Psychotropic Drugs Daniel Ishaku

PSYCHOTROPIC
DRUGS
ISHAKU DANIEL – II MSW
DEPARTMENT OF SOCIAL WORK
MADRAS CHISTIAN COLLEGE
MENTAL HEALTH & SOCIAL WORK
http://www.free-powerpoint-templates-design.com

CONTENTS
01
02
03
04
05
Introduction to Psychotropic Drugs
PSYCHOTROPIC DRUGS
A brief history of treatment in Psychiatry
HISTORY
The different Classification of
Psychotropic Drugs
CLASSIFICATION
An Ideal Psychotropic Drug
CHARACTERISTICS
List of references cited in presentation
REFERENCES

INTRODUCTION
TO PSYCHOTROPIC DRUGS

DEFINITION PSYCHOTROPIC DRUGS
Psychotropic drugs are a loosely
defined grouping of agents that
have effects on psychological
function and include antidepressants,
hallucinogens, and tranquilizers.
They are compounds that affect the
functioning of the mind through
pharmacological action on the central
nervous system.
- International Encyclopedia of the Social Sciences

Psychotropic drugs are prescribed to treat a variety of
mental health issues when those issues cause
significant impairment to healthy
functioning.
Psychotropic drugs typically work by changing or
balancing the amount of important chemicals in
the brain called neurotransmitters.

HISTORY OF PSYCHOPHARMACOLOGY
4000 BC 1853 1882 1903
Sympathy and Kindness.
Dhatura and Roots of
Serpentina Plant mixed
with oil (ghee).
AYURVEDA
Used for sedation.
Phenobarbital introduced
in 1912.
BARBITURATES
Paraldehyde used as a
hypnotic.
HYPNOTIC
Bromide used as a
sedative-hypnotic
SEDATIVES

1917 1922 1927 1931
Malarial treatment for
General Paralysis of the
Insane (GPI) received a
Nobel prize (Julius von
Wagner Jauregg).
First report of successful
treatment of psychoses
(Ganesh Sen and Kartik
Bose from India);
RESERPINE
Insulin-shock treatment
introduced for
schizophrenia.
MANFRED SAKEL
Barbiturate-induced
coma introduced for the
treatment of psychoses.
JACOB KLAESI

1936 1937 1938 1949
Lithium used in mania
(John F Cade); did not
receive much attention
even in Australia.
LITHIUM
ELECTROCONVULSIVE
THERAPY used for the
treatment of psychoses
(Ugo Cerletti and Lucio
Bini).
Amphetamines used in
the treatment of
behaviour disorders of
children (C Bradley).
AMPHETAMINES
Frontal lobotomy for
treatment of psychiatric
disorders (Egas Moniz and
Almenda Lima).
LOBOTOMY

ELECTRO-CONVULSIVE THERAPY (ECT)
involves a brief electrical stimulation of the
brain while the patient is under anesthesia.
LOBOTOMY
A surgical operation involving incision into
the prefrontal lobe of the brain, formerly
used to treat mental illness.

1955 1958 1958 1960
Chlordiazepoxide used
as an anti-anxiety agent
in (Sternbach;
CHLORDIAZEPOXIDE
HALOPERIDOL
synthesised in
Belgium (Janssen).
Tricyclic antidepressant
(TCA) for treatment of
depression (Thomas
Kuhn).
IMIPRAMINE
Meprobamate was
introduced as an anti-
anxiety agent.
MEPROBAMATE

1952
The revolution in
psychopharmacology came with
introduction of
CHLORPROMAZINE
(Jean Delay & Pierre Deniker).
(schizophrenia & manic-depression )
The number of admissions in mental
hospitals had a sudden decrease
after introduction of chlorpromazine.

RECENTLY
1967
|
Clomipramine used in OCD
(Fernandez and Lopez-Ibor).
|
1990s
|
RISPERIDONE
Second Generation Antipsychotics
introduced in market.

SOCIAL IMPACT
Reduced the
stigma surrounding
mental Illness &
increased the
psychiatric drugs
market
Also, Useful in the interrogation of suspects (CIA). E.g. Sodium Pentothal,
more commonly known as Truth Serum

CHARACTERISTICS
OF PSYCHOTROPIC DRUGS

CHARACTERISTICS
of an ideal psychotropic drug (modiﬁed after Hollister, 1983)
It should cure the underlying
pathology causing the
disorder or symptom(s) under
focus, so that the drug can be
stopped after sometime.
It should have no
side-effects or toxicity in the
therapeutic range.
It should beneﬁt all the
patients suffering from that
disorder.
It should have rapid onset
of action

CHARACTERISTICS
of an ideal psychotropic drug (modiﬁed after Hollister, 1983)
There should be no tolerance
to the drug so that same dose
is effective for long duration of
time.
It should not be lethal in
overdoses.
There should be no
tolerance to the drug so
that same dose is effective
for long duration of time.
There should be no
dependence on the drug and
no withdrawal symptoms on
stopping the drug.
It can be given in both inpatient
and out patient settings.

