Chapter 16: Psychotherapeutic Drugs

The foundational theories of mental disorder etiology, including the biogenic amine hypothesis, permissive hypothesis, and dopamine hypothesis, explain how dysregulation of serotonin, norepinephrine, and dopamine contributes to anxiety, depression, bipolar disorder, and psychotic conditions. The chapter systematically covers major drug classifications: anxiolytics including benzodiazepines and buspiron that reduce anxiety through central nervous system depression or serotonergic mechanisms; antidepressants encompassing tricyclic compounds, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors that elevate mood by modulating neurotransmitter availability; mood stabilizers such as lithium, valproic acid, lamotrigine, and carbamazepine that prevent mood cycling in bipolar disorder; and antipsychotics including first-generation and second-generation agents that manage psychotic symptoms through dopamine antagonism and additional receptor interactions. Critical clinical considerations include understanding black box warnings related to increased suicidality risk in young patients, recognizing serious adverse effects such as serotonin syndrome from excessive serotonergic activity, neuroleptic malignant syndrome from antipsychotic use, extrapyramidal symptoms and tardive dyskinesia affecting motor control, and metabolic complications including weight gain and glucose dysregulation. The chapter emphasizes nursing responsibilities spanning therapeutic drug monitoring, patient safety during overdose situations, comprehensive patient education regarding side effect management and medication adherence, recognition of significant drug interactions particularly with herbal supplements like Saint John's wort, and application of pharmacogenomic principles to individualize treatment selection. Integration of psychosocial interventions alongside pharmacotherapy optimizes outcomes in psychiatric care.