Drugs

Note: we have not updated the basic content of this module since the original Addictionary in 1992. So the information may be useful, but dated.

In this module we focus on psychiatric prescription drugs. For others of interest to addiction, see the module on Moodifiers. These drugs are listed by their most common psychiatric use.

Antidepressants

These drugs, introduced in the early 1960s, are used to treat long-term clinical depression. The most common are called tricyclic antidepressants (TGA). Unless otherwise noted, they increase norepinephrine (NE) or serotonin (5-HT) or both, and they are used most often to treat depression.

First generation TCAs Elavil (amitriptyline) and Tofranil (imipramine) are used for depression, especially of a biological origin, and sleep disorders.

Second generation TCAs Introduced in the early 1970s, these drugs generally have fewer side effects than the older TCAs. Norpramin (desipramine) and Pamelor (nortriptyline) are used like the older TCAS. Asendin (amoxapine) is used for psychotic depression and anxiety also. Sinequan (doxepin) is often used with anxiety or depression with alcoholism. Wellbutrin (bupropion) is also used to stabilize manic-depression.

Serotonin reuptake blockers The newest TCAS are more specific, usually affecting only the serotonergic system. They are often used with substance abuse or eating disorders. By blocking the reuptake of serotonin in the synapse, they make more of it available to the serotonin receptors. Desyrel (trazodone), Prozac (fluoxetine), and Anafranil (clomipramine) are examples.

MAO inhibitors By inhibiting the enzyme monoamine oxidase (MAO), these drugs increase those neurotransmitters that produce emotional stability. A major adverse effect of monoamine oxidase inhibitors is that certain foods contain the amino acid tyramine, which requires MAO for its metabolism. If someone on these drugs ingests hot dogs, cheese, alcoholic beverages, or certain other foods and medications, the tyramine will remain active and release excess norepinephrine (NE). This causes severe headaches, nausea, vomiting, and heart palpitations. A stroke or even death is possible.

Because of these and other side effects, MAO inhibitors are usually used only when other antidepressants do not work. Examples are Nardil (phenelzin), Marplan (isocarboxazid), and Parnate (tranylcypromine).

Antipsychotics

These drugs block the dopamine (DA) receptors in the brain, correcting the imbalance of nerve impulse transmission that seems to play a role in certain psychiatric disorders. They are often effective with severe anxiety, delusions, and hallucinations associated with psychosis. They are also called the major tranquilizers.

Low potency examples are Thorazine (chlorpromazine) and Mellaril (thioridazine). Higher potency is found in Haldol (haloperidol), Stelazine (trifluoperazine), Navane (thiothixene), Prolixin (fluphenazine), Moban (molindone), and Compazine (prochlorperazine), which also blocks acetylcholine (ACh), relieving severe nausea and vomiting.

Hypnotics

Hypnotics do not hypnotize people. The Greek word hypnos means sleep. So these are sedatives, or sleeping potions. Some work by decreasing norepinephrine, some by action on the sleep center of the brain, and some on the limbic system. In general, their action is not well understood. They are highly addicting, producing tolerance in about three or four weeks of prescribed dosages. They are very dangerous when combined with alcohol.

Barbiturates Examples are Amytal (amobarbital), Seconal (secobarbital), and Nembutal (pentobarbital).

Nonbarbiturates These include Placidyl (ethchlorvynol), Doriden (glutethimide), and Paral (paraldehyde).

Benzodiazepines Some benzodiazepines used for sleep are Dalmane (flurazepam) and Halcion (triazolam).

Antihistamines

These drugs are used primarily to reduce histamine, which is released in allergic reactions. They are chemically related to the antipsychotics or major tranquilizers such as Thorazine, and they produce a sedative effect, causing concern for driving or any activity where drowsiness is unsafe.

Examples of antihistamines are Benadryl (diphenhydramine) and Phenergan (promethazine), also used for motion sickness, and Atarax or Vistaril (hydroxyzine), also used for skin problems including itching.

Stimulants

In the past these drugs were usedas antidepressants and to suppress appetite. Today they are prescribed mostly for hyperactive children, for narcolepsy, and to augment the treatment of depression. They cause release of the neurotransmitter norepinephrine (NE).

Common stimulants are Dexedrine (dextroamphetamine), Ritalin (methylphenidate), Cylert (pemoline), and Pondimin (fenfluramine), which is still used for weight reduction.

Antianxiety Drugs

These are also called the minor tranquilizers. Most of them depress the limbic system and the gaba-benzodiazepine complex of the brain, reducing anxiety. Once thought to be nonaddicting, the benzodiazepine (BZP) drugs account for the majority of prescription drug addiction in the United States.

Long-acting BZPs Long-acting benzodiazepines include Valium (diazepam) and Librium (chlordiazepoxide).

Pro drugs Pro drugs (from Latin pro meaning before) have no pharmaceutical action themselves, but break down into active ingredients after entering the body. It was thought this would make them less addicting but it does not. Examples are Tranxene (chlorazepate), Centrax (prazepam), and Paxipam (halazepam).

Short-acting BZPs These short-acting benzodiazepines were thought to be less addicting because they act quickly and leave the body quickly. Actually, they have a greater chance of dependency than the longer acting BZPs. This may be similar to the high addiction potential of quick-acting drugs like tobacco and cocaine. Examples of short-acting BZPs are Xanax (alprazolam), Atavan (lorazepam), and Serax (oxazepam).

Short-acting nonspecific Other antianxiety drugs include Inderal (propranolol), which also lowers blood pressure and the likelihood of migraine headaches, Catapres (clonidine), which slows norepinephrine centers, lowers blood pressure, and is used in alcohol and opiate withdrawal, and Buspar (buspirone), which interacts with dopamine (DA), norepinephrine (NE), and serotonin (5-HT) neurotransmitters to relieve anxiety.

Mood Stabilizers

These drugs are used to control the mood swings of conditions like manic-depression. Lithium carbonate alters the metabolism of norepinephrine (NE) and serotonin (5-HT). Its levels in the bloodstream must be closely monitored, and there are often side effects. Tegretol (carbamazepine) reduces seizures and manic attacks.

Dangers of Rx

The medical profession has a sad history of using drugs to treat addiction. In the late nineteenth century opium was prescribed to cure alcoholism. Shortly after the turn of the century, they tried using heroin to treat opium addiction. As late as ten years ago, many physicians believed that Valium, at one time the most prescribed drug in the United States, was nonaddicting. It is clear that no addict, especially those with a history of chemical dependency, should take any kind of drug without careful consideration.

PA Members of Pill Addicts Anonymous (PAA) take an especially hard-line stand on prescription drugs. Their Step One says, “We admitted we were powerless over our addiction to pills and all other mind-altering substances — that our lives had become unmanageable.” If taking a hard line on prescription and OTC drugs appeals to you, write or call:

Pill Addicts Anonymous
PillsAnonymous.org

If you need a slightly more liberal approach, or if you have difficulty finding a PAA meeting, contact Narcotics Anonymous (see that module).


Drugs, see also: Addiction, Alcohol, Arousal, Binge history, Biochemistry, Blackouts, Chronic pain, Craving, Flashbacks, Moodifiers, Narcotics Anonymous, Neurotransmitters.

Updated (not including the basic drug info) 6 Sep 2016

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Addictionary 2 by Jan & Judy Wilson

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