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Simple and Practical Mental Health

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General

Potential side effects of psychotropic medications (with handouts for each medication)

Cardiovascular Risk Screening Form

How common are side effects of antidepressants?

Side effects: what’s the big deal?

Side Effects: Test Your Knowledge

How to assess persons who are “sensitive to medications.”

How to manage a person who is “sensitive to medications”

Dose reduction to manage adverse effects

Some medications have a low “therapeutic index”. What’ exactly is that?

Knowledge is power: Effective strategies for educating patients about potential adverse effects

How to identify potentially significant side effects hidden behind “misleading means”

Can medication X cause side effect Y?

What are boxed warnings (so-called “black box warnings”)

What to do about boxed warnings

Some medications have a low “therapeutic index”. What’ exactly is that?

Acne

What is acne vulgaris?

Why should mental health clinicians care about acne?

Lithium and acne: Evaluation and management

Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?

What do published studies on isotretinoin and depression/ suicidality show?

Akathisia

Akathisia: Introduction

Akathisia: Clinical features

Akathisia: Identification and evaluation

Akathisia: Treatment

Mirtazapine may cause akathisia at higher doses

Gabapentin for the treatment of akathisia?

Anticholinergics for the treatment of akathisia?

Amantadine for the treatment of akathisia?

Vitamin B6 for the treatment of akathisia?

Barnes Akathisia Rating Scale

Anticholinergic toxicity

Clinical case: New onset of acute anxiety and physical symptoms

How does toxicity from anticholinergic medications present clinically?

In older adults, avoid medications with anticholinergic activity

Are doxepin’s anticholinergic effects dose-dependent?

Use a rating scale for anticholinergic burden from medications

Bleeding

Are antidepressants that don’t inhibit serotonin uptake less likely to increase the risk of bleeding?

Who is at a higher risk of bleeding with antidepressants?

How do antidepressants increase the risk of bleeding?

Antidepressants and bleeding: When and what to ask

Which antidepressants in patients with a history of, or at higher risk for, bleeding

Are some SSRIs associated with a lesser or greater risk of bleeding?

Antidepressants and risk of stroke

Psychotropic medications and surgery or anesthesia

5-HTTLPR and adverse effects of antidepressants

Antidepressants and degree of inhibition of serotonin reuptake

Blurred vision

Psychotropic medications and blurred vision

Some questions to ask in evaluating a patient with blurred vision

Bruxism

Bruxism

Management of antidepressant-induced bruxism

Cognitive impairment

Proton pump inhibitors and cognitive impairment or dementia

Constipation

Management of clozapine-induced constipation

Diarrhea

Diarrhea due to psychotropic medications

Discontinuation syndromes (withdrawal)

Antidepressant discontinuation (withdrawal): Introduction

Antidepressant discontinuation (withdrawal): Risk factors

Antidepressant discontinuation (withdrawal): Clinical features

Antidepressant discontinuation (withdrawal): Management

Anticholinergic medication for antidepressant discontinuation syndrome?

Antidepressant discontinuation (withdrawal): Duloxetine

How can duloxetine can be tapered very slowly?

Antidepressant discontinuation and “brain zaps”

Dopamine agonist withdrawal syndrome (DAWS)

Cholinergic rebound syndrome

Dizziness (Orthostatic hypotension)

Dizziness/ Orthostatic hypotension

How to correctly measure and interpret orthostatic blood pressure and pulse

Management of orthostatic hypotension: Basic (level 1) strategies

Management of orthostatic hypotension: Intermediate (level 2) strategies

Management of orthostatic hypotension: Advanced (level 3) strategies 

Warning–the patient may faint after the very first dose

Should we use automated blood pressure instruments?

How to correctly measure blood pressure

Dry Mouth (Xerostomia)

Watch out for dry mouth

How to manage dry mouth

Dry mouth (xerostomia) management: pilocarpine “mouthwash”

Edema

Edema

Excessive sweating (Hyperhidrosis)

Antidepressant-Induced Excessive Sweating (ADIES)

Antidepressant-induced excessive sweating (ADIES) or Hyperhidrosis: Clinical features

Antidepressant-induced excessive sweating (ADIES) or Hyperhidrosis: Management

Glaucoma

Psychotropic medication induced glaucoma

Are psychiatric medications safe AFTER laser iridotomy for narrow-angle glaucoma?

Hair loss (Alopecia)

Valproate and hair loss (alopecia)

All about lithium-induced hair loss

How to evaluate suspected medication-induced hair loss

Headache

Lamotrigine and headache

Hyperammonemia (elevated serum ammonia level)

False positive elevation of plasma ammonia 

Valproate (Depakote®) and elevated serum ammonia level (hyperammonemia)

L-carnitine (levocarnitine; Carnitor®): Basic information

Hyperparathyroidism

Lithium induced hyperparathyroidism

How to screen for lithium-induced hyperparathyroidism

Lithium-induced hyperparathyroidism: Management

How to calculate corrected serum calcium

Sensipar® (cinacalcet) Prescribing Information

Hyperprolactinemia

Can buspirone cause increased prolactin or galactorrhea?

