei, L., & K Wong, I. C. (2021). Psychotropic medicine consumption in 65 countries and regions, 2008–19: A longitudinal study. The Lancet. Psychiatry, 8(12), 1071-1082. https://doi.org/10.1016/S2215-0366(21)00292-3
- World Health Organization. (2022, June 8). Mental disorders. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
- World Health Organization. (2023, September 27). Anxiety Disorders. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
- National Institute of Mental Health. (n.d.). Any Anxiety Disorder. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
- World Health Organization. (2023, March 31). Depressive disorder (depression). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression
- Mental Health America. (2023). Depression. Mental Health America. https://mhanational.org/conditions/depression
- Bipolar disorder. (n.d.). Www.who.int. https://www.who.int/news-room/fact-sheets/detail/bipolar-disorder
- National Institute of Mental Health. (2022). Bipolar Disorder. Www.nimh.nih.gov. https://www.nimh.nih.gov/health/statistics/bipolar-disorder
- Post-traumatic stress disorder. (n.d.). Www.who.int. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder
- National Center for PTSD. (2023, February 3). How Common Is PTSD in Adults? U.S. Department of Veteran Affairs. https://www.ptsd.va.gov/understand/common/common_adults.asp
- Schizophrenia Fact Sheet – Treatment Advocacy Center. (2022, January 1). Www.treatmentadvocacycenter.org. https://www.treatmentadvocacycenter.org/reports_publications/schizophrenia-fact-sheet/
- Conduct Disorder. (n.d.). Yale Medicine. https://www.yalemedicine.org/conditions/conduct-disorder
- Many countries have the same challenges. (n.d.). Health.ucdavis.edu. Retrieved July 10, 2024, from https://health.ucdavis.edu/health-magazine/issues/summer2017/features/challenges.html
- National Institute of Mental Health. (2014). Attention-Deficit/Hyperactivity Disorder (ADHD). Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd
- Brauer, R., Alfageh, B., Blais, J. E., Chan, E. W., L Chui, C. S., Hayes, J. F., C Man, K. K., Y Lau, W. C., C Yan, V. K., Beykloo, M. Y., Wang, Z., Wei, L., & K Wong, I. C. (2021). Psychotropic medicine consumption in 65 countries and regions, 2008–19: A longitudinal study. The Lancet. Psychiatry, 8(12), 1071-1082. https://doi.org/10.1016/S2215-0366(21)00292-3
- The Central Nervous System | SEER Training. (n.d.). Training.seer.cancer.gov. https://training.seer.cancer.gov/anatomy/nervous/organization/cns.html
- National Cancer Institute. (2019). Nerve Tissue | SEER Training. Cancer.gov. https://training.seer.cancer.gov/anatomy/nervous/tissue.html
- Teleanu, R. I., Niculescu, A.-G., Roza, E., Vladâcenco, O., Grumezescu, A. M., & Teleanu, D. M. (2022). Neurotransmitters—Key Factors in Neurological and Neurodegenerative Disorders of the Central Nervous System. International Journal of Molecular Sciences, 23(11), 1–24. https://doi.org/10.3390/ijms23115954
- Altamura, A. C., Moliterno, D., Paletta, S., Maffini, M., Mauri, M. C., & Bareggi, S. (2013). Understanding the pharmacokinetics of anxiolytic drugs. Expert Opinion on Drug Metabolism & Toxicology, 9(4), 423–440. https://doi.org/10.1517/17425255.2013.759209
- Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurology International, 13(4), 594-607. https://doi.org/10.3390/neurolint13040059
- Braund, T. A., Tillman, G., Palmer, D. M., Gordon, E., Rush, A. J., & F. Harris, A. W. (2021). Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: An iSPOT-D report. Translational Psychiatry, 11. https://doi.org/10.1038/s41398-021-01533-1
- Gutlapalli, S. D., Chaudhuri, D., Khan, K. I., Shouli, R. A., Allakky, A., Ferguson, A. A., Khan, A. I., Abuzainah, B., & Mohammed, L. (2022). Statins and Antidepressants: A Comprehensive Review and Clinical Outlook of the Risks and Benefits of Co-prescription (2022). Cureus, 14(12). https://doi.org/10.7759/cureus.32331
