__________________________________ Bridging the Gap: Integrating Behavioral Health into Primary Care
‒ Therapeutic effects: The desired effects of the medication. ‒ Side effects: The potential unwanted effects of the medication. ‒ Drug interactions: How the medication interacts with other medications or substances. Considering pharmacokinetics and pharmacodynamics is essential for optimizing medication efficacy and minimizing adverse effects. 5.2 COMMON PSYCHOTROPIC MEDICATIONS (ERNSTMEYER & CHRISTMAN, 2022) This section provides a more in-depth overview of common psychotropic medications prescribed in primary care (Ernst- meyer & Christman, 2022): Antidepressants • Selective serotonin reuptake inhibitors (SSRIs) ‒ Examples: Fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil)
‒ Buspirone: Acts as a partial agonist at serotonin receptors, indirectly influencing GABA activity. • Mood stabilizers: These medications modulate various neurotransmitter systems to stabilize mood and prevent extreme shifts between mania and depression. Their mechanisms of action are complex and not fully understood, but they may involve: ‒ Lithium: Alters intracellular signaling pathways and influences neurotransmitter release. ‒ Anticonvulsants: Enhance GABA activity and modulate glutamate activity, another excitatory neurotransmitter. • Antipsychotics: These medications primarily block dopamine receptors in the brain, reducing psychotic symptoms such as hallucinations and delusions. They can be divided into: ‒ First-generation antipsychotics (typical antipsychotics): Primarily block dopamine receptors.
Mechanism of action: Block serotonin reuptake, increasing its concentration in the synapse Indications: Depression, anxiety disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder), premenstrual dysphoric disorder Side effects: Nausea, insomnia, sexual dysfunction, headache, weight gain
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Second-generation antipsychotics (atypical antipsychotics): Block both dopamine and serotonin receptors.
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Understanding each medication’s specific mechanism of action helps select the appropriate treatment for a given condition. Pharmacokinetics and Pharmacodynamics • Pharmacokinetics (Grogan & Preuss, 2023): This refers to how the body processes a medication, including its absorption, distribution, metabolism, and excretion. These processes influence factors such as: ‒ Dosage: The amount of medication needed to achieve the desired effect. ‒ Frequency of administration: How often the medication needs to be taken. ‒ Time to onset of action: How long it takes for the medication to start working. ‒ Duration of action: How long the medication’s effects last. ‒ Drug interactions: How the medication interacts with other medications or substances. • Pharmacodynamics (Marino et al., 2023): This
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‒ Considerations: Generally well-tolerated but may interact with other medications • Serotonin-norepinephrine reuptake inhibitors (SNRIs) ‒ Examples: Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq) ‒ Mechanism of action: Block the reuptake of both serotonin and norepinephrine ‒ Indications: Depression, anxiety disorders, chronic pain (neuropathic pain, fibromyalgia)
Side effects: Nausea, insomnia, sexual dysfunction, headache, increased blood pressure Considerations : Effective for a broader range of conditions but may have more side effects than SSRIs
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refers to how the medication interacts with the body to produce its effects. This involves understanding: ‒ Mechanism of action: How the medication works at the cellular and molecular level.
• Tricyclic antidepressants (TCAs) ‒
Examples: Amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil)
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