CLASSIFICATION

CLASSIFICATION
ANTIPSYCHOTICS
ANTIDEPRESSANTS
ANTIANXIETY/ANTIPANIC
STIMULANTS
MOOD STABILIZERS
Treatment of psychotic
issues such as schizophrenia.
Used for treating depression
Chronic and Acute Anxiety
Generalized Anxiety to Panic Attacks
Attention-Deficit Hyperactivity
(ADHD).
Bipolar, Schizophrenia, or
Borderline Personality.

CLASSIFICATION
ANTIPARKINSONIAN
DRUGS
ANTICONVULSANTS
ALCOHOL & DRUGS OF
DEPENDENCE
Agents used in the treatment of
Parkinson's disease.
Agents used in the treatment of
epileptic seizures.
Chronic and Acute Anxiety
Generalized Anxiety to Panic Attacks

ANTIPSYCHOTICS
treatment of psychotic disorders and psychotic symptoms
These are also known as Major Tranquilizers, Neuroleptics,
Ataractics, Anti-schizophrenic Drugs and D2-RECEPTOR
( dopamine receptor) Blockers.
There are two types of Antipsychotic Drugs.
1. TYPICAL ANTIPSYCHOTICS
2. ATYPICAL ANTIPSYCHOTICS

ANTIPSYCHOTICS
TYPICAL ANTIPSYCHOTICS
Also known as First Generation Anti-psychotic Drugs,
typical, or conventional, antipsychotics were first developed
in the 1950s. Useful in the treatment of severe psychosis
and behavioral problems when newer medications are
ineffective.
However, these medications do have a high risk of side
effects, some of which are quite severe.

ANTIPSYCHOTICS
ATYPICAL ANTIPSYCHOTICS
Second Generation Antipsychotic Drugs approved
for use in the 1990s.
Less likely to produce extrapyramidal effects (physical
symptoms such as tremors, paranoia, anxiety, dystonia,
etc. as a result of improper doses or adverse reactions
to this class of drug)

ANTIPSYCHOTICS
Used to treat the following conditions:
ORGANIC PSYCHIATRIC DISORDERS
1. Delirium (in small doses; e.g.
haloperidol, risperidone)
2. Dementia (careful and
considered use for psychotic
features, and severe agitation)
3. Delirium Tremens (&
psychoses occurring in drug
and alcohol withdrawal states;
e.g. haloperidol, risperidone)
4. Drug induced psychosis (e.g.
haloperidol in amphetamine-induced
psychosis)
5. Other Organic Mental Disorders
(e.g. organic hallucinosis; o rganic
delusional disorder; secondary
mania)

ANTIPSYCHOTICS
NON-ORGANIC PSYCHOTIC DISORDERS
1. Schizophrenia
2. Schizo-affective disorder
3. Acute psychoses
4. Mania (with or without
mood stabilisers)
5. Maintenance treatment of
Bipolar Disorders (e.g.
olanzapine, quetiapine)
6. Major depression (for psychotic
features, a gitat ion, and m
elancholic features; along with
antidepressants)
7. Delusional disorders

ANTIPSYCHOTICS
NEUROTIC AND OTHER PSYCHIATRIC DISORDERS
1. Severe, intractable, and
disabling anxiety (rarely
used and not
recommended)
2. Treatment refractory
obsessive compulsive
disorder (as an adjunct)
3. Anorexia nervosa (rarely used
and not widely recommended)

ANTIPSYCHOTICS
MEDICAL DISORDERS
1. 1. Huntington’s chorea
(e.g. haloperidol)
2. Intractable hiccups (e.g.
chlorpromazine in low
doses) (rarely used)
3. Nausea and vomiting (rarely, in
low doses); ondansetron, an
anti-emetic drug, is a weak
antipsychotic
4. Tic disorders, e.g. Gilles de la
Tourette syndrome (e.g.
haloperidol, risperidone)

SIDE EFFECTS
The antipsychotics are safe drugs with a high therapeutic index and
wide margin of safety in routine clinical dosages

ANTIDEPRESSANTS
Used for treatment of Depressive Disorders
These are also called as Mood-Elevators and Thymoleptics
The ﬁrst tricyclic antidepressant (TCA) imipramine was used in 1958
by Thomas Kuhn.
DEPRESSION
1. Depressive episode (also called major depression, endogenous
depression)
2. Depressive episode with melancholia (with or without ECTs)
3. Depressive episode with psychotic features (with antipsychotics
or ECTs)

