Psychotherapeutic Drug Therapy

Psychotherapeutic medications produce their effects on the mind, emotions, and body by changing the chemical balance of the CNS. Most psychotherapeutic medications work by altering the activity of neurotransmitters, which are the chemical messengers carrying information between neurons, or nerve cells. The four major classes of psychotherapeutic medications are anxiolytics, antidepressants, mood stabilizers, and antipsychotics. As the nurse, you’ll administer psychotherapeutic medications and monitor their effects on your patients.

Anxiolytics are medications that reduce symptoms of anxiety such as uneasiness, fear, or panic, and are primarily used to treat anxiety disorders such as generalized anxiety disorder, or GAD; panic disorders; and trauma disorders, such as post-traumatic stress disorder, or PTSD.

Examples of anxiolytics include benzodiazepines, like alprazolam; and azapirones, like buspirone. Benzodiazepines work by increasing the activity of gamma-aminobutyric acid, which is the main inhibitory neurotransmitter in the CNS. Their effects can be felt relatively quickly, so they’re useful for episodes of acute anxiety. Common side effects include sedation and dizziness, and they have a potential for dependency with long-term use.

On the other hand, azapirones primarily bind with receptors for the neurotransmitter serotonin and can take up to 6 weeks of regular use for patients to experience symptom relief. Common side effects include dizziness, headache, and GI symptoms like nausea.

Next, there are several categories of antidepressants used to treat mood disorders such as depression and bipolar disorder. These medications mostly work by increasing the availability of certain neurotransmitters like serotonin, norepinephrine, or dopamine. Typically, antidepressants take up to 4 weeks of regular use for patients to experience symptom relief.

Now, as depressive symptoms start to improve early in therapy, antidepressants can actually increase the risk of suicidal thoughts and behavior. This could be due to improved energy and decision-making, which could allow the patient to carry out a suicide plan.

Other side effects vary based on the category of antidepressant. Tricyclic antidepressants, like doxepin, can cause dry mouth, weight gain, and sexual dysfunction. Selective serotonin reuptake inhibitors, or SSRIs, like sertraline, can cause GI distress and headache; while serotonin-norepinephrine reuptake inhibitors, or SNRIs, like duloxetine, can cause nervousness and an increase in diastolic blood pressure.