<p></p>
<p><b>Types of Psychotropic Drugs</b></p>

<ul type="disc">
    <li>Antidepressants</li>
    <li>Antipsychotics</li>
    <li>Anxiolytics</li>
    <li>Hypnotics</li>
    <li>Mood stabilizers</li>
    <li>Stimulants</li>
</ul>
<p><b>Most Frequently
Prescribed&nbsp;Psychotropic Drugs</b></p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Xanax (alprazolam), 48.5 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Zoloft (sertraline), 41.4 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Celexa (citalopram), 39.4 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Prozac (fluoxetine), 28.3 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Ativan (lorazepam), 27.9 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Desyrel (trazodone HCL), 26.2 million.</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Lexapro (escitalopram), 24.9 million.</p>
<h2><a name="_Toc14686158">Anti-depressants</a></h2>

<p>Antidepressants are grouped into&nbsp;classes&nbsp;based on how they affect the chemistry of the brain. While the antidepressants in a class will tend to have similar side effects and&nbsp;mechanisms of action, there are differences in their molecular
    structures which can influence how well the drug is absorbed, disseminated, or tolerated in different people.</p>

<p>There are three basic molecules, known chemically as monoamines, that are believed to be involved in mood regulation. These primarily work as neurotransmitters, which literally transmit nerve signals to their corresponding receptors in the brain. Antidepressants
    work by influencing these neurotransmitters, which include:</p>

<ul type="disc">
    <li><b>Serotonin</b>, the neurotransmitter whose role it is to regulate mood, appetite, sleep, memory, social behavior, and sexual desire</li>
</ul>

<h4><b>Image of the Chemical Bond of Serotonin</b></h4>
<p></p>
<p style="text-align: center;"><span style="font-weight: bold; font-size: 1rem;">&nbsp;</span><img src="@@PLUGINFILE@@/Serotonin.jpg" alt="Serotonin" width="350" height="336" class="img-responsive atto_image_button_middle" style="font-weight: bold; font-size: 1rem; text-align: center;"><span style="font-weight: bold; font-size: 1rem;">&nbsp;</span></p><span><p style="text-align: center;"><br></p></span>
<p></p>

<ul type="disc">
    <li><b>Norepinephrine</b>, which influences alertness and motor function and helps regulate blood pressure and heart rate in response to stress</li>
</ul>
<h4><b>Image of the Norepinephrine Chemical Bond</b></h4>
<p></p>
<p style="text-align: center;"><span style="font-size: 1rem;">&nbsp;</span><img src="@@PLUGINFILE@@/Norepinephrine.jpg" alt="Norepinephrine" width="350" height="294" class="atto_image_button_middle" style="font-size: 1rem; text-align: center;"></p><span><p style="text-align: center;"><br></p></span>
<p></p>
<h4><b>Image of the Dopamine Chemical Bond</b></h4>
<p></p><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp;</span><img src="@@PLUGINFILE@@/Dopamine.png" alt="Dopamine" width="500" height="370" class="atto_image_button_middle" style="font-size: 1rem; text-align: center;"></p><span><span style="font-weight: 600;"><p style="text-align: center;"><br></p></span></span><p></p><p><b style="font-size: 1rem;"><b style="font-size: 1rem;">Dopamine</b><span style="font-size: 1rem; font-weight: 400;">, which plays a central role in decision-making, motivation, arousal, and the signaling of pleasure and reward</span></b><br></p>

<p><br></p><p><u style="color: rgb(55, 71, 79); font-family: &quot;Open Sans&quot;; font-size: 1.715rem;">There are five classes of anti-depressants; SSRIs,&nbsp; SNRIs, MAOs, TCAs, &amp; atypical
antidepressants</u><br></p>

<h3><a name="_Toc14686159">Selective Serotonin Reuptake Inhibitors (SSRIs)</a></h3>

<p>There are a number of antidepressants that work by preventing the reabsorption (reuptake) of neurotransmitters into the body. Collectively known as&nbsp;reuptake inhibitors, they prevent the reuptake of one or more neurotransmitters so that more are available
    and active in the brain.
</p>

<p>Selective serotonin reuptake inhibitors&nbsp;(SSRIs) work by specifically inhibiting the reuptake of serotonin. SSRIs are a newer class of antidepressants first developed during the 1970s.</p>

<p>Examples include:</p>

<ul type="disc">
    <li>Prozac (fluoxetine)</li>
    <li>Paxil (paroxetine)</li>
    <li>Zoloft (sertraline)</li>
    <li>Celexa (citalopram)</li>
    <li>Luvox (fluvoxamine)</li>
    <li>Lexapro (escitalopram)</li>
    <li>Viibryd (vilazodone)</li>
</ul>

