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.

There are also atypical antidepressants, like bupropion, which have side effects such as agitation, decreased appetite, and weight loss.

Lastly, there are monoamine oxidase inhibitors, or MAOIs, like phenelzine. These are rarely used due to their high number of serious food and drug interactions that can cause serious reactions, like hypertensive crises.

Mood stabilizers, such as lithium, are used to treat bipolar disorder by preventing drastic shifts in mood, emotions, and energy levels.

Although the exact mechanism is unclear, it likely involves altering the metabolism of neurotransmitters like serotonin and glutamate, which is the main excitatory neurotransmitter in the CNS.

Symptom improvement is typically seen after 3 weeks of consistent use. Early in treatment, patients may experience transient side effects like mild hand tremors; muscle weakness; GI symptoms like diarrhea or constipation; thirst; and increased urination.

Lithium also has a narrow therapeutic index, meaning there’s a small difference between an effective dose and a toxic dose.

So, toxicity can manifest as a more extreme hand tremor, incoordination, blurred vision, a high volume of dilute urine, and continued GI upset.

Lastly, there are antipsychotics, which are used to treat disorders such as schizophrenia, acute mania, and organic mental illnesses, like dementia.

They alleviate psychotic symptoms like delusions and hallucinations, mostly by blocking dopamine D2 receptors. Some antipsychotics also block receptors for acetylcholine, histamine, serotonin, and norepinephrine to varying degrees, causing side effects like dry mouth, blurred vision, sedation, and orthostatic hypotension.

Antipsychotics can also cause more serious side effects, known as extrapyramidal symptoms, or EPS. EPS affect patients’ motor movements, causing akathisia, or the inability to be still; akinesia, or the absence of movement; and dystonia, or impaired muscle tone.

Left untreated, EPS can progress to tardive dyskinesia, or irreversible repeated muscle movements in the face, trunks, arms, and legs.

Now, first-generation antipsychotics, like haloperidol, are more likely to cause EPS than second-generation, or atypical, antipsychotics such as clozapine.

This could be due to clozapine’s weaker blockage of dopamine D2 receptors and strong blockage of serotonin receptors. When caring for a patient on a psychotherapeutic medication, you’ll coordinate with the registered nurse and other members of the health care team, like the psychologist or social worker, to implement your patient’s plan of care, and attend multidisciplinary care planning meetings to report on your patient’s progress.

Your care may also include gathering information, drawing laboratory specimens, administering medications, and monitoring effectiveness of treatment and for any side effects.

Finally, you’ll reinforce education with your patient and their family to promote their understanding of the medications, treatment plan, and when to notify their health care provider.

Alright, as a quick recap… Psychotherapeutic medications alter the balance of neurotransmitters in the CNS. These medications treat a wide range of mental health disorders and include anxiolytics, antidepressants, mood stabilizers, and antipsychotics.

As the nurse, you’ll administer psychotherapeutic medications and monitor their effects on your