Psychopharmacology - Antidepressants Psychology Essay (Essay Sample)
Book- Read Chapters 6 - 8 and 16 & 17 of Handbook of Clinical Psychopharmacology for Therapists Review the Appendices of Handbook of Clinical Psychopharmacology for Therapists
Your paper should be 5 pages in length plus a title and reference page
In a 2018 study, Levy, Scherer, Zikmund-Fisher, Larkin, Barnes, & Fagerlin concluded that approximately 81.1% of people withheld medically relevant information from their health-care providers. 45.7% of adults avoided telling their providers that they disagreed with their care recommendations, and 81.8% of adults withheld information because they didn’t want to be lectured or judged.
Levy, A. G., Scherer, A. M., Zikmund-Fisher, B. J., Larkin, K., Barnes, G. D., Fagerlin, A. (2018). Prevalence
of and factors associated with patient nondisclosure of medically relevant information to clinicians. JAMA
Network Open, 1(7):e185293. doi:10.1001/jamanetworkopen.2018.5293
From this perspective, we can appreciate how many clients who see therapists as well as prescribers may not fully share information with them. This could happen in several ways- either not sharing information, omitting information, or blatantly lying. Some deceit may be harmless- other types of deceit can be deadly- especially when a client is taking medications for mental health conditions.
Many clients may disagree with taking medications for fear of side effects, becoming “dependent” on the medication, having to take the medication for the rest of their life, etc. This has resulted in many clients seeking out “all natural” forms of treatment. When some of these forms of treatment prove ineffective, the client may combine prescription drugs with “natural” treatments. They may not tell their prescriber this, however, out of fear of being “lectured or judged.”
In this assignment, you are asked to consider one of the classes of antidepressant medications described in the course text. Next, you will prepare a paper in which you describe the following:
1. The class of antidepressants selected for review.
2. Description of the purported mechanism of action.
3. Potential “home remedies” or “natural supplements” that people may use in an attempt to treat the condition.
4. Explore possible drug/supplement interactions which could be problematic when combined.
5. Consider what you would do if the client tells you that he or she is using supplemental treatments to address their depression.
6. Consider “safer” alternatives that the client can use to work with their medication.
QUICK REFERENCE TO PSYCHIATRIC MEDICATIONS® DEVELOPED BY JOHN PRESTON, PSY.D., ABPP AND BRET A. MOORE, PSY.D., ABPP To the best of our knowledge recommended doses and side effects listed below are accurate. However, this is meant as a general reference only, and should not serve as a guideline for prescribing of medications. Please check the manufacturer’s product information sheet or the P.D.R. for any changes in dosage schedule or contraindications. (Brand names are registered trademarks.) desipramine Norpramin 150-300 mg low low +++++ 0 0 amitriptyline Elavil 150-300 mg high high ++ ++++ 0 nortriptyline Aventyl, Pamelor 75-125 mg mid mid +++ ++ 0 trazodone Oleptro 150-400 mg mid none 0 ++++ 0 nefazodone Generic Only 100-300 mg mid none 0 +++ 0 fluoxetine Prozac4, Sarafem 20-80 mg low none 0 +++++ 0 bupropion Wellbutrin4 150-400 mg low none ++ 0 ++ sertraline Zoloft 50-200 mg low none 0 +++++ + paroxetine Paxil 20-50 mg low low + +++++ 0 venlafaxine Effexor4 75-350 mg low none +++ +++ + desvenlafaxine Pristiq 50-400 mg low none +++ +++ + fluvoxamine Luvox 50-300 mg low low 0 +++++ 0 mirtazapine Remeron 15-45 mg mid mid +++ +++ 0 citalopram Celexa 10-40 mg low none 0 +++++ 0 escitalopram Lexapro 5-20 mg low none 0 +++++ 0 duloxetine Cymbalta 20-80 mg low none +++ +++ 0 vilazodone Viibryd 10-40 mg low low 0 +++++ 0 atomoxetine Strattera 60-120 mg low low +++++ 0 0 vortioxetine Trintellix 10-20 mg mid none 0 +++++ + levomilnacipran