The following information is not meant to replace instructions from your psychiatrist, but is for the purpose of letting you know what you might expect in terms of side effects, interactions with other medications or foods, and the importance of compliance. Most of this information was taken from NIMH Medication publication updated September 2005. ANTIPSYCHOTIC MEDICATIONS (Neuroleptic) aripiprazole (Abilify)* perphenazine (Trilafon) chlorpromazine (Thorazine) pimozide (Orap) chlorprothixene (Taractan) quetiapine (Seroquel)* clozapine (Clozaril, Prolixin)* risperidone (Risperdal)* fluphenazine (Permitil) thioridazine (Mellaril) haloperidol (Haldol) thiothixene (Navane) loxapine (Loxitane) trifluoperazine (Stelazine) mesoridazine (Serentil) trifluopromazine (Vesprin) molindone (Lidone, Moban) ziprasidone (Geodon)* olanzapine (Zyprexa)* * Atypical antipsychotic medications are newer medications developed in the 1990s. Because they have fewer side effects, today they are often used as a first-line treatment. Each has a unique side effect profile, but in general, these medications are better tolerated that the earlier drugs. Some cautions apply. v  These medications help to calm you down, stop the voices and  organize your thoughts. v  Get up slowly from a sitting or lying position. These medications may cause low blood pressure. v  Use a sunscreen lotion when out in the sun. Some people develop photosensitivity when taking these medications. v  Short term side effects that you may experience include: • Blurred Vision • Lactation or amenorrhea in women • Constipation • Muscle Spasms • Drowsiness • Restlessness • Dry Mouth • Skin Rash • Increase in appetite or weight gain • Stiffness v  Tell all doctors, nurses, and other health care providers what medication you are taking. v  Do not increase or decrease your dose of medication or stop it altogether before discussing it with whomever prescribed it. CLOZAPINE (Clozaril, Prolixin)* v  Clozaril is classified as an atypical antipsychotic medication and the effects exhibited differ from the more typical antipsychotic medications. v  Patients on Clozaril may experience relative freedom from extra pyramidal side effects. (i.e. stiffness, muscle spasm). v  Sedation is a side effect you may experience while starting on Clozaril. Your physician may advise against driving or any other potentially hazardous activity while on this medication. v  This medication may cause low blood pressure. Get up slowly from a sitting to standing position. v  Bi-weekly blood counts are required to monitor the occurrence of a lowered white blood cell count. v  It is very important for you to inform your doctor of the appearance of lethargy, weakness, fever, sore throat, malaise, or any signs of infection. v  Let your doctor know if you are pregnant or have a seizure disorder. v  Do not increase or decrease this medication or stop it all together before discussing with your doctor.   OTHER ATYPICALS Side effects you may experience while taking atypical antipsychotic medications include: insomnia, weight gain, agitation, headache, anxiety, rhinitis. Less common would be: somnolence, stiffness, shakes, dizziness, constipation, nausea and increased heart rate. In some people with heart problems or a slow heartbeat, Geodon can cause serious and potentially fatal heartbeat irregularities. Use of Abilify can cause diabetes or hypoglycemia. Zyprexa, Seroquel and Risperdal have also been linked to diabetes. v   Let your doctor know if you experience any of the above side effects. v  Blood monitoring is not necessary. v  These medications may cause low blood pressure. Get up slowly from a sitting to standing position. v  Do not increase or decrease this medication or stop it all together before discussing it with your doctor. Check with your doctor or pharmacist for add’l side effects of specific medications.   Some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in “depot” forms that can be injected once or twice a month. Discuss these options with your doctor or pharmacist.   