Pills for mental disorders: a list of drugs and instructions for use. Means for the treatment of mental illness and neurosis (psychotropic drugs)

Psychotropic drugs are aimed at changing the mental and emotional state of a person.

Depending on the effects they have and the mechanisms of their action, all psychotropic drugs can be divided into several main groups.

Antipsychotics

Antipsychotics, or otherwise antipsychotics, are used to treat psychosis, mania, schizophrenia. The main property of antipsychotic drugs is their ability to eliminate hallucinations and delusions in patients with these disorders.

Especially often antipsychotics are used to treat schizophrenia - a disease characterized by significant thinking disorders, inadequate perception of the world around with accompanying hallucinations and delusions.

This group of drugs includes derivatives of phenothiazine (chlorpromazine, etc.), butyrophenone (haloperidol, droperidol), thioxanthene (chlorprothixene).

The so-called atypical antipsychotics include clozapine, olanzapine, risperidone, aripiprazole and others.

Antidepressants

The main property of antidepressants is the elimination of signs of a depressive state: depression, dreary mood, feelings of despair, self-blame. Antidepressants must be used in a course, their main effect, as a rule, is delayed in time and manifests itself after 2-3 weeks of use. According to the type of action, antidepressants are divided into several classes.

• Inhibiting the reuptake of monoamines. This group includes tricyclic antidepressants (imipramine, amitriplitine), which prevent the uptake of serotonin and norepinephrine, as well as selectively disrupt the uptake of serotonin (fluoxetine, citalopram, paroxetine) and norepinephrine (maprotiline).
• MAO inhibitors. Non-selective MAO inhibitors (nialamide, phenelzine, transamine) and MAO-A inhibitors (moclobemide).
• Atypical antidepressants: mirtazapine, nomifeshine, venlafaxine, nefazadone.

Tranquilizers (anxiolytics)

Anxiolytics - psychotropic substances used to treat anxiety disorders. They reduce the feeling of fear, anxiety, eliminate emotional tension and anxiety.

The most common drugs in this group are benzodiazepine derivatives: diazepam, chlordiazepoxide, alprazolam, oxazepam.

Psychostimulants

Psychostimulants - a group of psychoactive substances that improve mental activity, increase concentration and increase efficiency, as well as give a feeling of vivacity and a burst of energy and temporarily reduce the need for sleep.

A powerful psychostimulant is, for example, amphetamine, but due to side effects and the development of dependence, its use is limited. In practice, the drug mesocarb (sidnocarb) is more often used. In addition, caffeine has a psychostimulating effect.

Sedatives

A group of drugs of synthetic and herbal origin that have a general calming effect, as well as reduce irritability and improve sleep.

Sedatives include bromides (sodium and potassium), preparations of valerian and motherwort, and benzodiazepines also have a sedative effect. Combined sedatives include corvalol, valocordin, validol, ankylosing spondylitis.

Nootropics

Nootropics - drugs that stimulate metabolic processes in the brain and have an antihypoxic effect. In some patients, nootropics improve memory, increase learning ability, prevent hypoxia, and improve blood circulation. Nootropics: piracetam, glycine, GABA, semax, ginkgo biloba and others.

Drugs that selectively affect the complex mental functions of a person, regulating his emotional state, motivation, behavior and psychomotor activity, are referred to as psychotropic drugs. These drugs are used mainly for the treatment and prevention of mental disorders, as well as somatic diseases. Classification of psychotropic drugs:

1) neuroleptics;

2) anxiolytic sedatives;

3) antidepressants;

4) psychostimulants;

5) psychodysleptics.

From a practical point of view, drugs are divided into the following groups:

1) neuroleptics;

2) tranquilizers;

3) sedatives;

4) antidepressants;

5) psychostimulants.

Antipsychotics (antipsychotics).

Antipsychotics differ from sedatives in the presence of antipsychotic activity, the ability to suppress delusions, hallucinations, automatism and other psychopathological syndromes and to have a therapeutic effect in patients with schizophrenia and other mental illnesses. They do not have a pronounced sleeping pill, but they contribute to the onset of sleep; enhance the effect of sleeping pills and other sedatives; potentiate the action of drugs, analgesics, local anesthetics and weaken the effects of psychostimulant drugs. They are characterized by antiemetic, hypotensive, antihistamine and other effects.

Derivatives of phenothiazines.

Aminazine(Aminazinum).

