Manual of Clinical Psychopharmacology

Transcription

1 Manual of Clinical Psychopharmacology Fourth Edition Alan F. Schatzberg, M.D. Kenneth T. Norris, Jr., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California Jonathan O. Cole, M.D. Professor of Psychiatry, Harvard Medical School, Boston; Senior Consultant, McLean Hospital, Belmont; Psychiatric Training Consultant, St. Elizabeth's Medical Center, Brighton, Massachusetts Charles DeBattista, D.M.H., M.D. Assistant Professor and Chief of Depression Clinic, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California Washington, DC London, England

2 Contents List of Tables List of Figures Preface xvii xxi xxiii 1 General Principles of Psychopharmacological Treatment 1 General Advice 3 Legal, Ethical, and Economic Issues 4 Bibliography 12 A Diagnosis and Classification 15 Mood Disorders 17 Bipolar Disorders 18 Depressive Disorders 20 Schizophrenia and Other Schizophrenia Spectrum Disorders 22 Anxiety Disorders 24 Somatoform Disorders 29 Personality Disorders 30 Psychoactive Substance Use Disorders 31 Child and Adolescent Disorders 31 FDA Approval of Symptom Reduction Strategies 32 DSM-V and Pharmacogenetics 32 Summary.33 Bibliography 34

3 Antidepressants 37 History 39 General Principles of Antidepressant Use 41 Choosing an Antidepressant 41 Dosage and Administration 44 Duration of Treatment 45 Selective Serotonin Reuptake Inhibitors 47 Pharmacological Effects 47 Indications 52 Side Effects 55 Overdose 61 Drug Interactions ' 62 Dosage and Administration 64 Discontinuation 68 Serotonin 2 Receptor Antagonists (Trazodone and Nefazodone) 70 Pharmacological Effects 70 Indications 72 Side Effects 73 Overdose 76 Drug Interactions 77 Dosage and Administration 78 Discontinuation 79 Selective Serotonin-Norepinephrine Reuptake Inhibitor (Venlafaxine) 79 Pharmacological Effects 80 Indications 80 Side Effects 82 Overdose 83 Drug Interactions 83 Dosage and Administration 84 Discontinuation 84 Combined Noradrenergic-Dopaminergic Antidepressant (Bupropion) 85 Pharmacological Effects 85 Indications 86 Side Effects 88 Overdose 88 Drug Interactions 89 Dosage and Administration 89 Mirtazapine 89 Pharmacological Effects 90 Indications 91 Side Effects 92 Overdose 94 Drug Interactions 94 Dosage and Administration 94 Reboxetine 95 Pharmacological Effects 95 Indications 96 Side Effects 97 Overdose 97 Dosage and Administration 97 Drug Interactions 98 Discontinuation 98 Duloxetine 98 Gepirone 100 Tricyclic and Tetracyclic Antidepressants 101 Structures 101 Pharmacological Effects 101 Indications" 107 Blood Levels 108 Side Effects 114 Overdose 117

4 Dosage and Administration 117 Discontinuation 120 Monoamine Oxidase Inhibitors 120 Pharmacological Effects 120 Indications 123 Side Effects 125 Overdose 128 Drug Interactions 128 Dosage and Administration 131 Discontinuation 132 Selective and Reversible Monoamine Oxidase Inhibitors 133 Novel Antidepressants 136 Bibliography 138 Antipsychotic Drugs 159 General Principles of Antipsychotic Use 161 The Drugs 161 Efficacy 168 Acute Antipsychotic Treatment 171 Early Inpatient Treatment 173 Maintenance Drug Therapy 177 Use in Other Psychiatric Disorders 182 Atypical Antipsychotics 187 Clozapine 187 Risperidone 194 Olanzapine 196 Quetiapine 200 Ziprasidone 203 Aripiprazole 205 Standard (Typical) Antipsychotics 206 Side Effects 208 Haloperidol Decanoate 225 Other Options for Treating Negative Symptoms 226 Alternatives to Antipsychotic Therapy 228 Antipsychotic Drugs in Development 231 Bibliography 233 Mood Stabilizers 245 Lithium 247 History and Indications 247 Pharmacological Effects 251 Clinical Indications 252 Side Effects 259 Preparations 266 Dosage and Administration 267 Use in Pregnancy 270 Lithium Information Center 270 Anticonvulsants 270 Valproate 271 Carbamazepine 283 Newer Anticonvulsants 290 Other Anticonvulsants: Topiramate, Tiagabine, and Oxcarbazepine 301 Antipsychotics 304 Benzodiazepines 305 Calcium Channel Blockers 306 Omega-3 Fatty Acids 308 Bibliography 309 Antianxiety Agents 321 Benzodiazepines 324 Indications 324 Pharmacological Effects -326 Subclasses : 327