ANTIMANIC MEDICATIONS carbamazepine (Tegretol)* carbamazepine extended-release (Equetro)* divalproex sodium, valproic acid (Depakote)* gabapentin (Neurontin)* lamotrigine (Lamictal)* lithium carbonate (Eskalith, Lithane, Lithobid) lithium citrate (Cibalith-S) topimarate (Topamax)* v  Lithium is the most common medication used to treat mania. It helps to stabilize your moods and keep you from getting too high or too low. v  You will need periodic blood lithium levels for as long as you take this medication. v  Find out from your doctor your own therapeutic lithium blood level. (usual range is 0.6 to 1.2 meq/liter) v  Your lithium (LiCo3) level can vary from time to time if there are changes in the following: • amount of salt in your diet • amount of fluid gained or lost from excessive drinking of fluids • vomiting, sweating heavily, or severe diarrhea v  Possible side effects that you may experience are: • Tremor • Fatigue • Nausea • Weight Gain • Increased Urination • Loose Stools • Rash / Acne • Increased Thirst • Thyroid Disorder v  When there is too much lithium in your system you can experience symptoms of toxicity. Should you experience any of these, call your doctor immediately. These symptoms may include: • Difficulty Walking • Severe Diarrhea • Slurred Speech • Severe Drowsiness • Severe Vomiting • Muscle Twitches v  Tell all doctors, nurses, and other health care provider (including dentists) what medications you are taking. v  Do not increase or decrease your lithium or stop it altogether before discussing it with your doctor.   VALPROIC ACID, DIVALPROEX SODIUM (Depakote) * Anticonvulsant medications have been established as anti-manic medication and can be used as an alternative to, or in combination with, lithium. v  Most common side effects are tremor, dizziness, sedation, nausea/vomiting, elevation of liver enzymes, some weight gain, abdominal pain and headaches. v  Your serum level of Depakote and your liver enzymes may be monitored while you are taking this medication. v  Notify your physician if your notice a yellowish tinge to your skin or eyes, or if you develop and shortness of breath, generalized body swelling, chest pain, pulse changes, or stomachache. v  If you develop extreme drowsiness, fatigue, exhibit slurred speech, mental confusion or unsteadiness on your feet, get medical attention immediately, as your drug level in your blood stream may be too high. v  Your skin may be extremely sensitive to sun. If you are going to be outside, be sure your skin is covered or use a sunscreen preparation with a rating of #15 or higher. Also, it would be helpful to wear a hat and sunglasses to protect your eyes.   CARBEMAZOPINE (Tegretol) v  This medication will help calm and relax you and will also stabilize your moods. It is an anticonvulsant drug. v  Your serum level of Tegretol and blood count will be monitored while you are taking this medication. Your doctor will order this at regular intervals (at least monthly at first). v  Side effects you may experience are: • Drowsiness` • Blurred Vision • Dry Mouth • Difficulty Urinating • Constipation • Dizziness • Lightheadedness • Unsteady on Feet • Reduced White Blood Cell Count v  If you develop a sore throat and/or swollen glands without other cold or flu symptoms, report this to your physician immediately. Also report any mouth ulcers and excessive bruising or skin breaks. v  Notify your physician if you notice a yellowish tinge to your skin or eyes, or if you develop any shortness of breath, generalized body swelling, chest pain or pulse changes. v  If you develop extreme drowsiness, fatigue, exhibit slurred speech, mental confusion or unsteadiness on your feet, get medical attention immediately, as your drug level in your blood stream may be too high. v  Your skin may be extremely sensitive to sun. If you are going to be outside, be sure your skin is covered or use a sunscreen preparation with a rating of SPF#15 or higher. Also, it would be helpful to wear a hat and sunglasses to protect your eyes. v  Get up slowly from a sitting or lying position, as this drug may lower your blood pressure. v  Do not increase or decrease your dose of medication or stop it altogether before discussing it with whomever prescribed it.   Other anticonvulsants used for bipolar include Lamictal, Topamax, and Equetro. The evidence for anticonvulsant effectiveness is stronger for acute mania than for long-term maintenance of bipolar disorder. Some antipsychotic medications have been approved for the treatment of mania in bipolar disorder. These include: Abilify, Geodon, Risperdal, Seroquel, and Zypreza. In addition, a combination medication, Symbyax (olanzapine and fluoxetine), has been approved for acute bipolar depression.   ANTIANXIETY MEDICATIONS (Benzodiazepines/Sedatives - Hypnotic Meds) alprazolam (Xanax) buspirone (BuSpar)** Not a benzodiazepine chlordiazepoxide (Librax, Libritabs, Librium) clonazepam (Klonopin) clorazepate (Azene, Tranxenze) diazepam (Valium) flurazepam (Dalmane) halazepam (Paxipam) Iorazepam (Ativan) oxazepam (Serax) prazapam (Centrax)   v  These medications help to decrease anxiety, calm nervousness or help you sleep. v  They can cause physical or emotional dependence. v  Possible side effects you may experience are: daytime drowsiness or hangover feeling, depressed mood, decreased tolerance to alcohol or other sedatives. v  Do not increase or decrease your dose or stop medication altogether without discussing with your physician.   