Advertisement

General Principles of Psychopharmacology

  • James M. Williams
  • George T. Grossberg
Chapter

Abstract

Much of psychopharmacology started as simple observations of chemical-induced improvement in psychotic and affective disorders. Once early antidepressants, antipsychotics, and mood stabilizers were discovered to have efficacy in the 1950s, considerable efforts were taken to describe the pharmacology and neurobiology of psychiatric conditions and medications. With the exponential increase in knowledge of psychotropes, clinicians have had trouble sifting through the pharmacokinetics, pharmacodynamics, indications, contraindications, side effects, interactions, dosages, and special indications for individual drugs and classes of these drugs. Despite the breadth, a basic understanding of psychotropes is necessary for patients to receive the most effective treatment while avoiding treatment-associated complications. Understanding some of the fundamentals of psychopharmacology will make drug navigation less of a task of memorization and more of an exercise in concept practice. When encountering complex patients on multiple medications, it can be comforting to consult a clinical guide for reminders of important issues such as hepatic P450 metabolic route and need for laboratory monitoring. Rather than mulling over every side effect of each individual drug, it’s helpful to remember mechanisms of action and predictable side effects from altering a neurotransmitter pathway such as adrenergic, serotonergic, cholinergic, or histaminergic neurotransmission.

Keywords

General principles of psychopharmacology Psychopharmacology general principles Neurobiology and psychopharmacology Pharmacokinetics and pharmacodynamics in psychopharmacology Drug regimens in psychopharmacology Drug interactions in psychopharmacology 