5 Dosage and Administration 334 Withdrawal 338 Side Effects 341 Overdose 342 Barbiturates 342 Amobarbital Sodium (Amytal) as a Parenteral Solution Catatonia 349 Meprobamate 351 Noradrenergic Agents 354 Clinical Indications 354 Dosage and Administration 356 Side Effects 357 Antihistamines 358 Buspirone 358 Antidepressants 361 Agoraphobia and Panic 362 Generalized Anxiety Disorder 363 Social Phobia 364 Body Dysmorphic Disorder 366 Posttraumatic Stress Disorder 367 Obsessive-Compulsive Disorder 370 Bibliography 373 Hypnotics 381 Insomnia 381 Behavioral Approaches 387 Pharmacological Approaches 388 Benzodiazepine Hypnotics 389 Barbiturates 396 Sedative Antihistamines and Other Nonbenzodiazepine Psychoactive Drugs With Hypnotic Properties 399 Nonbarbiturate Hypnotics 401 Methaqualone 403 L-Tryptophan 404 Melatonin 405 Valerian Extract 406 General Conclusions 407 Bibliography 409 Stimulants 413 Stimulant Abuse 419 Uses of Stimulants 420 Attention-Deficit/Hyperactivity Disorder 420 Depression 424 Acquired Immunodeficiency Syndrome 428 Other Medical Conditions 429 Drug Combinations 429 Psychosis 430 Stimulant Use Versus Abuse 431 Bibliography.432 Augmentation Strategies for Treatment-Resistant Disorders 437 Augmentation Strategies for Depression 438 Lithium-Antidepressant Combinations 438 Thyroid Supplement-Antidepressant Combinations 441 Estrogen-Antidepressant Combinations 444 Dopamine Agonist-Antidepressant Combinatibns 447 Monoamine Precursor-Antidepressant Combinations...:. 448 Selective Serotonin Reuptake Inhibitor Combinations 449 Antipsychotic-Antidepressant Combinations 452 Other TCA Combinations 454 Nefazodone Combinations 456

6 Augmentation Strategies for Bipolar Disorder 457 Combinations of Two or More Mood Stabilizers 457 Mood Stabilizer Antipsychotic Combinations 459 Mood Stabilizer-Antidepressant Combinations 461 Mood Stabilizers and Omega-3 Fatty Acids 462 Augmentation Strategies for Schizophrenia 463 Combinations of Two Antipsychotics 463 Combinations of Antidepressants and Antipsychotics 464 Combinations of Mood Stabilizers and Antipsychotics 466 Other Augmentation Strategies 467 Bibliography 468 ) Emergency Room Treatment 481 Agitation and Violence 482 Depression and Suicidality 486 Acute Psychotic Reactions 490 Mixed Psychotic Reactions 491 Schizophrenic, Schizophreniform, and Manic Psychoses 491 Delirium 494 Severe Anxiety 495 Stupor and Catatonia 496 Emergency Room Referrals 497 Bibliography 498 Pharmacotherapy for Substance Use Disorders 501 Stimulants 503 Opiates 505 Detoxification 505 Maintenance 508 Sedatives and Hypnotics 512 Detoxification 512 Pentobarbital Tolerance Test 513 Benzodiazepines 514 Alcohol 517 Maintenance Treatment 520 Cannabis 524 Hallucinogens 525 Phencyclidine 526 Bibliography 527, Pharmacotherapy in Special Situations 533 Pregnancy 533 Pediatric Psychopharmacology 540 Stimulants 541 Antipsychotics 545 Antidepressants 549 Mood Stabilizers 551 Antianxiety Drugs 553 Geriatric Psychopharmacology 554 Antidepressants 555 Hypnotics and Anxiolytics 557 Mood Stabilizers 558 Antipsychotics Medications for Dementia 560 Medications for Agitation 563 Mental Retardation 566 Medical Conditions 568 Psychiatric Disorders Resulting From Medical Illness 568 Psychiatric Disorders Associated With Nonpsychiatric Drugs 572 Psychiatric Disorders Complicated by Medical Disorders

7 Conclusion 582 Bibliography 583 Herbals and Dietary Supplements 595 St-John's-Wort (Hypericum Perforatum) 597 Uses 599 Mechanism of Action 600 Side Effects and Drug Interactions 600 Dosage and Administration 601 Omega-3 Fatty Acids 602 Uses and Mechanism of Action 602 Side Effects and Drug Interactions 602 Dosage and Administration 603 Kava (Piper Methysticum) 603 Uses 603 Mechanism of Action 604 Side Effects and Drug Interactions 604 Dosage and Administration 605 Valerian (Valeriana Officinalis) 605 Uses 605 Mechanism of Action 605 Side Effects and Drug Interactions 606 Dosage and Administration 606 Ginkgo (Ginkgo Biloba) 606 Uses 606 Mechanism of Action 607 Side Effects and Drug Interactions 607 Dosage and Administration 607 S-Adenosylmethionine (SAMe) 608 Uses 608 Mechanism of Action 608 Side Effects and Drug Interactions 609 Dosage and Administration 609 Inositol 609 Uses 609 Mechanism of Action 610 Side Effects and Drug Interactions 610 Dosage and Administration 610 DHEA (Dehydroepiandrosterone) 610 Uses 611 Mechanism of Action 611 Side Effects and Drug Interactions 611 Dosage and Administration 611 Bibliography 611 Appendix A: Strengths and Costs of Antidepressant and Antipsychotic Drugs 615 Appendix B: Suggested Readings 619 Index 621