Give me medications used in psychiatric
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Psychiatric Medications (Psychotropic Drugs)
Psychiatric medications are organized into the following major classes based on their primary clinical use:
1. Antipsychotics (Neuroleptics)
Used for: schizophrenia, schizoaffective disorder, bipolar mania, psychotic depression, delirium.
First-Generation (Typical) Antipsychotics
These block D2 dopamine receptors and carry higher risk of extrapyramidal side effects (EPSEs).
| Chemical Class | Examples |
|---|---|
| Phenothiazines - Aliphatic | Chlorpromazine |
| Phenothiazines - Piperazine | Fluphenazine, Trifluoperazine, Perphenazine |
| Phenothiazines - Piperidine | Thioridazine, Pipotiazine |
| Thioxanthenes | Flupentixol (Flupenthixol), Zuclopenthixol |
| Butyrophenones | Haloperidol, Droperidol |
| Diphenylbutylpiperidines | Pimozide |
| Substituted Benzamides | Sulpiride |
Piperazine phenothiazines, butyrophenones, and thioxanthenes carry the highest EPSE risk. Piperidine phenothiazines and benzamides have the lowest EPSE risk. - The Maudsley Prescribing Guidelines, 15th Ed.
Second-Generation (Atypical) Antipsychotics
Lower risk of EPSEs at therapeutic doses; broader receptor profiles.
| Drug | Notable Features |
|---|---|
| Clozapine | Most effective for treatment-resistant schizophrenia; risk of agranulocytosis (requires WBC monitoring) |
| Olanzapine | Effective; significant metabolic side effects (weight gain, dyslipidemia, diabetes) |
| Risperidone / Paliperidone | Dose-dependent EPSEs; highest hyperprolactinemia risk among SGAs |
| Quetiapine | Very low EPSE profile; sedating; used in bipolar depression |
| Aripiprazole | Partial D2 agonist; minimal metabolic effects; can reduce hyperprolactinemia caused by other antipsychotics |
| Ziprasidone | Minimal weight gain; QTc prolongation risk |
| Amisulpride | Benzamide; prolactin-elevating |
| Lurasidone | Approved for bipolar depression; minimal metabolic effects |
| Brexpiprazole | Partial D2/D3 agonist; also approved as MDD adjunct |
| Cariprazine | D3-preferring partial agonist; approved for schizophrenia and bipolar depression |
| Lumateperone | Newer agent; minimal metabolic effects |
| Iloperidone | Some weight gain; orthostatic hypotension |
| Asenapine | Sublingual formulation available |
| Sertindole | Used in some countries; QTc risk |
2. Antidepressants
Used for: major depressive disorder (MDD), anxiety disorders, OCD, PTSD, eating disorders, chronic pain.
SSRIs (Selective Serotonin Reuptake Inhibitors)
First-line agents - best tolerability profile.
- Fluoxetine
- Sertraline
- Paroxetine
- Citalopram
- Escitalopram
- Fluvoxamine (mainly OCD)
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- Venlafaxine
- Duloxetine (also for neuropathic pain, fibromyalgia)
- Desvenlafaxine
- Milnacipran / Levomilnacipran
TCAs (Tricyclic Antidepressants)
Older agents; effective but cardiotoxic in overdose.
- Amitriptyline
- Nortriptyline
- Imipramine
- Clomipramine (first-line for OCD)
- Doxepin
- Trimipramine
- Desipramine
- Maprotiline (tetracyclic)
MAOIs (Monoamine Oxidase Inhibitors)
Require tyramine-free diet (risk of hypertensive crisis).
- Phenelzine
- Tranylcypromine
- Isocarboxazid
- Moclobemide (reversible MAOI - RIMA; safer profile)
Other / Atypical Antidepressants
| Drug | Mechanism | Notes |
|---|---|---|
| Bupropion | NRI + NDRI | Also used for smoking cessation; no sexual side effects |
| Mirtazapine | NaSSA (blocks alpha-2 + H1) | Sedating; useful with insomnia or poor appetite |
| Trazodone | SARI (5-HT2 antagonist + weak SRI) | Low-dose: sleep; higher dose: antidepressant |
| Vortioxetine | Multimodal serotonergic | Cognitive benefits in depression |
| Vilazodone | SSRI + 5-HT1A partial agonist | |
| Agomelatine | MT1/MT2 agonist + 5-HT2C antagonist | Resynchronizes circadian rhythms |
3. Mood Stabilizers
Used for: bipolar disorder (mania, mixed states, maintenance, bipolar depression), schizoaffective disorder.