References

  1. 1.
    Peppers MP. Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease. Pharmacotherapy. 1996;16(1):49–57.PubMedGoogle Scholar
  2. 2.
    Eap CB. Personalized prescribing: a new medical model for clinical implementation of psychotropic drugs. Dialogues Clin Neurosci. 2016;18(3):313–22.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Schatzberg AF, Nemeroff CB. The American psychiatric publishing textbook of psychopharmacology. 4th ed. Arlington: American Psychiatric Publishing; 2009.Google Scholar
  4. 4.
    Miceli JJ, Glue P, Alderman J, Wilner K. The effect of food on the absorption of oral ziprasidone. Psychopharmacol Bull. 2007;40(3):58–68.PubMedGoogle Scholar
  5. 5.
    Holm R, Müllertz A, Mu H. Bile salts and their importance for drug absorption. Int J Pharm. 2013;453(1):44–55.  https://doi.org/10.1016/j.ijpharm.2013.04.003.CrossRefPubMedGoogle Scholar
  6. 6.
    Meissner W, Leyendecker P, Mueller-Lissner S, et al. A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain. 2009;13(1):56–64.CrossRefPubMedGoogle Scholar
  7. 7.
    DeVane CL. Clinical significance of drug binding, protein binding, and binding displacement drug interactions. Psychopharmacol Bull. 2002;36:5–21.PubMedGoogle Scholar
  8. 8.
    Mrazek DA. Psychiatric pharmacogenomic testing in clinical practice. Dialogues Clin Neurosci. 2010;12(1):69–76.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Zhou SF. Drugs behave as substrates, inhibitors and inducers of human cytochrome P450 3A4. Curr Drug Metab. 2008;9:310–22.  https://doi.org/10.2174/138920008784220664.CrossRefPubMedGoogle Scholar
  10. 10.
    Aronson JK. Meyler’s side effects of psychiatric drugs. 1st ed. Amsterdam: Elsevier Science; 2009.Google Scholar
  11. 11.
    Zhornitsky S, Potvin S, Moteshafi H, et al. Dose-response and comparative efficacy and tolerability of quetiapine across psychiatric disorders: a systematic review of the placebo-controlled monotherapy and add-on trials. Int Clin Psychopharmacol. 2011;26:183–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Aymanns C, Keller F, Maus S, Hartmann B, Czock D. Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol. 2010;5(2):314–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Mitchell PB. Therapeutic drug monitoring of psychotropic medications. Br J Clin Pharmacol. 2000;49(4):303–12.  https://doi.org/10.1046/j.1365-2125.2000.00174.x.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Aust Prescr. 2015;38(5):152–5.  https://doi.org/10.18773/austprescr.2015.055.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Neuvonen PJ, Kivistö K, Hirvisalo EL. Effects of resins and activated charcoal on the absorption of digoxin, carbamazepine and frusemide. Br J Clin Pharmacol. 1988;25(2):229–33.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ciociola AA, Cohen LB, Kulkarni P, Gastroenterology FD-RMCotACo. How drugs are developed and approved by the FDA: current process and future directions. Am J Gastroenterol. 2014;109(5):620–3.  https://doi.org/10.1038/ajg.2013.407.CrossRefPubMedGoogle Scholar
  17. 17.
    Ratner M. Pfizer settles largest ever fraud suit for off-label promotion. Nat Biotechnol. 2009;27(11):961–2.CrossRefPubMedGoogle Scholar
  18. 18.
    Radley DC, Finkelstein SN, Stafford RS. Off-label prescribing among off-based physicians. Arch Intern Med. 2006;166(9):1021–6.  https://doi.org/10.1001/archinte.166.9.1021.CrossRefPubMedGoogle Scholar
  19. 19.
    Stafford RS. Regulating off-label drug use – rethinking the role of the FDA. N Engl J Med. 2008;358:1427–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Wittich CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc. 2012;87(10):982–90.  https://doi.org/10.1016/j.mayocp.2012.04.017.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gabay M. The federal controlled substances act: schedules and pharmacy registration. Hosp Pharm. 2013;48(6):473–4.  https://doi.org/10.1310/hpj4806-473.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Lieberman JA. Managing anticholinergic side effects. Prim Care Companion J Clin Psychiatry. 2004;6(suppl 2):20–3.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Freedman R, Coon H, Myles-Worsley M, Orr-Urtreger A, Olincy A, Davis A, et al. Linkage of a neurophysiological deficit in schizophrenia to a chromosome 15 locus. Proc Natl Acad Sci USA. 1997;94(2):587–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Cottingham C, Wang Q. α2 adrenergic receptor dysregulation in depressive disorders: implications for the neurobiology of depression and antidepressant therapy. Neurosci Biobehav Rev. 2012;36:2214–25.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Pessiglione M, Seymour B, Flandin G, et al. Dopamine-dependent prediction errors underpin reward-seeking behaviour in humans. Nature. 2006;442(7106):1042–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Livingstone C, Rampes H. Lithium: a review of its metabolic adverse effects. J Psychopharmacol. 2006;20(3):347–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Bella AJ, Shamloul R. Psychotropics and sexual dysfunction. Cent Eur J Urol. 2013;66:466–71.Google Scholar
  28. 28.
