What medications are used to treat schizophrenia, mania, depression, and bipolar anxiety?

Medications for Schizophrenia, Mania, Depression, Bipolar Disorder, and Anxiety

The most effective approach to learning psychiatric medications is to organize them by drug class, mechanism of action, and primary indications, focusing on FDA-approved medications first and understanding their efficacy for specific symptoms and disorders.

Antipsychotics

First-Generation (Typical) Antipsychotics

• Primary uses: Schizophrenia, acute mania, psychotic symptoms
• Examples: Haloperidol, Fluphenazine, Thiothixene
• Cautions: High risk of extrapyramidal symptoms, tardive dyskinesia (50% risk after 2 years in elderly patients) 1
• Monitoring: Movement disorders, cardiovascular effects

Second-Generation (Atypical) Antipsychotics

• Primary uses: Schizophrenia, bipolar disorder (manic/mixed episodes), treatment-resistant depression (some agents)
• Examples:
  • Olanzapine: FDA-approved for schizophrenia, bipolar I disorder; can be combined with fluoxetine for bipolar depression 2, 3
  • Risperidone: Effective at low doses (0.25-3mg daily) for psychotic symptoms 1
  • Quetiapine: More sedating; useful for sleep disturbances in bipolar disorder 1
  • Aripiprazole: Preferred due to lower risk of weight gain and metabolic effects 4
• Advantages over typical antipsychotics: Fewer extrapyramidal symptoms, lower risk of tardive dyskinesia, improved cognition, possible decrease in suicidality 3
• Side effects: Weight gain (especially with olanzapine and clozapine), sedation, metabolic changes 3

Mood Stabilizers

Lithium

• Primary uses: Acute mania, maintenance therapy in bipolar disorder (FDA-approved for ages 12+) 4
• Monitoring: Serum levels, thyroid function, renal function
• Note: Lithium monotherapy for bipolar disorder has declined from 84% to 43% over time, with increased use of combination therapies 5

Anticonvulsants as Mood Stabilizers

• Valproate (Divalproex sodium):

  • FDA-approved for acute mania in adults 4
  • Initial dose: 125mg twice daily; titrate to therapeutic level (40-90 mcg/mL) 1
  • Monitoring: Liver enzymes, platelets, coagulation studies

• Carbamazepine:

  • FDA-approved for acute mania in adults 4
  • Initial dose: 100mg twice daily; titrate to therapeutic level (4-8 mcg/mL) 1
  • Monitoring: CBC, liver enzymes

• Lamotrigine:

  • Preferred for bipolar II depression due to efficacy and metabolically neutral profile 4

Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Primary uses: Depression, anxiety disorders
• Examples: Fluoxetine, Paroxetine, Citalopram/Escitalopram
• Caution: Should only be used with mood stabilizers in bipolar disorder to prevent triggering mania 4
• Note: Fluoxetine is FDA-approved for depression in children/adolescents aged 8+ years 1

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Primary uses: Depression, anxiety disorders
• Examples: Venlafaxine, Desvenlafaxine, Duloxetine
• Mechanism: Inhibit presynaptic reuptake of both serotonin and norepinephrine 1
• Note: Duloxetine is FDA-approved for generalized anxiety disorder in children/adolescents 7+ years 1

Anxiolytics

Benzodiazepines

• Caution: Should be avoided or used very short-term in bipolar disorder due to risks of dependency, tolerance, and potential mood destabilization 4

Alternative Anxiolytics for Psychiatric Disorders

• Gabapentin: Useful for comorbid restless leg syndrome and anxiety 4
• Pregabalin: Shows promise for anxiety in schizophrenia 6
• Trazodone: Used for sleep and anxiety (initial dose 25mg, max 200-400mg daily) 1

Effective Combination Strategies

1. For Bipolar Disorder:

   • Antipsychotic + Mood Stabilizer combinations (e.g., Aripiprazole + Lamotrigine or Olanzapine + Valproate) 4
   • Olanzapine + Fluoxetine for bipolar depression 2

2. For Treatment-Resistant Cases:

   • Atypical antipsychotics as add-on to mood stabilizers and antidepressants 3

Monitoring Requirements

Regular monitoring is essential for patients on these medications:

• Serum medication levels (for lithium, valproate, carbamazepine)
• Metabolic parameters: weight, BMI, blood pressure, fasting glucose, lipid panel
• Liver and renal function tests
• Thyroid function
• Complete blood count
• Movement disorder assessments (especially with typical antipsychotics) 4

Learning Strategy

1. Organize by primary indication: Create separate lists for schizophrenia, bipolar disorder, depression, and anxiety
2. Understand mechanisms of action: Group medications by how they work
3. Know FDA approvals: Focus first on officially approved indications
4. Learn common combinations: Understand which medications work well together
5. Memorize dosing ranges: Start with initial doses and therapeutic ranges
6. Study monitoring requirements: Know what to check and how often
7. Learn major side effects: Prioritize understanding serious or common adverse effects

By systematically studying these medication classes, their indications, mechanisms, dosing, and monitoring requirements, you can develop a comprehensive understanding of psychopharmacology for major psychiatric disorders.