It has a pronounced sedative effect, as well as antiemetic, antihistamine, hypotensive, enhances the effect of sleeping pills, painkillers.

Application: mental illness accompanied by psychomotor agitation is taken orally after meals at 0.025-0.05 1-3 times a day. In / m enter 1-5 ml of a 2.5% solution. In / in 2-3 ml (with 20 ml of 40% glucose solution) slowly with psychomotor agitation. Doses for children are individual.

Side effects: hypotension, extrapyramidal disorders, allergic reactions, dyspepsia, hepatitis.

Contraindications: diseases of the liver and kidneys, hypotension, cardiovascular decompensation, dysfunction of the stomach.

Release form: dragee 0.025 No. 30; 0.05 No. 30; tablets 0.01 No. 50 for children; 2.5% solution, 1 ml. List B.

Tizercin(Tisercin).

Indications. Psychomotor agitation, psychosis, schizophrenia, depression and neurotic reactions with a sense of fear, anxiety, insomnia. Taken orally at 0.025-0.4 g per day; i / m 2-4 ml of a 2.5% solution; if necessary - up to 0.5–0.75 g.

Side effects: extrapyramidal disorders, vascular hypotension, dizziness, constipation, dry mouth, allergic reactions.

Contraindications: diseases of the liver, hematopoietic system; hypotension, decompensation of the cardiovascular system.

Release form: dragee 0.025 g No. 50; 1 ml ampoules of 2.5% solution No. 10. List B.

Etaperazine(Aethaperazinum, Perphenazini hydrocloridum).

It is more active than chlorpromazine in its antiemetic effect and in its ability to soothe hiccups.

Application: neurosis accompanied by fear, tension, indomitable vomiting and hiccups, vomiting of pregnant women, skin itching in dermatology.

Mode of application: taken orally in the form of tablets after meals. For taking doses - 0.004-0.01 1-2 times a day. When excited, the daily dose can be - 30-40 mg. The course of treatment is from 1 to 4 months. Maintenance therapy 0.01–0.06 per day.

the same as for chlorpromazine.

Release form: coated tablets, 0.004 each; 0.006 and 0.01 No. 50, No. 100, No. 250. List B.

Moditen, fluorophenazine(Moditen, Phthorphenazinum).

It is similar in structure to etapirazine and has a strong antipsychotic effect, combined with some activating effect. The sedative effect is moderately pronounced. In terms of its effect on delusions and hallucinations, it is less active than triftazin.

Application: various forms of schizophrenia, depressive-hypochondriac states. Small doses in neurotic conditions, accompanied by fear and tension.

Mode of application: taken orally starting from 0.001-0.002 g per day and gradually increasing the dose to 10-30 mg per day (in 3-4 doses at intervals of 6-8 hours). Maintenance therapy - 1-5 mg per day; i / m is administered starting from 1.25 mg (0.5 ml of a 0.25% solution) to 10 mg per day.

Side effects: convulsive reactions, extrapyramidal disorders, allergic phenomena.

Contraindications: acute inflammatory diseases of the liver, diseases of the cardiovascular system with severe decompensation, acute blood diseases, pregnancy.

Release form: tablets 1; 2.5 and 5 mg; ampoules of 1 ml of a 0.25% solution. List B.

Moditen-depot, Fluorphenazine-decanoate(Phthorphenazinum decanoate).

A strong antipsychotic with a prolonged action, the drug after a single intramuscular injection acts depending on the dose up to 1-2 weeks or more.

Application: the same as that of moditen, convenient for patients who find it difficult to prescribe neuroleptics in the usual form.

Dosage and administration: appoint i / m at 12.5-25 mg, and sometimes 50 mg (0.5-2 ml of a 2.5% solution) 1 time in 1-3 weeks.

Side effects: parkinsonism, akathisia, tremor of fingers. To prevent and stop these phenomena, cyclodol or other antiparkinsonian drugs are taken.

Contraindications: The same.

Release form: in 1 ml ampoules of a 2.5% solution in oil (25 mg in 1 ampoule).

Stelazin(Stelazine).

Active antipsychotic agent.

Application: schizophrenia and other mental illnesses that occur with delusions and hallucinations.

Mode of application: taken orally at 0.005, followed by an increase in dose by an average of 0.005 per day (average therapeutic dose of 0.03-0.05 g per day); 1–2 ml of a 0.2% solution is injected intramuscularly.

