Antiepileptic

(divalproate, CBZ, LTG)

MOA of AEDs

Antidepressants

Antipsychotics
(asenapine, olanzapine,
quetiapine)

MOA of AP

Prophylactic, to avoid
cycling of episodes
Bipolar depression

Serious adverse effects (typical of

AEDs)

Induce mixed state, increase cycle rate

or cause mania or hypomania

First line, used to treat

remission and
maintenance; not only for
acute psychosis

ANXIOLYTICS
Acting via amino acid
MOA of AEDs


transmission
Anxiety disorders
(benzodiazepines, AEDs)
TMI. Everything with
panic, anxiety and phobia
Acting via monoaminergic
MOA of ADs

on their nomenclature are
NTs
ADs
(antidepressants TCA,
MAOI, SSRI, SNRI, NaSSA)
Antipsychotics
MOA of APs

LEGEND: *Reuptake inhibitors | -Enzyme inhibitors | + Mixed receptor blockers

EJBC A2019

Same side effect as parent drugs

Not an effective antimanic

agent; FDA approved for
maintenance phase only
Causes more problems
than benefits; may not
work at all
Typical AP are ineffective

Not all atypicals help
mixed state

SSRIs are recommended as
first line tx

*SNRI
(venlafaxine, duloxetine)

Blocks 5HT2&
noradrenaline reuptake

*NDRI
(bupropion)

Blocks norepinephrine
and dopamine reuptake,
similar cascade as SSRI
Reversible inhibitor of
MAO (2 weeks) &
destroy its function
Increased 5HT2, NE and
D
Blocks alpha 2
autoreceptors on
epinephrine and
heteroreceptors on
serotonin neurons

Increases 5HT2 and NE

-MAOI
(isocarboxazid, phenelzine,
tranylcypromine)
- RIMA
(moclobemide)
+NaSSA
(mirtazapine, mianserin)

+SARI
(trazodone, nefazodone)

Blocks 5HT2A rediced

sexual dysfxn, sleep
disruption;

Stimulates 5HT1A

Lithium carbonate

Inositol phosphate
metabolism modulation;
inhibition of IMPase:
modulates PKC signaling
activity

Decreases intracellular
NA; attenuates
fluctuation in CAMP;
neuroprotection

EJBC A2019

Depressive disorders
DMDD, MDD,
Premenstrual dysphoric
d/o, substance induced
depressive d/o

Bulimia, electrolyte
imbalance
Diet w tyramine

MOOD STABILIERS
Bipolar and related d/o

Bipolar I & II, cyclothymic
d/o, substance induced
bipolar, etc.

Amelioration of affective
and psychotic symptoms
during manic phase

Improvement in
depression

<150 mg: same as SSRI

>150 mg: increased diastolic BP and
other noradrenergic effects (see NDRI)

SHARES (seizures, headache, agitation,

rash, emesis, sleep disruption &
shaking)
HANDS, SHARES

Blood dyscrasias, hepatotoxicity,
teratogenicity, serotonin syndrome,
HTN crisis
Antihisitaminergic: weight gain,
sedation
Anticholinergic: dry mouth, urinary
retention, constipation, confusion,
fever (red as beet, dry as bone, blind
as a bat, mad as a hatter, hot as hare),
etc.

Neutopenia, serotonin syndrome,
hepatotoxicity

Antihisitaminergic: weight gain,
sedation
Alpha blockade: orthostatic
hypotension

Serotonin syndrome

Nausea, vomiting, diarrhea, weight
gain, edema, tremors, fatigue,
cognitive impairment, polyuria and
polydipsia, goiter, hypothyroidism, T
wave flattening alopecia, psoriasis,
acneiform, rashes, Ebsteins anomaly,
Li toxicity

Advantages: dual action,

higher remission rates
than SSRI
Disadvantages: SNRIs are
less balanced, titration is
necessary

HTN crisis is caused by

tyramine release of NE

Inc NE+Dec MAO = HTN
crisis

5HT2A and 5HT1A oppose

each other

PK: complete absorption,

not bound to plasma
proteins, eliminated
through renal route:
proportional to Na and
hydration

DRUG

MOA

PSYCHOPHARMACOLOGIC AGENTS
INDICATIONS
CONTRAINDICATIONS
ANTIPSYCHOTICS

Depressed sensorium,

parkinsonism,

pregnant, respiratory

depression, geriatric
Psychotic
patients
(schizophrenia,
schizoaffective,
schizophreniform,
psychosis, manic phase of
bipolar, delusional

disorders)

Non-Psychotic
(Alzheimers, Gilles dela
Tourette, tetanus,
antiemetic, cingultus,
preoperative medications,
antishistaminic)

Typical Antipsychotics
- Phenothiazines
(chlorpromazine,
thioridazine,
trifluoroperazine)
- Butyrophenones
(haloperidol)
- Thioxanthenes
(thiothixene)
Atypical Antipsychotics
- Tight D2 binding
(ziprazidone, loxapine,
clozapine, risperidone,
paliperidone, sertindole,
olanzapine, sulpride,
amisulpride)
- Readily D2 dissociating
(quetiapine)
- Partial D2 agonist
(aripiprazole)

D2 blockade/ D2
antagonist

*Tricyclic antidepressants
3o amines
(amitypltyline, imipramine,
deoxepine)
2o amines
(nortriptyline, desipramine)

Blocks 5HT2, NE and D2

reuptake

*SSRI
(cilatopram, escilatopram,
parozetine, fliozetine,
sertraline)

Blocks 5HT2 reuptake

MDD, augmentation in
bipolar, premenstrual
dysphoric d/o, anxiety d/o

*NARI
(reboxetine)

Blocks noradrenaline
reuptake

EJBC A2019

D2&5HT2 antagonist

ANTIDEPRESSANTS
Depressive disorders

DMDD, MDD,
Premenstrual dysphoric
d/o, substance induced
depressive d/o

SIDE EFFECTS

COMMENTS

EPS, prolactin elevation, negative

symptoms, cognitive impairment,
tardive dyskinesia

Phenothiazines cross react

with other receptors:
cholinergic, histaminergic,
adrenergic, serotonergic

Prior
EPS + tardive dyskinesia, negative
symptoms, cognition
Current
Weight gain, CVD, hyperglycemia,
hyperlipidemia, akathisia, diabetes,
dizziness,

Clozapine agranulocytosis, seizure

Causes less EPS than

typical, improves positive
symptoms, efficacy vs
negative symptoms is well
established

Antihisitaminergic: weight gain,

sedation
Anticholinergic: dry mouth, urinary
retention
Alpha 1 blockade: dizziness,
orthostatic hypotension
Blockade of fast Na channels:
prolongation of QTc

Torsades de Pointes, SIADH, Serotonin
syndrome
HANDS (headache, anxiety, nausea,
diarrhea, sexual dysfxn, sleep,
somnolence)

UGI bleed, SIADH, SSRI discontinuation
syndrome, serotonin syndrome