Chapter 65: Psychiatric Medications

Antidepressant medications are organized by mechanism, beginning with selective serotonin reuptake inhibitors that elevate serotonin through presynaptic reuptake blockade, followed by serotonin-norepinephrine reuptake inhibitors that target dual neurotransmitter systems, tricyclic antidepressants with anticholinergic properties requiring cardiac monitoring, and monoamine oxidase inhibitors that demand strict dietary restrictions and prolonged washout periods to prevent hypertensive emergencies. Mood stabilization relies on lithium, which requires continuous therapeutic drug monitoring within narrow ranges and careful attention to sodium and fluid balance, alongside anticonvulsant medications such as valproate, carbamazepine, and lamotrigine that provide alternatives with distinct toxicity profiles and laboratory monitoring needs. Antipsychotic classification distinguishes between typical agents that carry higher risks for extrapyramidal symptoms and neuroleptic malignant syndrome, and atypical agents associated with metabolic complications. Acute and chronic anxiety management incorporates benzodiazepines for short-term relief with dependency concerns, buspirone as a non-sedating alternative, and beta blockers for performance-related anxiety. Sedative-hypnotic medications and non-benzodiazepine sleep agents address insomnia while requiring nursing vigilance regarding fall risk and dependence potential. The chapter incorporates herbal and botanical preparations, examining their psychoactive properties and significant drug interaction risks. Nursing responsibilities encompass client education regarding alcohol interactions, driving safety, symptom monitoring, medication adherence, and recognition of adverse effects including serotonin syndrome and tardive dyskinesia, establishing the foundation for safe psychiatric medication administration and therapeutic outcomes.