Side effects: extrapyramidal disorders, vegetative disorders, in some cases toxic hepatitis, agranulocytosis and allergic reactions.

Contraindications: diseases of the liver and kidneys, heart disease with impaired conduction and in the stage of decompensation, pregnancy.

Release form: coated tablets, 0.005 and 0.01 g No. 50; 10 ml ampoules of 0.2% solution No. 10; 0.5% solution No. 12.

Haloperidol(Haloperidol).

Neuroleptic with a pronounced antipsychotic effect.

Application: schizophrenia, manic, hallucinatory, delusional states, acute and chronic psychoses of various etiologies, in complex therapy.

Mode of application: take orally 0.002-0.003 g per day, intramuscularly and intravenously, 1 ml of a 0.5% solution is injected.

Side effects: extrapyramidal disorders. Drowsiness.

Contraindications: CNS diseases, depression, cardiac conduction disorders, liver and kidney diseases.

Release form: tablets of 0.0015 and 0.005 g No. 50; 1 ml ampoules of 0.5% solution No. 5; vials of 10 ml of a 0.02% solution. List B.

Droperidol(Droperidolum).

This antipsychotic has a fast, strong, but short-lived effect.

Possesses antishock and antiemetic action.

It lowers blood pressure, has an antiarrhythmic effect, and has a strong cataleptic activity.

Application: psychomotor agitation, hallucinations, relief of hypertensive crises; in anesthesiology in combination with the analgesic fentanyl for premedication, during the operation itself and after it. Administered intravenously for 30-60 minutes for premedication and neuroleptanalgesia (before surgery) 2.05-10 mg (1-4 ml of 0.25% solution) together with 0.05-0.1 mg (12 ml of 0.005% - ny solution) of fentanyl or 20 mg (1-2% solution) of promedol. At the same time, 0.5 mg (0.5 ml of a 0.1% solution) of atropine is administered. Apply only in a hospital setting.

Side effects: possibly lowering blood pressure and respiratory depression.

Contraindications: severe atherosclerosis, conduction disorders of the heart muscle, diseases of the cardiovascular system.

Release form: ampoules of 5 and 10 ml of a 0.25% solution (12.5 or 25 mg; 2.5 mg in 1 ml). List A.

Derivatives of thioxanthene.

Chlorprothixene(Chlorprothixen).

It has antipsychotic, antidepressant and sedative effects.

Application: depression with anxiety symptoms, alcoholic delirium, sleep disturbance, somatic diseases with neurosis-like disorders, pruritus. Take orally 0.025-0.05 g 3-4 times a day, if necessary - 0.6 g per day with a gradual dose reduction.

Side effects: hypotension, dry mouth, drowsiness, tachycardia, blurred vision, dizziness, pruritus.

Contraindications: alcohol and barbiturate poisoning, epilepsy, parkinsonism, old age, heart disease.

Release form: tablets of 0.015 and 0.05 g No. 50. List B.

Derivatives of the benzamide series.

Prosulpin(Prosulpin).

Blocks dopamine receptors in the brain, causes an antipsychotic effect.

It has antidepressant, antiemetic and disinhibitory effects.

Application: psychosis, depression, neurotic conditions, migraine.

Mode of application: take orally 200-600 mg per day (in 2-3 doses). M.S.D. - 2 years

Side effects: dizziness, sleep disorders, mental agitation, dry mouth, constipation, vomiting, hypertension.

Contraindications: pheochromocytoma, arterial hypertension, pregnancy, epilepsy.

Release form: tablets 200 mg No. 30.

Leponex(Leponex).

It has a pronounced antipsychotic and sedative effect.

Application: schizophrenia.

Mode of application: taken orally in several doses; the average dose is 300 mg per day, the maximum - 600 mg per day, maintenance - 150-300 mg per day.

Side effects: drowsiness, fatigue, headache, dizziness, tachycardia, hypotension, nausea, vomiting, constipation, urination disorders.

Contraindications: agranulocytosis, severe liver and kidney disease, coma, toxic psychosis, heart disease.

Release form: tablets of 25 and 100 mg No. 50; ampoules of 2 ml (50 mg in solution for injection) No. 50.

Tranquilizers (anxiolytics)

Tranquilizers (anticonvulsants) are synthetic substances that reduce the feeling of fear, anxiety, internal tension, but at the same time activate positive emotions.