- Eyles, E., Margelyte, R., Edwards, H. B., Moran, P. A., Kessler, D. S., C Davies, S. J., Bolea-Alamañac, B., Redaniel, M. T., & Sullivan, S. A. (2024). Antipsychotic Medication and Risk of Metabolic Disorders in People With Schizophrenia: A Longitudinal Study Using the UK Clinical Practice Research Datalink. Schizophrenia Bulletin, 50(2), 447-459. https://doi.org/10.1093/schbul/sbad126
- Shah, N., Grover, S., & Rao, G. P. (2016). Clinical Practice Guidelines for Management of Bipolar Disorder. Indian Journal of Psychiatry, 59(Suppl 1), S51. https://doi.org/10.4103/0019-5545.196974
- Hafeman, D. M., Merranko, J., Liao, F., Gill, M. K., Goldstein, T. R., Diler, R., Ryan, N., Goldstein, B. I., Axelson, D. A., Strober, M., Keller, M., Hunt, J., Hower, H., Weinstock, L. M., Yen, S., & Birmaher, B. (2020). Lithium Versus Other Mood Stabilizing Medications in a Longitudinal Study of Bipolar Youth RH = Lithium in Youth With Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 59(10), 1146. https://doi.org/10.1016/j.jaac.2019.06.013
- Rybakowski, J. K. (2023). Mood Stabilizers of First and Second Generation. Brain Sciences, 13(5). https://doi.org/10.3390/brainsci13050741
- Nazarova, V. A., Sokolov, A. V., Chubarev, V. N., Tarasov, V. V., & Schiöth, H. B. (2022). Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.1066988
- Ali, M. M., Taha, M. M., Ahmed, A. E., Ali, S., Baiti, M. A., Alhazmi, A. A., Alfaifi, B. A., Majrabi, R. Q., Khormi, N. Q., Hakami, A. A., Alqaari, R. A., Alhasani, R. A., & Abdelwahab, S. I. (2023). Psychotropic Medication Adherence and Its Associated Factors Among Schizophrenia Patients: Exploring the Consistency of Adherence Scales. Cureus, 15(9). https://doi.org/10.7759/cureus.46118
- Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews, 9. https://doi.org/10.1186/s13643-020-1274-3
- Horowitz, M. A., & Moncrieff, J. (2024). Gradually tapering off antipsychotics: Lessons for practice from case studies and neurobiological principles. Current Opinion in Psychiatry, 37(4), 320-330. https://doi.org/10.1097/YCO.0000000000000940
- Rajendran, Y., Kondampati, N., Eerike, M., Mali, K., & C, L. F. (2024). A Longitudinal Analysis of Black Box Warnings: Trends and Implications for Drug Safety. Cureus, 16(4). https://doi.org/10.7759/cureus.57597
- Risks of Benzodiazepines. (2020, October 30). National Center for Health Research. https://www.center4research.org/fda-black-box-warnings-benzodiazepines-miscarriages/
- Research, C. for D. E. and. (2020). FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. FDA. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
- Food and Drug Administration. (2018). Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. FDA. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications
- Yan, J. (2008). FDA Extends Black-Box Warning to All Antipsychotics. Psychiatric News, 43(14), 1–27. https://doi.org/10.1176/pn.43.14.0001
- Mok, P. L. H., Carr, M. J., Guthrie, B., Morales, D. R., Sheikh, A., Elliott, R. A., Camacho, E. M., Staa, T. van, Avery, A. J., & Ashcroft, D. M. (2024). Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ, 385, e076268. https://doi.org/10.1136/bmj-2023-076268
- DailyMed – LITHIUM CARBONATE capsule. (n.d.). Dailymed.nlm.nih.gov. Retrieved July 14, 2024, from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=18dc0a0c-8cee-4d20-9350-895d8de85147
- Goldenberg, M. M. (2010). Overview of Drugs Used For Epilepsy and Seizures: Etiology, Diagnosis, and Treatment. Pharmacy and Therapeutics, 35(7), 392-415. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912003/
- Research, C. for D. E. and. (2023). FDA updating warnings to improve safe use of prescription stimulants used to treat ADHD and other conditions. FDA. https://www.fda.gov/drugs/drug-safety-and-availability/fda-updating-warnings-improve-safe-use-prescription-stimulants-used-treat-adhd-and-other-conditions
To access Psychotropic Medications, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
To access Psychotropic Medications, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