Antidepressant medications such as Anafranil, Prozac, Luvox, Paxil, Zoloft, Lexapro, and Effexor are used to treat some anxiety disorders.   ANTI-PARKINSONIAN MEDICATIONS amantadine (Symmetrel) benztropine (Cogentin) diphenhydramine (Benadryl) procyclidine (Kemadrin) trihexphenidyl (Artane)   v  These medications help stop stiffness and relieve side effects from other medications. v  Tell doctors, nurses and health care providers that you are taking these medications. v  As with other psychotropic medications, do not increase or decrease the dose or stop it altogether without discussing it with your doctor.   MAO-I ANTIDEPRESSANTS isocarboxazid (Marplan) phenelzine (Nardil) tranylcypromine (Parnate) v  These medications help relieve depressive symptoms. v  These medications may cause a fall in blood pressure upon arising with lightheadedness or insomnia. v  While taking an MAO-I, you must follow a special low tyramine diet. v  The foods to avoid include: • Aged Cheese • American Cheese • Any meat 2 days old • Bananas • Beer • Beef/Chicken Liver • Caffeine Products • Chocolate • Cola • Dried Fruits • Excessive Cocoa • Guacamole • Lentils • Lima Beans • Luncheon Meats • MSG • Overly Ripened • Pickled Foods • Red Wines • Snowpeas     Fruit • Soy Beans • Soy Sauce • Vegetables • Yeast Extract v  Medications or drugs to be avoided while taking MAO-Is include: • Cold Tablets • Diet Pills • Decongestants • Cocaine • Sinus Preparations • Demerol • Amphetamines v  If you ingest the foods or medications to avoid, let your doctor know immediately, or go to an emergency room. You may experience: • Severe Headache • Severe High Blood Pressure • Stiff Neck • Fever • Rapid Pulse • Convulsions • Chest Pains v  Be sure to let all doctors and nurses know you are taking this medication. v  Do not increase or decrease your dose of medication or stop it altogether without discussing it with your doctor.   TRICYCLIC OR TETRACYCLIC ANTIDEPRESSANTS amitriptyline (Elavil, Endep) maprotilene (Ludiomil) amoxapine (Ascendin) nortriptyline (Aventyl, Pamelor) clomipramine (Anafranil) protriptyline (Vivactil) desipramine (Norpramin, Pertofran) doxepin (Adapin, Sinequan) trazadone (Desyrel) imipramine (Tofranil) trimipramine (Surmontil)   v  These medications help relieve depressive symptoms. v  You may feel drowsy when first taking these medications. v  Get up slowly from a sitting or lying position. These medications may cause low blood pressure. v  Short-term side effects that you may experience include: • Dry Mouth • Blurred Vision • Tremor • Nasal Congestion • Constipation • Drowsiness • Difficulty Urinating • Lightheadedness v  Let all doctors and any other health care provider know what medications you are taking. v  Do not increase or decrease your dose of medication or stop it altogether without discussing it with whoever prescribed it. SSRI ANTIDEPRESSANTS (Selective Serotonin Reuptake Inhibitors) citalopram (Celexa) fluvoxamine (Luvox) escitalopram (Lexapro) paroxetine (Paxil) fluoxetine (Prozac) sertraline (Zoloft)   The past decade has seen the introduction of many new antidepressants that primarily affect one neurotransmitter (serotonin) and are called selective serotonin reuptake inhibitors (SSRIs). They have fewer side effects such as sedation. They do not cause seizures, have adverse effects on the heart, cause difficult urination or constipation, mental confusion or dry mouth. Let your doctor know of any side effects you may be having, any medical illness, or if you are experiencing any sexual difficulties. v  This medication helps to relieve depressive symptoms. v  Commonly reported short-term side effects are: • Nausea • Tremors • Dry Mouth • Nervousness • Anxiety • Diarrhea • Headache • Drowsiness • Insomnia • Sedation • Sexual Dysfunction v  Less frequent side effects are: • Constipation • Heartburn • Blurred Vision • Rash • Tactile Changes • Dizziness • Hot Flashes v  Let your doctor know of any side effects you may be having, any medical illness or if you are pregnant, or if you are experiencing any sexual difficulties. v  Do not increase or decrease your medication or stop it altogether before discussing it with your doctor.   