The main representatives are benzodiazepine derivatives that act on specific receptors localized in the limbic system and hypothalamus, used in the treatment of neurotic and borderline conditions; sleep disorders; diseases of the cardiovascular system.

Substances that do not have hypnotic, muscle relaxant and anticonvulsant properties that do not reduce attention and performance are called daytime tranquilizers.

Benzodiazepines.

Sibazon(Sibazonum).

Synonyms: diazepam, seduxen; has a pronounced tranquilizing effect; relatively strong anticonvulsant activity, antiarrhythmic action.

Application: neurotic and neurosis-like states; normalization of sleep; in combination with other anticonvulsants for the treatment of epilepsy; withdrawal syndrome in alcoholism; preoperative preparation of patients; itchy dermatoses; as a sedative and sleeping pill for peptic ulcer patients.

Mode of application: appoint inside starting with a dose of 0.0025-0.005 g 1-2 times a day. A single dose for adults is from 0.005 to 0.015 g, for children 0.002-0.005 g. The daily dose should not exceed 0.025 g in 2-3 doses.

Side effects: drowsiness, nausea, dizziness, menstrual disorders, decreased libido.

Contraindications: acute diseases of the liver and kidneys, severe myasthenia gravis, pregnancy; alcohol intake.

Release form: tablets 0.005 g No. 50, 0.001 and 0.002 No. 20. List B.

Xanax(Xanax).

The active substance is alprazolam. Reduces anxiety, feelings of anxiety, fear, tension. It has antidepressant properties, central muscle relaxant and moderate hypnotic activity.

Application: a state of fear and anxiety; neurotic and reactive depressions; depression that developed against the background of somatic diseases. In states of anxiety, take orally 250 mcg 3 times a day.

The average maintenance dose is 500 mcg (4 mg per day in divided doses); with depression - 500 mcg 3 times a day; if necessary - up to 1-4 mg per day. Cancel the drug to produce gradually.

Side effects: drowsiness, dizziness, urinary retention or incontinence, changes in body weight.

Release form: tablets of 250 and 500 mcg, 1, 2, 3 mg No. 30.

Tranxen(Tranzene).

The active substance is dipotassium clorazepate. It has a sedative, anticonvulsant and muscle relaxant effect.

Application: same as xanax; for the prevention of delirium in patients with alcoholism.

Mode of application: appoint inside 25-100 mg per day.

Side effects: drowsiness, muscle weakness, nausea, vomiting.

Contraindications: respiratory failure, pregnancy.

Release form: capsules of 5 and 10 mg No. 30.

Phenazepam(Phenazepanum).

It has a pronounced hypnotic, tranquilizing, hypnotic and muscle relaxant effect.

Application: same as xanax.

Mode of application: take orally 0.0005-0.001 g to 0.002-0.005 g 2-3 times a day.

Side effects: the same.

Contraindications: severe myasthenia gravis, impaired liver and kidney function, pregnancy, work that requires a quick reaction, alcohol poisoning, sleeping pills.

Release form: tablets 0.0005 and 0.001 No. 50; 1 ml ampoules of 3% solution No. 10.

This group also includes chlosepid ( Chlozepidum), or elenium, nozepam ( nozepamum), their synonyms are tazepam, oxazepam. As a daytime tranquilizer - mezapam ( Mezapamum), synonym - rudotel. Its calming effect is combined with some activating effect. On an outpatient basis, adults are prescribed in the morning and at noon at 0.005, in the evening - at 0.01. The maximum dose is 0.06-0.07 g.

Contraindications: the same as for other drugs in this group.

These are natural and synthetic substances that eliminate hyperexcitability, irritability. The main mechanism of action is an increase in the processes of inhibition or a decrease in the processes of excitation, providing a regulatory effect on the functions of the central nervous system. They enhance the effect of sleeping pills, analgesics and other neurotropic sedatives, facilitate the onset of natural sleep and deepen it. It is used to treat a mild degree of neuroses, neurasthenia, the initial stage of hypertension, neuroses of the cardiovascular system, spasms of the gastrointestinal tract. Sedatives include bromides and preparations derived from plants.

Sodium bromide(Sodium bromide).

It has the ability to concentrate and enhance the processes of inhibition in the cerebral cortex, to restore the balance between the processes of excitation and inhibition.