    Caroff SN, Hurford I, Lybrand J, Campbell EC. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurol Clin. 2011;29(1):127–viii.  https://doi.org/10.1016/j.ncl.2010.10.002.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Wenzel-Seifert K, Wittmann M, Haen E. QTc prolongation by psychotropic drugs and the risk of torsade de pointes. Dtsch Arztebl Int. 2011;108(41):687–93.  https://doi.org/10.3238/arztebl.2011.0687.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Gadde KM, Parker CB, Maner LG, Wagner HR 2nd, Logue EJ, Drezner MK, et al. Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women. Obes Res. 2001;9:544–51.CrossRefPubMedGoogle Scholar
  31. 31.
    Jacob S, Spinler SA. Hyponatremia associated with selective serotonin-reuptake inhibitors in older adults. Ann Pharmacother. 2006;40:1618–22.CrossRefPubMedGoogle Scholar
  32. 32.
    Leth-Møller KB, Hansen AH, Torstensson M, Andersen SE, Ødum L, Gislasson G, et al. Antidepressants and the risk of hyponatremia: a Danish register-based population study. BMJ Open. 2016;6(5):e011200.  https://doi.org/10.1136/bmjopen-2016-011200.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Sayyah M, Eslami K, AlaiShehni S, Kouti L. Cognitive function before and during treatment with selective serotonin reuptake inhibitors in patients with depression or obsessive-compulsive disorder. Psychiatry J. 2016;2016:5480391.  https://doi.org/10.1155/2016/5480391.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Hill SK, Bishop JR, Palumbo D, Sweeney JA. Effect of second-generation antipsychotics on cognition: current issues and future challenges. Expert Rev Neurother. 2010;10(1):43–57.  https://doi.org/10.1586/ern.09.143.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Newcomer JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19(Suppl 1):1–93.PubMedGoogle Scholar
  36. 36.
    Creed F. How do SSRIs help patients with irritable bowel syndrome? Gut. 2006;55(8):1065–7.  https://doi.org/10.1136/gut.2005.086348.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Parveen S, Javed MA. Stevens Johnson syndrome associated with lamotrigine. Pak J Med Sci. 2013;29(6):1450–2.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Herstowska M, Komorowska O, Cubała WJ, Jakuszkowiak-Wojten K, Gałuszko-Węgielnik M, Landowski J. Severe skin complications in patients treated with antidepressants: a literature review. Adv Dermatol Allergol/Postȩpy Dermatologii I Alergologii. 2014;31(2):92–7.  https://doi.org/10.5114/pdia.2014.40930.CrossRefGoogle Scholar
  39. 39.
    Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms. Ther Adv Psychopharmacol. 2015;5(6):357–68.  https://doi.org/10.1177/2045125315612334.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Howland RH. Potential adverse effects of discontinuing psychotropic drugs. Part 3: antipsychotic, dopaminergic, and mood-stabilizing drugs. J Psychocsoc Nurs Ment Health Serv. 2010;48(8):11–4.CrossRefGoogle Scholar
  41. 41.
    Howland RH. Potential adverse effects of discontinuing psychotropic drugs. Part 2: antidepressant drugs. J Psychocsoc Nurs Ment Health Serv. 2010;48(7):9–12.CrossRefGoogle Scholar
  42. 42.
    Vitale SG, Laganà AS, Muscatello MR, La Rosa VL, Currò V, Pandolfo G, Zoccali RA, Bruno A. Psychopharmacotherapy in pregnancy and breastfeeding. Obstet Gynecol Surv. 2016;71(12):721–33.  https://doi.org/10.1097/OGX.0000000000000369.CrossRefPubMedGoogle Scholar
  43. 43.
    Diav-Citrin O, Shechtman S, Ornoy S, et al. Safety of haloperidol and penfluridol in pregnancy: a multicenter, prospective, controlled study. J Clin Psychiatry. 2005;66:317–22.CrossRefPubMedGoogle Scholar
  44. 44.
    Reis M, Källén B. Maternal use of antipsychotics in early pregnancy and delivery outcome. J Clin Psychopharmacol. 2008;28:279–88.CrossRefPubMedGoogle Scholar
  45. 45.
    Einarson A, Boskovich R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract. 2009;15:183–92.CrossRefPubMedGoogle Scholar
  46. 46.
    Coughlin CG, Blackwell KA, Bartley C, et al. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy. Obstet Gynecol. 2015;125:1224–35.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Kulkarni J, Worsley R, Gilbert H, et al. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies. PLoS One. 2014;9:e94788.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Ban L, Gibson JE, West J, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG. 2014;121:1471–81.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Ward RK, Zamorski MA. Benefits and risks of psychiatric medications during pregnancy. Am Fam Physician. 2002;66:629–36.PubMedGoogle Scholar
  50. 50.
    Enato E, Moretti M, Koren G. The fetal safety of benzodiazepines: an updated meta-analysis. J Obstet Gynaecol Can. 2011;33:46–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NBF, Machado S. Psychotropic drugs and liver disease: a critical review of pharmacokinetics and liver toxicity. World J Gastrointest Pharmacol Ther. 2017;8(1):26–38.  https://doi.org/10.4292/wjgpt.v8.i1.26.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Reddy DS, Reddy MS. Serum lithium levels: ideal time for sample collection! Are we doing it right? Indian J Psychol Med. 2014;36(3):346–7.  https://doi.org/10.4103/0253-7176.135399.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Chohan PS, Mittal R, Javed A. Antipsychotic medication and QT prolongation. Pak J Med Sci. 2015;31(5):1269–71.  https://doi.org/10.12669/pjms.315.8998.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.St. Louis University School of MedicineSt. LouisUSA
  2. 2.Division of Geriatric Psychiatry, Department of Psychiatry & Behavioral NeuroscienceSt. Louis University School of MedicineSt. LouisUSA

Personalised recommendations