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Medications to treat bipolar illness, anxiety, depression, and other psychiatric illnesses

MOOD STABILIZERS

Lamictal	Inhibits glutamate (stimulating neurotransmitter)	Stevens Johnson Syndrome (rare)	100-200 mg daily
Lithium	Alters sodium transport	Tremor, ataxia	300 mg TID
Depakote	Increases GABA (soothing neurotransmitter)	Hepatotoxicity	10 mg x body weight

ANTIPSYCHOTICS

Risperdal	As do all the so-called atypicals, blocks dopamine 2 receptors reducing hallucinations and delusions and blocks serotonin 2A receptors decreasing EPS	Risk of CVA in elderly; dose dependent EPS & hyperprolactinemia	0.5- 6 mg daily
Seroquel	Sedating	Hypotension	100-800 mg divided doses
Geodon	Generally activating	Agitation or sedation; rarely causes EPS	120-240 mg in divided doses
Zyprexa	Good for psychotic depression	Weight gain; diabetes; metabolic syndrome	5-20 mg at bedtime
Abilify	Partial serotonin and dopamine agonist	Nausea	5-30 mg daily
Haldol Decanoate	Decanoate injection increases compliance	EPS; akathisia; tardive dyskinesia	100-200 mg IM monthly
Stelazine	As with other older neuroleptics probably just as effective as newer antipsychotics but with more EPS	EPS; akathisia; tardive dyskinesia	5-20 mg daily
Thorazine	Sedation	Hypotension	50- 800 mg daily

ANTIDEPRESSANTS

Prozac	As with all SSRIs useful in panic; PTSD; OCD	Avoid in agitated insomniacs	20-60 mg daily
Zoloft	Enhances dopamine	GI side effects—diarrhea	50-200 mg daily
Paxil CR	Social anxiety	Cutting tablet destroys controlled release	12.5-50 mg daily
Lexapro	Best tolerated antidepressant; low sexual side effects	Cognitive and affective flattening	10-20 mg daily
Luvox	Rapid antianxiety and insomnia benefits	Can increase tricyclic blood levels	100-300 mg divided
Effexor XR	Boosts norepinephrine and serotonin	Withdrawal side effects if DC quickly	75-300 mg daily
Cymbalta	Useful in chronic pain and stress urinary incontinence	May increase BP	60 mg daily; 40 mg BID for stress incontinence
Wellbutrin XL	May help sexual SE caused by SSRIs	Insomnia; agitation	150-450 mg daily
Vivactil	Activating; energizing; increases dopamine	Anticholinergic SE	10-40 mg divided
Pamelor	Chronic pain	Therapeutic window	50-150 mg daily
Elavil	Sedating; helpful in insomnia; chronic pain	Cardiac precaution	50-300 mg bedtime
Trazodone	Treatment of choice for insomnia	Ataxia; tremor	50-600 mg bedtime

ANTIANXIETY AGENTS

Xanax	Short acting	Breakthrough anxiety	0.25-0.5 mg QID
Ativan	Useful with Risperdal in acute agitation	Confusion	0.5-2 mg TID
Klonopin	Adjunct with SSRIs in panic disorder	Use with caution in liver disease	0.5-1 mg QID

PSYCHOSTIMULANTS

Ritalin	Useful for depression in medically ill elderly patients	Slows growth in children?	2 mg/kg/day
Adderall	Fatigue as residual symptom of depression	Cardiac Caution	5-40 mg divided
Provigil	Sleep apnea; improves attention; useful in fatigue	Headache	200 mg daily