Application: neurasthenia, hysteria, irritability, insomnia, initial forms of hypertension, as well as epilepsy and chorea. Assign inside before meals in solutions (potions). The dose for adults is from 0.1 to 1 g 3-4 times a day, in the form of a 3% solution - 1-2 tbsp. l. at night or 2-3 times a day.

Side effects: bromism, which is expressed in the form of a runny nose, cough, general lethargy, memory loss, skin rash and conjunctivitis. In this case, with a large amount of sodium chloride (10-20 g per day) and water (3-5 liters per day), you need to rinse your mouth and wash your skin often, empty your intestines regularly.

Release form: powder from which solutions and mixtures are prepared.

Bromocamphor(Bromcamphora).

Indications, application: the same as sodium bromide, but also improves cardiac activity.

Release form: powders and tablets of 0.15 and 0.25.

Belloid(Belloid).

Combined drug that has a calming and adrenolytic effect.

Application: disorders of the autonomic nervous system, insomnia, increased irritability. Assign inside 1 tablet 3-4 times a day.

Side effects: nausea, vomiting, diarrhea, dry mouth.

Release form: dragees in a package of 50 pieces.

This group also includes the drug bellataminal ( Bellataminalum), which is also used for neurodermatitis and climacteric neuroses.

Contraindications: pregnancy, glaucoma.

The group of sedatives includes magnesium sulfate(Magnesii sulfas), is available in the form of powders and ampoules; solution of 25%, 5 and 10 ml. When administered parenterally, it has a calming effect on the central nervous system. Depending on the dose, a sedative, hypnotic or narcotic effect is observed. It has a choleretic effect, in large doses it has a curare-like effect.

Application: as a sedative, laxative, anticonvulsant, antispasmodic, choleretic, for the treatment of hypertension in the initial stage and for the relief of hypertensive crises; for labor pain relief. In magnesium sulfate poisoning, calcium chloride is used.

Rhizome with valerian roots(Rhizoma cum radicibus Valerianae).

Valerian preparations reduce the excitability of the central nervous system, enhance the effect of sleeping pills, and have an antispasmodic effect.

Application: increased nervous excitability, insomnia, cardioneurosis, spasms of the gastrointestinal tract. Assign inside an infusion of 20 g of root per 200 ml of water, 1 tbsp. l. 3-4 times a day; tincture with 70% alcohol in vials of 20-30 drops 3-4 times a day; thick extract in tablets of 0.02-0.04 per dose.

Release form: rhizome with valerian roots, 50 g per pack; in briquettes of 75 g; tincture of 30 or 40 ml; thick extract in tablets of 0.02 No. 10 and No. 50.

This group includes preparations from motherwort herb ( Herba Leonuri), passionflower herbs ( Herba Passiflorae) and peony tinctures ( Tinctura Paeoniae).

Also apply herbal medicines of combined action.

Novopassit(Novo Passit).

Combined preparation consisting of a complex of extracts of medicinal plants and guaifenesin.

Application: mild forms of neurasthenia, sleep disorders, headaches caused by nervous tension. I take 1 tsp inside. (5 ml) 3 times a day, up to 10 ml per day.

Side effects: dizziness, lethargy, drowsiness, nausea, vomiting, diarrhea, pruritus, constipation.

Contraindications: myasthenia gravis, hypersensitivity to the components of the drug.

Release form: solution of 100 ml in a vial.

This group also includes the drug phytosed 100 ml.

Application: the same as that of the novopassitis.

Corvalol(Corvalolum) is similar to the imported product valocordin(Valocardinum), belongs to the group of combined drugs. Valocordin also includes hop oil, which enhances the effect. Both drugs have a mild hypnotic effect, reflex and vasodilating and antispasmodic activity, but valocordin acts more strongly.

Application: neuroses, states of excitation, functional disorders of the cardiovascular system. Assign inside 15-20 drops, with tachycardia and spasms - up to 40 drops.

Side effects: in some cases, drowsiness and slight dizziness can be observed, with a decrease in the dose, these phenomena disappear.

Release form: corvalol 15 ml; valocordin 20 and 50 ml.

This group also includes the drug valocormide(Valocormidum). Combined drug, which also includes sodium bromide.

Application: same as Corvalol.

Side effects and contraindications: like sodium bromide. Produced in bottles of 30 ml.