<p>SSRIs tend to have fewer side effects than older antidepressants but are still known to nausea, insomnia, nervousness, tremors, and sexual dysfunction.</p>

<p>In addition to treating depressions, SSRIs are also sometimes used to treat obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), eating disorders, and premature ejaculations. They have also proved helpful during stroke recovery.</p>

<h4>Effects</h4>

<p>These more modern antidepressants have fewer changes in the slow activity (associated with less viscero/autonomic side-effect), with a mild fronto-central beta increase in the range of 18-25 Hz and a decrease in alpha anteriorly.</p>
<p>Here is a short video on SSRIs</p>
<p>&nbsp;<a href="https://www.youtube.com/watch?v=uiXcAbrO8kU">SSRI Video</a><br></p>

<h3><a name="_Toc14686160">Serotonin and
Norepinephrine Reuptake Inhibitors (SNRIs)</a></h3>

<p>Serotonin and norepinephrine reuptake inhibitors&nbsp;(SNRIs) work in a similar way to SSRIs except that they inhibit the reuptake of both norepinephrine and serotonin. The first SNRI was FDA-approved in December 1993.</p>

<p>Increasing norepinephrine levels in tandem with serotonin levels can be particularly useful or people with&nbsp;psychomotor retardation&nbsp;(the slowing of physical movement and thought).
</p>

<p>Examples of SNRIs include:</p>

<ul type="disc">
    <li>Effexor (venlafaxine)
    </li>
    <li>Cymbalta (duloxetine)
    </li>
    <li>Pristiq (desvenlafaxine)
    </li>
    <li>Savella (milnacipran)
    </li>
    <li>Fetzima (levomilnacipran)
    </li>
</ul>

<p>Common side effects of SNRIs include nausea, drowsiness, fatigue, constipation, and dry mouth.</p>

<p>Some SNRIs, like Cymbalta, can also be used to treat chronic pain, a condition closely linked to the development of depression. They have also proven useful in treating generalized anxiety, post-traumatic stress disorder (PTSD), social anxiety disorder
    (SAD), panic disorder, and nerve pain associated with fibromyalgia.</p>

<p>If the frontal lobe has regular frequency alpha seen in excess, especially with eyes-closed frontal alpha hypercoherence, then in our experience, an SSRI or an SNRI may be used to increase frontal function.</p>
<p>Here's a video on how SNRIs work</p>
<p><a href="https://www.youtube.com/watch?v=FrE7nfqlBjs">SNRI Video</a><br></p>

<h3><a name="_Toc14686161">Tricyclic
Antidepressants (TCAs)</a></h3>

<p>Tricyclic antidepressants&nbsp;(TCAs) are an older class of drug first discovered in the 1950s. They were named after their chemical structure, which is composed of three interconnected rings of atoms.</p>

<p>TCAs work similarly to reuptake inhibitors in that they block the absorption of serotonin and norepinephrine into nerve cells, as well as another neurotransmitter known as&nbsp;acetylcholine&nbsp;(which helps regulate the movement of skeletal muscles).</p>

<p>Examples of TCAs include:</p>

<ul type="disc">
    <li>Elavil (amitriptyline)**</li>
    <li>Norpramin (desipramine)</li>
    <li>Asendin (amoxapine)</li>
    <li>Anafranil (clomipramine)</li>
    <li>Pamelor (nortriptyline)</li>
    <li>Tofranil (imipramine)*</li>
    <li>Vivactil (protriptyline)</li>
    <li>Surmontil (trimipramine)</li>
    <li>Sinequan (doxepin)</li>
</ul>

<h4>Effects</h4>

<p><b>*Imipramine</b></p>

<p>This drug produces an increase in slow activity, a decrease in alpha 1 and 2 amplitude, and an increase in the faster beta frequencies in the mid to upper 20 Hz range and up.</p>

<p>**<strong>Amitriptyline</strong></p>
<p>This drug produces more slowing than imipramine, though the other effects are similar. This corresponds to an increased initial sedative effect and its use as a sleeping medication for sleep onset as well as the usual wakefulness effects of antidepressants.
    In epileptics, there are increases in paroxysmal discharges, which can be controlled normally with adjustments to the anti-epileptic medications.</p>

<p>In addition to their use in depression, tricyclic antidepressants can help treat chronic pain. They were also once commonly used in children with attention deficit hyperactivity (ADHD) but have since been replaced with more effective drug agents with
    fewer side effects.</p>
<p>Here's a video on Tricyclic antidepressants</p>
<p><a href="https://www.youtube.com/watch?v=lzcYPKjjQvY">Tricyclic Antidepressants</a><br></p>

