Chapter 69: Psychotherapeutic Medications

Antidepressants represent the primary intervention for mood and anxiety disorders, with selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors blocking monoamine reuptake to elevate mood; however, these agents carry risks including serotonin syndrome when combined with monoamine oxidase inhibitors and require monitoring for suicidal ideation during early treatment phases. Tricyclic antidepressants and monoamine oxidase inhibitors offer alternative mechanisms but present significant side effects including anticholinergic effects and hypertensive crises respectively, necessitating careful baseline assessment and dietary restriction. Lithium functions as a mood stabilizer for bipolar disorder within a narrow therapeutic window, demanding precise serum level monitoring and maintenance of fluid and electrolyte balance to prevent toxicity ranging from mild tremor to life-threatening seizures. Benzodiazepines and sedative-hypnotic medications manage acute anxiety and insomnia through central nervous system depression via gamma-aminobutyric acid potentiation, though discontinuation must occur gradually to prevent withdrawal seizures. Antipsychotic medications address psychotic symptoms through dopamine antagonism, with typical agents targeting positive symptoms and atypical agents better addressing negative symptoms, yet both classes risk extrapyramidal syndrome and the potentially fatal neuroleptic malignant syndrome. Substance use disorder treatment utilizes medication-assisted approaches including benzodiazepines for alcohol withdrawal management, methadone and buprenorphine for opioid dependence, and disulfiram for alcohol aversion therapy. Finally, attention-deficit hyperactivity disorder responds to central nervous system stimulants while cognitive decline in Alzheimer's disease benefits from acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists depending on disease stage.