These are medicinal substances that eliminate the symptoms of depression in neuropsychiatric and somatic patients. In most cases, drug interaction occurs at the level of synaptic neurotransmission. Moreover, some antidepressants block the metabolic pathways for the destruction of neurotransmitters (norepinephrine, serotonin, dopamine), while others block their reuptake by the presynaptic membrane. Antidepressants are divided into the following groups: monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic, selective serotonin reuptake inhibitors, combined and transient antidepressants and normothymic agents.

Tricyclic and tetracyclic antidepressants.

Imizin(Imizinum).

Synonym: Melipramin. The main representative of this group. It inhibits the reverse neuronal uptake of monoamines - neurotransmitters.

Application: depressive conditions of various etiologies, neutrogenic enuresis in children. Assign inside from 0.075-0.1 g per day (after meals), gradually increasing the dose to 0.2-0.25 g per day. The course of treatment is 4-6 weeks. 0.025 g 1-4 times a day - maintenance therapy. In a hospital with severe depression, 2 ml of a 1.25% solution are injected intramuscularly, 1-3 times a day. V. R. D. inside - 0.1, V. S. D. - 0.3 g, intramuscular single - 0.05, daily - 0.2 g.

Side effects: headaches, sweating, dizziness, palpitations, dry mouth, disturbance of accommodation, urinary retention, delirium, hallucinations.

Contraindications: monoamine oxidase inhibitors, thyroid drugs, acute diseases of the liver, kidneys, hematopoietic organs, glaucoma, cerebrovascular accidents, infectious diseases, prostate adenoma, atony of the bladder. Careful use is required for epilepsy, in the 1st trimester of pregnancy.

Release form: tablets of 0.025 g and 1.25% solution in ampoules of 2 ml. List B.

Amitriptyline(Amitriptylinum).

In structure and action, it is close to imizin.

Application: the same as imizin.

Side effects: the same, but unlike imizin does not cause delirium, hallucinations.

Release form: dragee 25 mg No. 50; injection solution of 2 ml in ampoules No. 10 (1 ml contains 10 mg of the active substance).

Maprotiline(Maprotilinum).

Synonym: Ludiomil. Enhances the pressor action of norepinephrine, selectively inhibits the capture of norepinephrine by presynaptic nerve endings. It has a moderate tranquilizing and anticholinergic activity.

Application: depression of various etiologies; appoint inside 25 mg 3 times a day with a gradual increase in dose to 100-200 mg per day. With intravenous drip, the daily dose is 25-150 mg.

Side effects: the same as for imizin and amitriptyline.

Contraindications: the same as imizin and amitritriptyline.

Release form: dragee 10, 25, 50 mg No. 50, solution for injection in ampoules of 2 ml No. 10.

monoamine oxidase inhibitors.

The action is manifested in the inhibitory effect on the deamination of monoamines. There are inhibitors of irreversible and reversible action, the latter being non-selective and selective action (type A).

Aurorix(Aurorix).

Antidepressant, reversible type A inhibitor.

Application: depressive syndromes. Take orally 150 mg 2 times a day after meals, if necessary - up to 600 mg per day.

Side effects: dizziness, sleep disturbances and others characteristic of antidepressants.

Contraindications: childhood, acute cases of confusion.

Release form: 150 and 300 mg film-coated tablets, No. 30.

Selective serotonin reuptake inhibitors.

fluoxetine(Fluozetine).

Application: depression of various origins, obsessive thoughts. Take orally 1 capsule (20 mg per day in the morning). M. S. D. - no more than 80 mg.

Side effects and contraindications: the same as other antidepressants.

Release form: capsules, tablets of 20 mg No. 14 and 28.

Combined and transitional antidepressants.

Amixid(Amixid).

A combination drug of amitriptyline and chlordiazepoxide.

Application: depression of various origins with anxiety syndrome. Assign inside 1 tablet 2-3 times a day, if necessary - up to 6 tablets per day.

Side effects: the same as other antidepressants.

Contraindications: acute period of myocardial infarction, simultaneous administration of MAO inhibitors.

Release form: tablets in package number 100.

Heptral(Heptral).

Antidepressant and hepatoprotector.

Application: depression, liver disease, withdrawal syndrome.

Average doses - 1200-1600 mg per day; IV drip or IM 200-400 mg.

The course of treatment is 2-3 weeks.

Side effects: discomfort in the epigastric region, sleep disturbance.

Release form: tablets No. 20. Lyophilized dry substance for injection in a vial in combination with a solvent, 5 pieces per pack.

lithium carbonate(Lithii carbonas).