Fetzima 40-120 mg low none +++ ++ 0 MAO INHIBITORS phenelzine Nardil 30-90 mg low none +++ +++ +++ tranylcypromine Parnate 20-60 mg low none +++ +++ +++ selegiline Emsam (patch) 6-12 mg low none +++ +++ +++ ATYPICAL ANTIDEPRESSANTS brexanolone Zulresso see footnote 5 … … see footnote 5 … … esketamine Spravato see footnote 6 … … see footnote 6 … … Usual Selective Action On NAMES Daily Dosage Neurotransmitters2 Generic Brand Range Sedation ACH1 NE 5-HT DA 1ACH: Anticholinergic Side Effects 2NE: Norepinephrine, 5-HT: Serotonin, DA: Dopamine (0 = no effect, + = minimal effect, +++ = moderate effect, +++++ = high effect) 3Uncertain, but likely effects 4Available in standard formulation and time release (XR, XL or CR). Prozac available in 90mg time released/weekly formulation 5This medication is used to treat postpartum depression. It is administered IV over a period of 60 hours. 6This medication is used to treat severe, acute suicidal impulses and treatment resistant depression. It is administered via nasal spray and doses vary considerably. lithium carbonate Eskalith, Lithonate 600-2400 0.6-1.5 olanzapine/ fluoxetine Symbyax 6/25-12/50mg4 (2) carbamazepine Tegretol,Equetro 600-1600 4-10+ NAMES Daily Serum1 Generic Brand Dosage Range Level BIPOLAR DISORDER MEDICATIONS divalproex Depakote 750-1500 50-100 lamotrigine Lamictal 50-500 (2) oxcarbazepine Trileptal 1200-2400 (2) Note: Many antipsychotic medications are used to treat various aspects of bipolar disorder (see page two for a list) Daily Serum1 Generic Brand Dosage Range Level NAMES 1Lithium levels are expressed in mEq/l, carbamazepine and valproic acid levels express in mcg/ml. 2Serum monitoring may not necessary 3Not yet established 4Available in: 6/25, 6/50, 12/25, and 12/50mg formulations ANTIDEPRESSANTS © Copyright 2019, John Preston, Psy.D and P.A. Distributors 1Note: Adult Doses. 2Sustained release 3Note: Many generic brands have emerged recently. Included here are the most common. Generic Brand Daily Dosage1 PSYCHO-STIMULANTS methylphenidate3 Ritalin 5-50 mg methylphenidate3 Concerta2 18-54 mg methylphenidate3 Metadate 5-40 mg methylphenidate3 Methylin 10-60 mg methylphenidate3 Daytrana (patch) 15-30 mg methylphenidate3 Quillivant XR (liquid)2 10-60 mg dexmethylphenidate Focalin 5-40 mg dextroamphetamine Dexedrine 5-40 mg NAMES lisdexamphetamine Vyvanse 30-70 mg d- and l-amphetamine Adderall 5-40 mg modafinil Provigil, Sparlon 100-400 mg armodafanil Nuvigil 150-250 mg amphetamine salts Mydayis 12.5-50 mg amphetamine sulfate Adzenys 3.1-18.8 mg amphetamine salts Evekeo 5-40 mg Generic Brand Daily Dosage1 PSYCHO-STIMULANTS NAMES NAMES ANTIPSYCHOTICS ANTI-ANXIETY BENZODIAZEPINES diazepam Valium 2-10 mg 5 mg chlordiazepoxide Librium 10-50 mg 25 mg clonazepam Klonopin 0.5-2.0 mg 0.25 mg lorazepam Ativan 0.5-2.0 mg 1 mg alprazolam Xanax 0.25-2.0 mg 0.5 mg OTHER ANTIANXIETY AGENTS buspirone BuSpar 5-20 mg gabapentin Neurontin 200-600 mg hydroxyzine Atarax, Vistaril 10-50 mg propranolol Inderal 10-80 mg atenolol Tenormin 25-100 mg guanfacine Tenex, Intuniv 0.5-3 mg clonidine Catapres, Kapvay 0.1-0.3 mg pregabalin Lyrica 25-450 mg prazosin2 Minipress 5-20 mg 1Doses required to achieve efficacy of 5 mg of diazepam 2For treatment of nightmares and day time anxiety NAMES Single Dose Generic Brand Dosage Range Equivalence1 NAMES Single Dose Generic Brand Dosage Range HYPNOTICS temazepam Restoril 15-30 mg triazolam Halcion 0.25-0.5 mg zolpidem Ambien 5-10 mg zolpidem Intermezzo 1.75 mg zaleplon Sonata 5-10 mg eszopiclone Lunesta 1-3 mg ramelteon Rozerem 4-16 mg diphenhydramine Benadryl 25-100 mg doxepin Silenor 3-6 mg suvorexant Belsomra 15-40 mg REFERENCES and RECOMMENDED BOOKS Handbook of Clinical Psychopharmacology For Therapists (2017) Preston, O’Neal and Talaga Quick Reference & Bipolar Medications • Free Books • Free Downloads Website: www.PsyD-fx.com Clinical Psychopharmacology Made Ridiculously Simple 8th Edition (2020) Preston, Moore and Johnson LOW POTENCY chlorpromazine Thorazine 50-800 mg + + 100 mg clozapine