Lithium
- The classic mood stabilizer for over 50 years
- Mechanism: inhibits inositol monophosphatase, modulates G proteins, inhibits GSK-3 and PKC
- Effective for mania, maintenance (especially manic episodes), and suicide prevention
- Narrow therapeutic window - requires plasma level monitoring
- Side effects: tremor, nausea, weight gain, polyuria, hypothyroidism, nephrotoxicity
- Stahl's Essential Psychopharmacology
Anticonvulsants Used as Mood Stabilizers
| Drug | Spectrum | Key Use |
|---|---|---|
| Valproate (Valproic acid / Sodium valproate) | Mania + some maintenance | Broad; teratogenic (avoid in women of childbearing age) |
| Carbamazepine | Mania + maintenance | Enzyme inducer; many drug interactions |
| Lamotrigine | Bipolar depression + maintenance | Does NOT treat acute mania; risk of Stevens-Johnson syndrome if titrated too fast |
| Oxcarbazepine | Mania (off-label) | Fewer interactions than carbamazepine |
Note: Not all anticonvulsants work as mood stabilizers - gabapentin and topiramate, for instance, are NOT proven effective for bipolar disorder. - Stahl's Essential Psychopharmacology
4. Anxiolytics and Sedative-Hypnotics
Benzodiazepines
Act on GABA-A receptors. Used for anxiety, insomnia, alcohol withdrawal, seizures, procedural sedation.
- Short-acting: Oxazepam, Lorazepam, Temazepam, Triazolam
- Intermediate-acting: Alprazolam, Clonazepam
- Long-acting: Diazepam, Chlordiazepoxide, Clonazepam, Nitrazepam, Flurazepam
Risk of tolerance, dependence, and withdrawal. Chronic use discouraged.
Non-Benzodiazepine Hypnotics ("Z-drugs")
- Zolpidem, Zaleplon, Zopiclone, Eszopiclone
Buspirone
- 5-HT1A partial agonist; non-addictive; for generalized anxiety disorder (GAD); takes weeks to work
Pregabalin / Gabapentin
- Licensed for GAD (pregabalin); also used off-label for anxiety
Beta-blockers
- Propranolol: used for performance anxiety / situational anxiety (off-label)
5. ADHD Medications
Stimulants (first-line)
- Methylphenidate (Ritalin, Concerta) - dopamine/norepinephrine reuptake inhibitor
- Amphetamine salts (Adderall, Dexedrine) - also release dopamine/norepinephrine
Non-stimulants
- Atomoxetine - selective NRI; non-controlled; also used in anxiety comorbidity
- Guanfacine - alpha-2A agonist; also for tic disorders
- Clonidine - alpha-2 agonist; especially in children with sleep issues
6. Drugs for Dementia
| Drug | Class | Indication |
|---|---|---|
| Donepezil | Acetylcholinesterase inhibitor | Mild to severe Alzheimer's |
| Rivastigmine | AChE inhibitor | Alzheimer's + Parkinson's dementia |
| Galantamine | AChE inhibitor + nicotinic modulator | Mild to moderate Alzheimer's |
| Memantine | NMDA receptor antagonist | Moderate to severe Alzheimer's |
7. Drugs for Substance Use Disorders
| Drug | Use |
|---|---|
| Disulfiram | Alcohol deterrent (causes flushing/nausea with alcohol) |
| Naltrexone | Alcohol and opioid use disorder (blocks opioid receptors) |
| Acamprosate | Alcohol maintenance (modulates GABA/glutamate) |
| Methadone | Opioid substitution therapy |
| Buprenorphine | Opioid substitution / partial agonist |
| Varenicline | Nicotine dependence (partial nicotinic receptor agonist) |
| Bupropion | Smoking cessation |
8. Other Psychiatric Medications
| Drug | Use |
|---|---|
| Clonazepam | Panic disorder, seizures, akathisia |
| Propranolol | Antipsychotic-induced akathisia, performance anxiety |
| Anticholinergics (Biperiden, Procyclidine, Benztropine) | Antipsychotic-induced EPSEs (parkinsonism, acute dystonia) |
| Ketamine / Esketamine | Treatment-resistant depression (intranasal esketamine, FDA-approved) |
| Lithium augmentation | Treatment-resistant unipolar depression |
| Melatonin / Ramelteon | Sleep disorders, circadian rhythm disturbance |
| Cyproheptadine | Antidepressant-induced sexual dysfunction, serotonin syndrome (off-label) |
Key Sources:
- The Maudsley Prescribing Guidelines in Psychiatry, 15th Ed.
- Stahl's Essential Psychopharmacology - Neuroscientific Basis
- Katzung's Basic and Clinical Pharmacology, 16th Ed.
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