<h3><a name="_Toc14686162">Monoamine
Oxidase Inhibitors (MAOIs)</a></h3>

<p>One of the first classes of antidepressants developed were&nbsp;
    <a href="https://www.verywellmind.com/monoamine-oxidase-inhibitors-maois-2584303">monoamine
oxidase inhibitors</a>&nbsp;(MAOIs). This antidepressant class, first discovered in the 1950s, inhibits the action of an enzyme called monoamine oxidase, whose role it is to break down monoamines. By blocking this effect, more neurotransmitters are
    available for use in mood regulation.
</p>

<p>Examples of MAOIs include:
</p>

<ul type="disc">
    <li>Nardil (phenelzine)</li>
    <li>Parnate (tranylcypromine)</li>
    <li>Marplan (isocarboxazid)</li>
    <li>Emsam (selegiline)</li>
</ul>

<p>MAOIs have proven useful in treating&nbsp;agoraphobia, social phobia,&nbsp;bulimia, PTSD, borderline personality disorder, and bipolar depression. Even so, its use is usually reserved for when other antidepressant options have failed.</p>

<h4>Effects</h4>

<p>These medications have a wider variation of response than the other antidepressants.&nbsp;
    <em>Isocarboxazide</em>&nbsp;increases 30-20 Hz and decreases slower and higher frequencies, similar to a stimulant profile.&nbsp;<em>Nialamide and Tranylcypromine
produce</em>&nbsp;a more typical profile, though with more variability.</p>

<h3><a name="_Toc14686163">Atypical
Antidepressants</a></h3>

<p>There are also other fairly new antidepressants that do not fit into any of the above-listed categories. Broadly described as atypical antidepressants, they affect serotonin, norepinephrine, and dopamine levels in unique ways.&nbsp;&nbsp;</p>

<p>Examples of include:</p>

<ul type="disc">
    <li>Wellbutrin (bupropion), classified as a&nbsp;
        <strong>dopamine reuptake inhibitor</strong>, is used to treat depression and seasonal affective disorder as well as a smoking cessation aid.
    </li>
    <li>Remeron (mirtazapine) is a&nbsp;<strong>noradrenergic antagonist&nbsp;</strong>used for major depression, that blocks receptors of the stress hormone epinephrine (adrenaline) on the brain.</li>
    <li>Oleptro (trazodone) and Brintellix (vortioxetine) are&nbsp;<strong>serotonin antagonist and reuptake
     inhibitors&nbsp;</strong>(SARIs) used for major depression the both inhibit serotonin reuptake and block adrenergic receptors.</li>
    <li>Symbax combines the SSRI fluoxetine with the antipsychotic drug fluoxetine to treat bipolar depression or treatment-resistant depression.</li>
</ul>

<p>Side effects can vary by drug type but may include dizziness, dry mouth, insomnia, nausea, vomiting, constipation, blurry vision, weight gain, and sexual dysfunction.</p>

<h1><a name="_Toc14686165">Anesthetic &amp; Sedative Medication</a> </h1>
<p><a name="_Toc14686165"></a></p>
<p><a name="_Toc14686165">An&nbsp;<b>anesthetic</b>&nbsp;(American English) or&nbsp;<b>anaesthetic</b>&nbsp;(British English;&nbsp;see spelling differences) is a&nbsp;drug&nbsp;used to induce&nbsp;anesthesia&nbsp;- in other words, to result in a temporary loss of&nbsp;sensation&nbsp;or&nbsp;awareness. They may be divided into two broad classes:&nbsp;general anesthetics, which result in a reversible loss of&nbsp;consciousness, and&nbsp;local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness.</a></p>
<p><a name="_Toc14686165">A wide variety of drugs are used in modern anesthetic practice. Many are rarely used outside&nbsp;anesthesiology, but others are used commonly in various fields of healthcare. Combinations of anesthetics are sometimes used for their&nbsp;synergistic&nbsp;and&nbsp;additive&nbsp;therapeutic effects. Adverse effects, however, may also be increased.&nbsp;Anesthetics are distinct from&nbsp;analgesics, which block only sensation of&nbsp;painful&nbsp;stimuli.</a></p>
<p></p><br>

<h2><a name="_Toc14686166">Effects (most volatile)</a></h2>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Marked drop in gamma band activity (25 – 50Hz)</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Increase in theta/delta frequencies&nbsp; (<u>Theta</u> comes from inhibition of normal thalamic pacemaker cells, <u>Delta</u> results from extreme depression of the thalamus). &nbsp;<b>Anesthetics</b>&nbsp;and their combinations which affect GABA<sub>A</sub>&nbsp;receptors
    creates slowing that can mimic slow wave sleep, with burst suppression at higher concentrations</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Increase in the power of the frontal electrodes (
    <u>Beta</u>: is the result of sensory stimuli influencing the reticular activating system with desynchronization of thalamic pacemakers, maximal in the prefrontal regions)</p>

