Treatments for Substance Use Disorders

The chapter on treatments for substance use disorders discusses and reviews the use of medication-assisted treatments with (a) methadone, buprenorphine/naloxone, and naltrexone for opioid use disorders; (b) disulfiram, acamprosate, naltrexone, and several off-label medications for alcohol use disorders; and (c) nicotine replacement therapies, bupropion, and varenicline for tobacco use disorders. The chapter reviews the mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects of these medications, followed by an in-depth discussion of their clinical use in these disorders. The chapter also briefly reviews several non-Food and Drug Administration (FDA)-approved medicines studied for cocaine, cannabis, and amphetamine use disorders. It also briefly discusses complementary and alternative pharmacotherapies, such as the use of cannabinoids. It also discusses the use of these medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of approved substance use disorder medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

Stimulants and Other ADHD Medicines

The chapter on adult attention-deficit/hyperactivity disorder (ADHD) medicines discusses and reviews the use of psychostimulants (such as methylphenidate and amphetamines), and nonstimulants (such as atomoxetine, guanfacine, and clonidine). It reviews their mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects. It further reviews stimulants’ risk of misuse and dependence. The chapter also briefly discusses complementary and alternative pharmacotherapies. It includes an in-depth review of the clinical use of these medications for ADHD (particularly in college students) and for other psychiatric disorders (such as binge-eating disorder) and other medical disorders. It also discusses the use of ADHD medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of ADHD medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Mood Stabilizers

The chapter on mood stabilizers discusses and reviews the use of available treatments for bipolar disorder, including lithium, selected anticonvulsants (such as valproate, carbamazepine, oxcarbazepine, and lamotrigine) and second-generation antipsychotics. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and adverse effects. The chapter also reviews emerging pharmacotherapies such as the use of ketamine. It also briefly discusses complementary and alternative pharmacotherapies and the use of omega-3 fatty acids. The chapter includes an in-depth review of the clinical use of the previously listed medications for bipolar depression, mania, mixed episodes, and bipolar maintenance. It also reviews the risks of using antidepressants for bipolar depression. It also discusses the use of mood stabilizers in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of mood stabilizers that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Antipsychotics

The chapter on antipsychotics discusses and reviews the use of first-generation antipsychotics, including haloperidol and chlorpromazine, as well as the use of second-generation antipsychotics, including risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, clozapine, paliperidone, iloperidone, asenapine, lurasidone, brexpiprazole, and cariprazine. Pimavanserin is also discussed. The chapter reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, and potential risks including neuroleptic side effects such as acute dystonias, parkinsonian symptoms, akathisia, and tardive dyskinesia. Metabolic syndrome (which includes risks of weight gain, hyperglycemia, and hyperlipidemias) and cardiac risks are also discussed. The chapter also briefly discusses complementary and alternative pharmacotherapies. It then provides an in-depth review of the clinical use of antipsychotics for psychotic and behavioral disorders, as well as for other nonpsychotic psychiatric and medical disorders. It also discusses the use of antipsychotics in women of childbearing age, notably in regard to pregnancy and breastfeeding considerations. Finally, the chapter includes a table of antipsychotics that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and Food and Drug Administration indications.

Introduction

This introductory chapter notes the development and increased use of psychiatric medications over the past 70 years. It introduces the reader to the topics that are discussed in the subsequent chapters of this book. It reviews the differences between efficacy studies and effectiveness studies and how evidence gained from these studies can inform clinical knowledge. The availability of practice guidelines and algorithms are noted as well. This chapter also lists clinical variables that need to be taken into account before selecting any psychiatric medicine. Finally, it notes the importance of learning about the use of psychotropic medications in women of childbearing potential and during breastfeeding.

Anti-Anxiety Medicines and Hypnotics

The chapter on anti-anxiety medicines and hypnotics discusses and reviews the use of benzodiazepines and barbiturates, medicines without abuse potential used for the treatments of anxiety (such as buspirone, propranolol, clonidine, prazosin, hydroxyzine, pregabalin, gabapentin, and quetiapine), as well as newer hypnotics including “z-drugs” considered for insomnia and sleep. It reviews their mechanisms of action, clinical characteristics, potential medication interactions, adverse effects, as well as their risks of dependence and misuse. It also briefly discusses complementary and alternative pharmacotherapies such as melatonin and cannabidiol. The chapter includes an in-depth discussion of the clinical use of these medications for anxiety and insomnia. It also discusses the use of anxiolytics in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of commonly used anti-anxiety medicines and hypnotics that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings and Food and Drug Administration indications.

Antidepressants

The chapter on antidepressants discusses and reviews the use of tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors, as well as bupropion, mirtazapine, nefazodone, trazodone, and the newer antidepressants vilazodone and vortioxetine. It reviews each medication’s mechanism of action, clinical characteristics, potential medication interactions, adverse effects, and other risks. The chapter also reviews emerging pharmacotherapies such as ketamine, esketamine, and brexanolone. It also briefly discusses complementary and alternative pharmacotherapies. The chapter includes an in-depth discussion of the clinical use of antidepressants for the treatment of unipolar depression and other psychiatric and medical disorders. It also discusses the use of antidepressants in women of childbearing age, notably in regards to pregnancy and breastfeeding considerations. Finally, each chapter includes a table of antidepressants that includes each medication’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.