How to measure and interpret serum prolactin

How exactly to add aripiprazole for hyperprolactinemia

Hypersalivation (Sialorrhea)

Clozapine-induced hypersalivation (sialorrhea)

Clozapine-induced hypersalivation (sialorrhea): Treatment

Hypertension (Increased blood pressure)

Key facts about increased blood pressure on venlafaxine

Hyponatremia

Hyponatremia due to psychotropic medications

How common is new-onset hyponatremia during antidepressant treatment?

How to diagnose SIADH

Does medication-induced hyponatremia change lithium blood levels?

Insomnia

MAO inhibitor-induced insomnia

Kidney Stones

Warning! Topiramate can cause kidney stones

Liver damage

Antidepressants can injure the liver, some more than others

How to use antidepressants in persons with liver disease

Disulfiram and liver toxicity

False positive elevation of plasma ammonia

When and how often should hepatic function tests be done in patients on disulfiram?

Loss of appetite (Anorexia)

Tips on managing loss of appetite due to a stimulant (in adults)

Metabolic Acidosis

Metabolic acidosis

How to monitor for possible metabolic acidosis

What is the anion gap and how can we easily calculate it from the lab results?

Topiramate and metabolic acidosis

How to manage metabolic acidosis due to topiramate

Myocarditis

Another very serious side effect of clozapine that we should know about

Nausea

Medication-induced nausea: Introduction

Medication-induced nausea: Level 1 (basic) strategies for prevention and management

Medication-induced nausea: Level 2 (intermediate) strategies for prevention and management

Ginger for medication-induced nausea

Ondansetron (Zofran®), QT prolongation, and psychotropic medications

Oral sores

Oral sores in a patient on lamotrigine 

Pancreatitis

Valproate-induced pancreatitis

Parkinsonism

Can we prevent antipsychotic-induced parkinsonism?

Does dose reduction work for neuroleptic-induced parkinsonism?

Amantadine for antipsychotic-induced parkinsonism

Pharmacogenomics of side effects

Serotonin transporter promoter region

Serotonin transporter linked polymorphic region (5-HTTLPR)

5-HTTLPR and efficacy of antidepressants

5-HTTLPR and adverse effects of antidepressants

5-HTTLPR and antidepressant-induced mania

Serotonergic receptors

Serotonin 2A receptor gene (HTR2A) polymorphisms and adverse effects

HTR2C polymorphisms and medication-induced weight gain

Blood-brain barrier/ P-glycoprotein

ABCB1 polymorphisms and psychotropic medications

Cytochrome P450 enzymes

Pharmacogenetic testing: Cytochrome P450 enzymes

HLA gene testing

HLA antigens and psychotropic drugs

Melanocortin 4 receptor (MC4R)

Melanocortin 4 receptor (MC4R) and weight gain

Commercially-available pharmacogenomic tests

(listed alphabetically)

CNSDose® (CNSDose, LLC)

Genecept assay® (Genomind, LLC)

GeneSight® pharmacogenomic test batteries (Assurex Health)

Commercially available pharmacogenomic test panels

Polyuria/ Diabetes Insipidus

Lithium-induced polyuria and diabetes insipidus

Lithium-induced polyuria and diabetes insipidus: Evaluation

Lithium-induced polyuria and diabetes insipidus: Treatment

Priapism

Trazodone and priapism

Medication-induced priapism of the clitoris

Psychiatric and Behavioral Side Effects

Can lamotrigine cause psychiatric side effects?

QT prolongation and other ECG changes

Lithium’s effects on the electrocardiogram (ECG, EKG)

What to do about the risk of arrhythmias with lamotrigine.

Antipsychotics and QTc prolongation

Antibiotics, antipsychotics, and QTc prolongation

Doesn’t escitalopram cause QTc prolongation?

How to look up whether a drug can cause QTc prolongation or torsades

Three SSRIs that may cause QT prolongation

Can mirtazapine increase the risk of QT prolongation?

Do modafinil/ armodafinil need cardiovascular monitoring?

  Rash (see “Skin reactions”)

Raynaud's phenomenon or syndrome

Can psychostimulant medications cause Raynaud’s syndrome?

Renal impairment

Lithium-induced renal impairment: Clinical recommendations

Case: Rising serum creatinine in a patient on lithium

Case: Elevated serum creatinine that remained stable for many years

Which preparation of lithium is less likely to harm the kidneys?

Seizures

Antidepressants and seizures

Bupropion and seizures: the facts and the myths

Is a history of seizures in early childhood a contraindication to using bupropion?

What factors can increase the risk of seizures with bupropion?