<p>
    <!--[if !supportLists]-->·&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
    <!--[endif]-->Marked increase in hypercoherence/synchrony</p>

<p><span>Each anesthetic agent will have a different effect
on the EEG. Their profile will change the closer they get to isoelectric.
Increasing the dose of anesthetics will produce slowing, then burst
suppression, then electro-cerebral silence (isoelectric EEG) </span></p>

<p><span>These maps are a patient who was in a car accident and
was taking a combination of pain management medications. The blending of
sedatives and hypnotics tends to produce an excessive slowing in the EEG.</span></p>
<a href="https://www.youtube.com/watch?v=T25jvLC6X0w">
    <h3><span><span style="">Excessive slowing in the theta band as a result of combining
hypnotics and sedatives</span>.<i> Image
generated from Neuroguide version 3.0.6.</i></span>
    </h3>
    </a><p style="text-align: center;"><span style="font-size: 1rem;">&nbsp;</span><br></p><p style="text-align: center;"><br></p><p style="text-align: center;"><a href="https://www.youtube.com/watch?v=T25jvLC6X0w" style="font-size: 1rem;"><img src="@@PLUGINFILE@@/sedatives.png" alt="sedatives and hypnotics" width="500" height="662" class="img-responsive atto_image_button_middle"></a></p><br><br><span><span>Excessive slowing into the theta band as a result of
combining hypnotics and sedatives.</span>&nbsp;</span><i style="color: rgb(55, 71, 79); font-family: &quot;Open Sans&quot;; font-size: 1.715rem;">Image generated from Neuroguide version 3.0.6.<br></i><br>
    <p style="text-align: center;"><br></p>
    <p style="text-align: center;"><img src="@@PLUGINFILE@@/Meds2.png" alt="Meds2" width="500" height="448" style="font-size: 1rem;" class="img-responsive atto_image_button_middle"></p>
    <h1><a name="_Toc14686167">Stimulants</a> </h1>

    <p><img src="@@PLUGINFILE@@/Adderall.jpg" alt="Adderall" width="400" height="603" class="img-responsive atto_image_button_left"><br></p>

    <p>
        <!--[if !supportLists]-->-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <!--[endif]-->Used for ADHD disorders mainly</p>

    <p>
        <!--[if !supportLists]-->-&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Different ADHD profiles:</p>

    <p>
        <!--[if !supportLists]-->o&nbsp;&nbsp;
        <!--[endif]-->High theta/beta ratio or theta/alpha ratio</p>

    <p>
        <!--[if !supportLists]-->o&nbsp;&nbsp;
        <!--[endif]-->Higher relative theta</p>

    <p>
        <!--[if !supportLists]-->o&nbsp;&nbsp;
        <!--[endif]-->Frontal spindling beta</p>

    <p>
        <!--[if !supportLists]-->o&nbsp;&nbsp;
        <!--[endif]-->Mu rhythm</p>

    <p>
        <!--[if !supportLists]-->o&nbsp;&nbsp;
        <!--[endif]-->Temporal lobe alpha</p>

    <h2><a name="_Toc14686168">Effects of Stimulants</a></h2>

    <p></p>
    <ul>
        <li>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Normalization of EEG</li>
        <li>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; No change from baseline</li>
        <li>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Decrease in theta, theta/alpha, and theta/beta ratios</li>
        <li>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Increase in beta amplitudes</li>
    </ul>
    <p></p>







    <p>Stimulants increase the activity in the RAS, with the Raphe nucleus releasing norepinephrine, decreasing the polarization in the reticular nucleus of the thalamus and thus increasing the “clocking” or peak frequency of the rhythmic alpha activity
        and increasing faster activity.</p>

    <p><strong>Amphetamines:</strong>&nbsp;Both&nbsp;<em>dextro and methamphetamines</em>&nbsp;like&nbsp;<em>Dextrostat or Adderal</em>&nbsp;are similar in effect, with decreased slower activity and increased beta from 12-26 Hz. There is a paradoxical increase
        in alpha noted in the QEEG work of Itil (Itil et al., 1980). This is likely from the increased activation effect mentioned in the opening section.</p>

    <p><strong>Methylphenidate:</strong>&nbsp;<em>Ritalin</em>&nbsp;produces a decrease in delta and theta, with a more pronounced posterior alpha increase and an increase in low beta, with effects delayed up to 6 hours, compared to the rapid effects of
        the amphetamines.
    </p><br>
    <p></p>