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 Inhibitors
 Mood 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.
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Tardive Dyskinesia : rapid repetitive movements.
* Neuroleptic Malignant Syndrome: confusion, fever,
muscle rigidity.
->5HT2A and 5HT2C Serotonin Blockeade
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Clozapine= Clozaril
Risperidone= Risperdal (consta inj)
Olanzapine= Zyprexa
Quetiapine= Seroquel
Ziprasidone= Geodon
Aripiprazole= Abilify
Paliperidone= Invega (sustenna inj)
Asenapine= Saphris
Iloperidone= Fanapt
Lurasidone= Latuda
 Sedation (seroquel +++)
 Weight gain (zyprexa, clozaril+++)
 Metabolic changes (zyprexa, seroquel, clozaril)
 EPS, TD
 Risks if pregnancy
 Constipation, dry mouth
 Irritability
 Changes in blood cells (clozaril needs blood counts
regularly)
 Psychotic Disorders: Schizophrenia, Schizoaffective
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Disorder, Schizophreniform Disorder, depression with
psychosis, drug induced and other organic psychosis.
Acute mania
Maintenance of Bipolar Illness
Tourette’s Syndrome and other tic disorders
Treatment-Resistant Depression: Abilify and Seroquel
Other uses (not FDA): personality disorders, chronic
aggression, OCD.
Psychosis and Bipolar illness in Children and
adolescents.
 Lithium= Eskalith, Lithobid
 Valproic acid = Depakote, Depakene, ER
 Carbamazepine= Tegretol, Equetro, Carbatrol, XR
 Lamotrigine = Lamictal
 Oxcarbamazepine= Trileptal
 Gabapentin= Neurontin
 Topiramate= Topamax
 Thirst/ Increased Urination
 Tremor
 Weight gain
 Nausea, diarrhea
 Acne
 Fatigue
 Thyroid abnormalities
 Toxicity: severe tremor, confusion, seizures
 Interactions with Diuretics, NSAID’s, lisinopril
-> Increases GABA transmission
 Gastrointestinal
 Low platelet count
 Tremor
 Sedation
 Weight gain
 Alopecia
-> Blocks sodium channels
 Dizziness, uncoordination
 Double vision
 G.I. upset
 Tremor
 Decreased white blood cells
 Rash
* 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 mania
 Cyclothymia
 Schizoaffective Disorder
 Aggression
 Personality Disorders with unstable affect
 Alcohol Abuse (+/-)
 Anxiety
 Chronic pain syndromes
 Fluoxetine= “Prozac”
 Paroxetine= “Paxil, Paxil CR, Pexeva”
 Citalopram= “Celexa”
 Sertraline= “Zoloft”
 Fluvoxamine= “Luvox”
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 Duloxetine= “Cymbalta”
 Venlafaxine= “Effexor, Effexor ER, XR”
 Desvenlafaxine= “Pristiq”
 Vilazodone= “Viibryd”
 Nausea and decreased appetite
 Increased sweating
 Tremor
 Headaches
 Sleep changes (quantity, quality, dreams)
 Sexual dysfunction*
 Diarrhea/constipation
 Bruxism
 HTN (SNRI’s)
 Tricyclics: sedation, hypotension, dry mouth, blurry
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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 Disorder
 Dysthymic Disorder
 Panic Disorder
 Social Anxiety Disorder
 Generalized anxiety Disorder
 PTSD (zoloft)
 OCD (fluvoxamine), Impulse Control Disorders
 Bulimia Nervosa
 Personality Disorders (BPD)
 Neuropathic Pain, Fibromyalgia
 Insomnia
 Enuresis (imipramine)
 ADHD (Wellbutrin)
 Smoking cessation (Wellbutrin)
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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= Strattera
 Methylphenidate = 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 inhibitors
 Donepezil= “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
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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 CAM
Birth Control
Substance Abuse
Epocrates.com
Erowid.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 services
 Largest uninsured group in the US
 Research on Evidence based treatments tested mainly
on white populations
 Over-reliance on family and religion
 Low socio-economic status: 2-3 times more likely to
have a mental illness
 Poor Health overall
 Stigma of mental illness and Psychiatry care
 Being an “Illegal alien”
 Lost in Translation: 1% of APA members are Hispanic
 Gender roles
 Different Hispanic cultures/ countries
 Over-representation in the criminal and Juvenile
justice systems