OTHER NEW ANTIDEPRESSANT MEDICATIONS BUPROPION (Wellbutrin) v  This medication helps to relieve depressive symptoms. v  Let the physician know if you have a seizure disorder or are bulimic. v  Let your doctor know of any medical illness, or if you are pregnant. v  Short term side effects you may experience are: • Increased Restlessness • Agitation • Anxiety • Decreased Appetite • Dry Mouth • Tremor • Headache / Migraine • Nausea • Constipation v  Let all health care providers know what medications you are taking. v  Do not increase or decrease your medication or stop it altogether before discussing it with your physician. Wellbutrin has not been associated with sexual dysfunction or weight gain. BUSPIRONE (Buspar) Minor tranquilizer and anti-anxiety drug. Reported to lack dangers of drug addiction associated with other anti-anxiety drugs. Side effects can be drowsiness, nausea, headache, fatigue, nervousness, light-headedness, and excitement. The combination of this drug with MAO inhibitors may produce high blood pressure and can be dangerous. VENLAFAXINE (Effexor) A new class of antidepressant - a serotonin norepinephrine reuptake inhibitor (SNRI). May be alternative to polydrug therapy. Touted as similar to Prozac in side-effect profile, but with added punch. v  Adverse reactions may include CNS somnolence, dizziness, nervousness, dry mouth and anxiety. v  GI symptoms may include nausea, constipation, anorexia and vomiting. v  Urogenital symptoms may include abnormal ejaculation. v  Other symptoms may include headache, sweating and blurred vision. v  Do not use this medication with MAO inhibitors or if you have seizure disorder. NEFAZODONE (Serzone) Similar to Desyrel. Can be sedating and cause weight gain. No sexual impairment. Cases of life-threatening hepatic failure have been reported in patients treated with nefazodone (Serzone). Patients should call the doctor if the following symptoms of liver dysfunction occur - yellowing of the skin or whites of eyes, unusually dark urine, loss of appetite that lasts for several days, nausea or abdominal pain. MIRTAZAPINE (Remeron) Low dose can be sedating. High dose can be energizing and cause weight gain.   OTHER NEW MEDICATIONS New medications are being approved every year. Among the newest are Cymbalta, Lithium Oratate, Symbyax and Trileptal. Check with your doctor or pharmacist for more information and whether these medications are appropriate for you.   TAKING YOUR MEDICATION As with all the other medications mentioned, do not adjust your dosage of medication or stop it altogether without discussing it first with the doctor who prescribed it. Also, notify your doctor if you are pregnant, and advise him/her of any other medications you are taking. Always check with the doctor before taking any over-the-counter medications.   When to take medications: Take your medications at the same time every day. If you make taking medications part of our regular daily schedule, you are more likely to remember them. Ask your doctor if you can take your medication with meals, at bedtime, etc. so you can better remember. Missed doses: If you miss a dose . . . don’t panic! You must stay on your medication as ordered to avoid relapse, but one missed dose or late dose will not cause a major problem if you take your medication on a regular basis.   Pill containers: Remember that drug stores can give your medication in two different kinds of containers - child-safe and ordinary ones. The childsafe containers are necessary if you are likely to have children around your home who could get into the medications, thinking they are candy. On the other hand, child-safe tops are very hard for some people to get off the medicine bottle. If this will be a problem, ask your druggist for the easy flip-off caps on your medicine.   If you are taking more than one medication, and at different times of the day, it is essential that you take the correct dosage of each medication. An easy way to make sure you do this is to use a 7-day pillbox, available in any pharmacy and to fill the box with the proper medication at the beginning of each week. Many pharmacies also have pillboxes with sections for medications that must be taken more than once a day. You can also use small jars to create your own system. This can help you make sure you don’t forget to take the right number of pills, and to know you have already taken them in case you get mixed up.   Medication and Pregnancy: If you are a woman of childbearing age, you should discuss any plan to become pregnant with your doctor prior to discontinuing birth control methods. Your doctor can best help you to plan this in a safe way for both you and your baby.   Medication and Alcohol: Alcohol and drugs generally do not mix well with medication. Alcohol can also cause mood swings and interact with the medication, making it difficult to get stabilized. Discuss with your doctor if even minimal use is considered.   There are ongoing clinical trials available, some sponsored by pharmaceutical manufacturers and others by the National Institute of Mental Health. Call the Mental Health Association of Broward County at 954-746-2055 for information on clinical trials.