Key information about seizures with clozapine

Transcranial Magnetic Stimulation (TMS): Risk of seizures

Sexual adverse effects

Sexual dysfunction

How often does antidepressant-induced sexual dysfunction resolve spontaneously?

Trazodone and priapism

Arizona Sexual Experiences Scale (ASEX)

An introduction to the Changes in Sexual Functioning Questionnaire (CSFQ)

How to administer, score, and interpret the Changes in Sexual Functioning Questionnaire (CSFQ)

Which laboratory tests in men with erectile dysfunction?

How to reduce the risk of erectile dysfunction

Management of sexual dysfunction: Interview with Anita Clayton, MD

Which PDE-5 inhibitor for erectile dysfunction?

How long before sexual activity should PDE-5 inhibitors be taken?

Beta blockers can worsen or improve erectile dysfunction

Cyproheptadine (Periactin®) for antidepressant-induced sexual dysfunction (ADISD)?

Does bupropion treat antidepressant-induced sexual dysfunction?

Skin reactions

Acne is a potential side effect of lithium

Rash, irritation, or itching with transdermal patches

How common are benign and serious rashes with lamotrigine?

Dermatological precautions when starting lamotrigine

Restarting lamotrigine

Restarting lamotrigine: how many days? 

Warning-this could happen if we are not careful (Restarting lamotrigine)

Is it a benign or dangerous skin rash?

Non-drug causes of Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

Do past infections increase the risk of Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)?

What to do about skin rash on SSRIs

Also see: Oral sores in a patient on lamotrigine 

Tardive dyskinesia

How EXACTLY to screen for tardive dyskinesia

Does any atypical antipsychotic have a lower risk of tardive dyskinesia?

Management of tardive dyskinesia: First-line options

Management of tardive dyskinesia: Second-line options

Comparing the VMAT2 inhibitors

Valbenazine (Ingrezza®) and VMAT2

An Expert answers YOUR questions about tardive dyskinesia

Is TD less likely with second-generation (“atypical”) antipsychotics?

Is tardive dyskinesia reversible if the antipsychotic is stopped?

 Valbenazine (Ingrezza®): Basic information

Deutetrabenazine (Austedo®): Basic Information

Abnormal Involuntary Movement Scale

Abnormal Involuntary Movement Scale (AIMS): Examination procedure

Abnormal Involuntary Movement Scale (AIMS): Scoring instructions

Antidepressant-induced tardive dyskinesia

Thyroid dysfunction

An introduction to lithium-induced hypothyroidism

How common is lithium-induced hypothyroidism?

What are the risk factors for lithium-induced hypothyroidism?

How should lithium-induced hypothyroidism be evaluated?

How should lithium-induced hypothyroidism be managed? 

Tinnitus

Why tinnitus is important for mental health clinicians

Key things to ask about if a patient complains of tinnitus

Tinnitus associated with antidepressant medications

Tremors

Medication-induced tremors: An overview

How to examine a person with tremors

How to monitor change in the severity of a tremor

Lithium-induced benign tremor: Introduction

Lithium-induced benign tremor: Clinical features

Lithium-induced benign tremor: Evaluation

Lithium-induced benign tremor: Treatment

Beta-blockers for lithium-induced benign tremor

Antiepileptic medications for lithium-induced benign tremor?

Vitamin B6 for lithium-induced benign tremor?

Urinary hesitancy/retention

Urinary hesitancy or retention due to atomoxetine

How to manage medication-induced urinary hesitancy/retention.

Urinary incontinence

Can antidepressants cause urinary incontinence?

Weight gain/Metabolic adverse effects

Monitoring for metabolic side effects in patients on a second-generation (atypical) antipsychotic

Monitoring for metabolic side effects in children and adolescents on a second-generation (atypical) antipsychotic

Do adolescents have more metabolic side effects with second-generation antipsychotics?

Does weight gain with second-generation (atypical) antipsychotics plateau after the first few months?

Metformin to prevent or treat metabolic adverse effects due to antipsychotics

Who is more likely to benefit from metformin for management of metabolic adverse effects?

Metformin for antipsychotic-induced weight gain in children and adolescents?

Potential adverse effects of metformin

Tips on prescribing metformin

How long does antipsychotic-induced hyperglycemia take to resolve?

Resolution of hyperglycemia after switching to aripiprazole

Can we use topiramate to treat medication-induced weight gain?

Metformin and topiramate for metabolic adverse effects?

Can melatonin increase blood sugar?

HTR2C polymorphisms and medication-induced weight gain

Melanocortin 4 receptor (MC4R) and weight gain

Side effects references

Side effects: References

Comments

  1. Chinmay Kulkarni says

    Hello Sir, Can you please also cover Headache as a side effect. What should be the strategy if patients starts getting headache as side effect?

    Reply

  2. Mumbi Kairu says

    Can you please cover rhabdomyolysis and schizophrenia treatment after a patient has had rhabdomyolysis due to psychotropics? What psychotropics are more favorable and not to be given after? Thank you

    Reply

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