Clozaril 300-900 mg 0 50 mg quetiapine Seroquel 150-600 mg +/0 ++++ 50 mg HIGH POTENCY perphenazine Trilafon 8-60 mg +++++ 10 mg haloperidol Haldol 2-40 mg +++++ 2 mg pimozide Orap 1-10 mg +++++ 1-2 mg risperidone Risperdal 4-6 mg + 1-2 mg paliperidone Invega 3-12 mg + 1-2 mg olanzapine Zyprexa 5-20 mg +/0 1-2 mg ziprasidone Geodon 60-160 mg +/0 10 mg iloperidone Fanapt 12-24 mg + 1-2 mg asenapine Saphris 10-20 mg + 1-2 mg lurasidone Latuda 40-80 mg + 10 mg aripiprazole Abilify 15-30 mg ++ 2 mg brexpiprazole Rexulti 1-4 mg 1 mg cariprazine Vraylar 1.5-6 mg +/0 1 mg Bipolar Medications A Concise Guide (2019) Preston: Free Download Child and Adolescent Psychopharmacology Made Simple (2015) Preston, O’Neal, Talaga 1Usual daily oral dosage. 2Orthostatic Hypotension. Dizziness and falls. 3Acute: Parkinson’s, dystonias, akathisia. Does not reflect risk for tardive dyskinesia. All neuroleptics may cause tardive dyskinesia, except clozapine. 4Monitor BMI. 5Must monitor for blood lipids, fasting glucose, baseline at 12 weeks, and then atleast annually. 6Dose required to achieve efficacy of 100 mg chlorpromazine. 7In recent times a number of second generation antipsychotics have been developed in injectable form for acute treatment and longer term prophylaxis. These are not mentioned in this quick reference. 8Note: Many antipsychotic medications are approved for the treatment of various phases of bipolar disorder. St. John’s Wort1, 2 600-1800 mg SAM-e3 400-1600 mg Omega-34-EPA 1-2 g Folic Acid7 400-800 mcg L-methylfolate7, 8 7.5-15 mg N-acetylcysteine5 1200-2400 mg Chamomile6 200-1500 mg 5-HTP7 300-600 mg Magnesium L-Threonate8 500-2000 mg Name Daily Dose OVER THE COUNTER 1Treats depression and anxiety 2 May cause significant drug-drug interactions 3Treats depression 4Treats depression and bipolar disorder 9Note: also available as Deplin 1-methylfolate (prescription) 7.5-15 mg 5 For trichotillomania 6Treats anxiety 7 Treats depression 8 Treats sleep Generic Brand Dosage Range1 Sedation EPS3 Equivalence5 Weight4 Gain +++++ +++ 0/+ 0/+ +++++ 0/+ ++ ++ +++++ 0/+ ++ ++ 0/+ 0/+ + 0/+ +/0 +/0 Ortho2 Metabolic Side Effects +++++ +++++ ++ ++ 0/+ 0/+ +++++ 0/+ 0/+ 0/+ 0/+ 0/+ 0/+ 0/+ high high mid mid low low low low mid low mid low mid low low low high high mid mid low low mid mid low mid mid low mid low low low ANTI OBSESSIONALS Clomipramine Anafranil 150-300 mg All SSRIssource..
Reuptake inhibitors are some of the most common inhibitors recommended to be consumed by people. Basically, the term reuptake describes a process that involves the reabsorption of neurotransmitters after their release to transmit signals towards the brain’s nerve cells (webmd.com, 2019). The role of a reuptake inhibitor is to stop this process from taking place. These inhibitors enable the neurotransmitter to assume a position within the synapse, instead of getting reabsorbed.
Mechanism of Action
As earlier mentioned, reuptake inhibitors block or reduce the rate at which neurotransmitters get reabsorbed and still maintain their position in the synapse. Subsequently, neurotransmitters collect in the synapse, which substantially increases their concentration in this area. Notably, this further increases neurotransmitter binding to postsynaptic and presynaptic neurotransmitter receptors. Basing on the disorder or person in question, any reuptake inhibitor can dramatically affect the behavior as well as the cognition of a particular individual. More so, the binding of such inhibitors in the extracellular permeation pathway led to non-competitive inhibition of the bacterial homolog LeuT by try-cyclic antidepressants. However, depending on the competitiveness, when it comes to blocking the transmission of serotonin by the various antidepressants, it seems that in neurotransmitter transporters, they bind in an area overlapping the substrate site. Besides, there are multiple types of reuptake inhibitors, among which include SSRIs, SNRIs, as well as the NDRIs.
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