DRUG THERAPY

Drug therapy is a proven effective therapeutic intervention for all mental disorders. Drugs used in psychiatry mainly belong to five classes of drugs:

Antidepressants

Antidepressants are used to treat depression and other disorders, such as obsessive compulsive disorder, anxiety disorders (e.g., generalized anxiety disorder and panic disorder) as well as to treat numerous other disorders.

Depending on their mechanism of action and their chemical structure, antidepressants are divided into the following categories:

  1. Tricyclic (Amitriptyline, Clomipramine, Doxepin, Maprotiline, Nortriptyline)
  2. Monoamine oxidase inhibitors (MAOIs: Moclobemide)
  3. Selective serotonin reuptake inhibitors (SSRIs: Fluoxetine, Fluvoxamine, Citalopram, Escitalopram, Sertraline, Paroxetine)
  4. Serotonin – Norepinephrine reuptake inhibitors (SNRIs: Venlafaxine, Duloxetine)
  5. Norepinephrine – Dopamin reuptake inhibitors (NDRI: Bupropion)
  6. Serotonin antagonist and reuptake inhibitors (SARI: Trazodone)
  7. Noradrenergic and specific serotonergic antidepressants (Nassa: Mirtazapine)

Antipsychotics

Antipsychotics are used for the treatment of psychotic disorders, such as schizophrenia, but also in the treatment of affective disorders, such as bipolar disorder and depression as well as for the treatment of obsessive compulsory disorder and other disorders.

They are divided into two categories:

a) The first generation, or typical, of which most commonly used in clinical practice are Haloperidol, Chlorpromazine, Levomepromazine, Trifluoperazine, Perphenazine and Zuclopenthixol and

b) The second generation, or atypical, antipsychotics where Amisulpride, Aripiprazole, Ziprasidone, Clozapine, Quetiapine, Olanzapine, Risperidone, Paliperidone and Sertindole belong.

Mood Stabilizers

The term “mood stabilizers” is used to describe a range of substances, such as lithium and some anticonvulsants, which are mainly used for the treatment of bipolar disorder. In this group we find:

  1. Lithium
  2. Valproic
  3. Carbamazepine
  4. Lamotrigine
  5. Gabapentin and
  6. Topiramate

Anxiolytics and Hypnotics

Anxiolytics are drugs used to relieve stress. These include Benzodiazepines and Buspirone. Hypnotics are used for sleeping success. These include Benzodiazepines, Zolpidem, Zaleplon, Zopiclone and Melatonin.

The use of anxiolytics and hypnotics should be done sparingly and only when necessary because of problems associated with the development of tolerance and dependence on these drugs. Also, discontinuation should be done gradually because of withdrawal symptoms.

The most commonly used benzodiazepines in clinical practice are:

  1. Alprazolam
  2. Lorazepam
  3. Diazepam
  4. Bromazepam
  5. Clorazepate
  6. Chlordiazepoxide
  7. Prazepam

Anti-dementia drugs

In this category of drugs, we find substances used in the treatment of dementias, mainly Alzheimer’s disease, whose main therapeutic target is the inhibition or slowing of the disease’s progression. These substances belong to two categories: a) The cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) and b) The NMDA receptor antagonists (Memantine).