ANTIDEPRESSANTS
DEPRESSION
4. Dysthymia (with psycho
therapy)
5. Reactive depression (with
psychotherapy)
6. Depressive equivalents
and masked depression
(sometimes)
7. Atypical depression (e.g.
MAO inhibitors)
8. Secondary depression (e.g. in
hypothyroidism, Cushing’s
syndrome)
9. Abnormal grief reaction

ANTIDEPRESSANTS
CHILD PSYCHIATRIC DISORDERS
1. Enuresis (with or without
behaviour therapy)
2. ATTENTION DEﬁCIT
DISORDER with Hyper
Activity (in low doses,
after 6 years of age, when
stimulant medication is not
available)
3. School phobia (sometimes, in
low doses)
4. Separation anxiety disorder (in
children)
5. Somnambulism
6. Night terrors

ANTIDEPRESSANTS
OTHER PSYCHIATRIC DISORDERS
1. Panic attacks (e.g. SSRIs)
2. Agoraphobia and social
phobia
3. Obsessive Compulsive
Disorder with or without
depression (e.g.
clomipramine, SSRIs)
4. Cataplexy (associated with
narcolepsy)
5. Aggression in elderly (e.g.
trazodone)
6. Eating disorders (e.g. ﬂuoxetine
in Bulimia Nervosa)
7. Borderline Personality Disorder
(for treatment of depressive
symptoms)

ANTIDEPRESSANTS
OTHER PSYCHIATRIC DISORDERS
8. Trichotillomania (e.g.
clomipramine; ﬂuoxetine)
9. Depersonalization
syndrome
10. Post-traumatic Stress
Disorder (PTSD)
11. Generalized anxiety
disorder (e.g. SSRIs)
12. Nicotine dependence (e.g.
bupropion is used for treatment of
craving)
13. Alcohol dependence (e.g.
ﬂuoxetine sometimes used for
treatment of craving)

Chronic and Acute Anxiety. Generalized Anxiety to Panic Attacks
Also known as Minor Tranquilizers and Anxiolytics, can be classiﬁed
as follows:
BARBITURATES
Barbiturates can be divided into four main types:
1. Long Acting
The duration of action is more than 8 hours.
Examples include phenobarbital.

2. Intermediate Acting
The duration of action is 5-8 hours. Examples include amobarbital and
pentobarbital.
3. Short Acting
The duration of action is 1-5 hours. Examples include secobarbital.
4. Ultra-Short Acting
The duration of action is less than 1 hour. Examples include
thiopentone and methohexital.

SIDE EFFECTS OF BARBITURATES
Barbiturates are no longer used or recommended as anti-anxiety
agents. They produce multiple side effects such as:
- excessive sedation
- respiratory and circulatory depression,
- Hepatic Enzyme induction,
- dependence,
- withdrawal symptoms and potential for use in suicide.

NON-BARBITURATE, NON-BENZODIAZEPINE ANTI-ANXIETY AGENTS
These can be further divided into the following categories:
CARBAMATES
The common examples are meprobamate, tybamate and
carisoprodol. These are not used commonly due to the potential for
abuse and dependence.
PIPERIDINEDIONES
An example is glutethimide. This drug too is not used now-a-days due
to its dependence potential.

CATEGORIES OF NON-BARBITURATE, NON-BENZODIAZEPINE
ANTI-ANXIETY AGENTS
ALCOHOLS
The examples include ethanol, chloral hydrate and ethchlorvynol.
These drugs are highly dependence producing and clearly not
recommended.
QUINAZOLINE DERIVATIVES
An example is Methaqualone. Methaqual one had become a street
drug (i.e. a drug of abuse) and its use was discontinued as an anti-
anxiety agent and a hypnotic.

ANTI-ANXIETY AGENTS
ANTI-HISTAMINICS
The common examples include diphenhydramine, hydroxyzine and
promethazine. In past, diphenhydramine was usually combined with
methaqualone or diazepam. They may be used as hypnotic-sedatives,
but their use as anti-anxiety agents is minimal and probably not safe.
CYCLIC ETHERS
An example is Paraldehyde. It is not used commonly as it is not very
effective and is also dependence producing.

ANTI-ANXIETY AGENTS
OTHERS
Antipsychotics (such As Thioridazine, ﬂupentixol, Olanzapine,
Quetiapine) and Anti Depressants (such as Doxepine) have
sometimes been used for the treatment of severe, intractable anxiety.

