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Psychiatric drugs

Drugs used in psychiatry fall into four basic categories:

1. Anti-anxiety
2. Sleep-inducing
3. Antipsychotic
4. Antidepressant

Note: A given medication (the 'generic' form) may be marketed under different registered brand names. In the following text and tables, generic pharmaceutical names are italicised, and brand names are in bold type with the registered trade mark symbol '®' attached.

Categories 1 and 2 above:

Both anti-anxiety and sleeping tablets are listed in 'the Pams' area of the medication section. Note that barbiturates such as Amylobarbitone® are now rarely prescribed. Barbiturate overdose slows respiration and can cause death.

Category 3 above:

The antipsychotics are available either as tablets or as long-acting injections. They are used to treat the symptoms of psychosis, such as delusions and hallucination's. Although two to three weeks are required for these drugs to take effect, there is an initial calming effect (similar to benzodiazepines but with some unpleasant side effects).

Long-acting antipsychotic injections:

Modecate® fluphenazine decanoate, Haldol® haloperidol decanoate, and Fluanxol® flupenthixol decanoate. These release the drug's effect slowly over a period of 2 to 3 weeks from beneath the skin at the injection site. The advantage is that the sufferer doesn't have to remember to take tablets 3 to 4 times a day.

Antipsychotic tablets:

Largactil® chlorpromazine, Melleril® thioridazine, Stelazine® trifluperazine, Orap® pimozide, Serenace® haloperidol, Navane® thiothixene, Risperdal® risperidone. These may cause dizziness.

Main side effects of the antipsychotics are:

• Muscle stiffness.
• Unpleasant muscular restlessness that causes the sufferer to keep moving around (for instance walking up and down).
• A noticeable shake, particularly shaking of the hands.

These side effects can be controlled by either:

• Reduction in dosage; or
• A side effect tablet, such as Cogentin® or Artane®. The latter are sometimes abused, resulting in hallucinations and euphoria.

Other side effects of antipsychotic drugs may include excess salivation; a dry mouth; constipation; sleepiness; dizziness; sexual problems; and, with Largactil®, sun sensitivity (requiring use of a sun block cream). Some or all of these side effects may be distressing. Sufferers should be reassured that their doctor will do everything possible to minimise any unpleasant feelings. Such reassurance will help the sufferer to comply with their medication advice.

A very long term side effect (which may take years to appear and which may become permanent) is 'tardive dyskinesia', where the sufferer has odd facial and chewing movements. Sometimes the limbs are also affected. Such actions look distressing but usually do not seem to bother the sufferer.

Category 4 above:

Antidepressant drugs play an important part in the management of depression. The specific types and their names are listed and described on page 115. Newer, less toxic antiserotonin types include Prozac® fluoxetine, Aropax 20® paroxetine, and Zoloft® sertraline.

These medications take 2 to 3 weeks to begin to work. The side effects (such as sleepiness, dry mouth, loss of libido, constipation and dizziness) differ between types, as does the way they work. Nardil® phenelzine requires a special diet. They are all dangerous in overdosage, although the newer drugs are less dangerous.

Lithium carbonate and Tegretol® carbam-azepine are used with manic depression, and stabilise severe mood swings. Severe side effects occur, and regular blood test monitoring (especially with lithium treatment) is essential.