BENZODIAZEPINES
Since the discovery of CHLORDIAZEPOXIDE in 1957 by Sternbach,
Benzodiazepines have replaced other antianxiety drugs and hypnotics
are now gradually becoming drugs of ﬁrst choice in management of
anxiety disorders.

INDICATIONS
1. Generalized anxiety
disorder; adjustment
disorder with anxious
mood (Short-term use)
2. Panic disorder,
Agoraphobia, and School
phobia (particularly
Alprazolam and
Clonazepam; along with
Antidepressants) .
3. Agitated Depression
(short-term use, along
with antidepressants, for
ﬁrst 1-2 weeks)
4. Short-term treatment of
insomnia

5. Stage 4 NREM-sleep
Disorders such as enuresis,
somnambulism ( diazepam
reduces duration of Stage 4
NREM-sleep)
6. Nightmares (diazepam also
reduces the REM-sleep
duration).
7. Pre-medication in
Anaesthesia (intravenous
lorazepam, midazolam, or
diazepam)
8. Anticonvulsant use (drugs
of choice for status
epilepticus, myoclonic
seizures and certain infantile
spasms)

9. To produce skeletal muscle
relaxation (e.g. in tetanus,
cerebral palsy)
10. Treatment of alcohol and
other drug withdrawal
syndromes
11. For minor surgical,
endoscopic or obstetric
procedures
12. Acute mania (lorazepam,
usually with lithium or atypical
antipsychotics).
13. Antipsychotic-induced
Akathisia
14. Narcoanalysis or
abreaction (IV diazepam)

MOOD STABILISERS
Drugs used in Prophylaxis of Bipolar Disorder
These drugs are usually effective in treatment of mania and therefore
the word antimanic is often used to describe them. They are also
called mood-stabilising agent or a prophylactic agents.
The most commonly used mood-stabilising agents include
1. Lithium
2. Valproate
3. Carbamazepine,
4. Lamotrigine,
Though there are several other experimental mood stabilisers such as
Oxcarbaze Pine.

MOOD STABILISERS
LITHIUM
1. Treatment of acute mania
2. Prophylaxis of bipolar
mood disorder.
3. Treatment of schizo-
affective disorder
4. Prophylaxis of unipolar
mood disorder
5. Treatment of Cyclothymia
6. Treatment of acute depression
(as an adjuvant for refractory
depression)
7. Treatment of chronic alcoholism
and psychoactive use disorders
(e.g. cocaine dependence)
8. Treatment of Kleine-Levin
syndrome.

MOOD STABILISERS
VALPROATE
Bipolar Disorders
Acute Mania (as a ﬁrst-line
agent for the treatment of
acute mania in oral and IV
forms)
a. Co-morbid substance abuse or
other psychiatric disorders
b. Later age at onset and/or shorter
duration of illness
c. History of poor response to
lithium

MOOD STABILISERS
CARBAMAZEPINE
1. Seizures
i. Complex Partial Seizures
(CPS)
ii. Generalised Tonic Clonic
seizures
iii. Alcohol withdrawal seizures
( rum ﬁts), if persistent (also
used sometimes for
treatment of simple alcohol
withdrawal syndrome)
2. Psychiatric disorders
i. Bipolar mood disorder
(especially for rapid cyclers;
lithium-refractory patients;
ii. Impulse Control Disorder and
aggression (in some cases)
iii. Psychosis (especially mania)
with epilepsy

REFERENCES
Note: The presenter does not own any of the content used.
1. Niraj Ahuja, A short Textbook of Psychiatry (2011), Retrieved on 19th September, 2019
2. Gabbard, G. (August, 2000). A neurobiologically informed perspective on psychotherapy. Retrieved
from http://bjp.rcpsych.org/content/177/2/117.abstract.
3. Grohol, J. M. (2013). Top 25 psychiatric prescriptions for 2013. Retrieved from
http://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013.
4. Mayo Clinic. (n.d.). Depression (major depression). Retrieved from
http://www.mayoclinic.com/health/antidepressants/MH00071.
5. Mental disorders affect one in four people. (2001, October 4). Retrieved from http://www.who.int/w
hr/2001/media_centre/press_release/en.
6. National Institute on Drug Abuse. (n.d.). InfoFacts: Stimulant ADHD medications - methylphenidate
and amphetamines.Retrieved from
http://www.drugabuse.gov/publications/infofacts/stimulant-adhd-medications-methylphenidate-amp
hetamines.
7. National Institute of Mental Health. (n.d.). Mental health medications. Retrieved from
http://www.nimh.nih.gov/health/publications/mental-health-medications/compelte-index.shtml#pub8
8. Seligman, M. (1995, December). The effectiveness of psychotherapy: The consumer reports study
Retrieved from http://horan.asu.edu/cpy702readings/seligman/seligman.html.

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