Prevents the development of the depressive phase of psychosis. Mechanism of action: inhibits the transmembrane transfer of sodium ions, which stabilize the membrane of the nerve cell and increase its excitability; accelerates the metabolism of norepinephrine, reduces the level of serotonin, increases the sensitivity of brain neurons to dopamine.

Application: manic and hypomanic states of various origins, chronic alcoholism. For medicinal purposes, from 0.6–0.9 g per day, gradually increasing the dose, bring it to a daily dose of 1.5–2.1 g, sometimes up to 2.4 g, making sure that the concentration of lithium in the blood does not exceed 1 .6 µv/l.

After the disappearance of manic symptoms, the daily dose is gradually reduced.

Can be taken simultaneously with antipsychotics and antidepressants.

It is necessary to control the water-salt balance.

Side effects: dyspeptic disorders, a temporary increase in body weight, increased thirst are possible.

Contraindications: kidney and cardiovascular disorders, pregnancy, salt-free diet.

Release form: tablets 0.3 No. 10.

kontemnol(Contemnol).

Application: manic-depressive psychosis, psychopathy, chronic alcoholism, migraine. The average oral dose is 1 g per day for 1 dose.

Side effects and contraindications: like a lithium preparation.

Release form: retard tablets 500 mg No. 100.

These are means that can affect the mental functions of a person (memory, behavior, emotions, etc.), and therefore they are used for mental disorders, neurotic and neurosis-like disorders, states of internal tension, fear, anxiety, restlessness.

CLASSIFICATION OF PSYCHOTROPIC DRUGS

1) Sedatives.

2) Tranquilizers.

3) Antipsychotics.

4) Anti-manic.

5) Antidepressants.

Let's start the analysis of this group of drugs with sedatives.

Sedatives are sedatives. Sedatives (sedatives) include:

1) small doses of barbiturates,

2) salts of bromine and magnesium,

3) preparations of plant origin (valerian, motherwort, passionflower herbs, etc.).

All of them, causing a moderately calming effect, have an indiscriminate, slightest, depressing effect on the cerebral cortex. In other words, sedatives enhance inhibitory processes in the neurons of the cerebral cortex.

Of the bromine salts, SODIUM BROMIDE and POTASSIUM BROMIDE are most commonly used. Valerian preparations are widely used in the form of infusions, tinctures, extracts.

Motherwort herb preparations are also sedatives. Use infusion and tincture of motherwort. Passiflora preparation - Novopassit. Common hop infusions, Quater's mixture (valerian, bromides, menthol, etc.), magnesium ions (magnesium sulphate).

Indications for use: sedatives are used for neurasthenia, hysteria, mild forms of neuroses, increased irritability, insomnia associated with this.

The second group of drugs from psychotropic drugs is a group of tranquilizers. Tranquilizers are modern sedatives with a selective effect on the emotional sphere of a person. The term tranquilizers comes from the Latin tranquillium - tranquility, peace. The psychotropic effect of tranquilizers is mainly associated with their effect on the libetic system of the brain. In particular, tranquilizers reduce the spontaneous activity of hippocampal neurons. At the same time, they have a depressing effect on the hypothalamus and the activating reticular formation of the brain stem. Acting in this way, tranquilizers are able to reduce the state of internal tension, anxiety, fear, fear.

Based on this, this group of drugs is also called anxiolytics. The fact is that the Latin term anxius- or English "anxious" is translated as "anxious, full of fear, fear", and the Greek lysis - dissolution.

Therefore, in the literature, the term anxiolytics is used as a synonym for the concept of tranquilizers, that is, means that can reduce the state of internal stress.

Due to the fact that these funds are mainly used to treat patients with neurosis, they have their third main name, namely, anti-neurotic drugs.

Thus, we have three equivalent terms: tranquilizers, anxiolytics, anti-neurotic agents, which we can use as synonyms. You can also find synonyms in the literature: small tranquilizers, psychosedatives, ataractics.

Of the tranquilizers used in medical practice, benzodiazepine derivatives are the most widely used, since they have a wide range of therapeutic effects and are relatively safe.

SIBAZON (Sibazonum; in the table at 0.005; in amp. 0.5% solution of 2 ml); synonyms - diazepam, seduxen, relanium, valium. Preparations of the same group: chlozepid (elenium), phenazepam, nozepam, mezapam (rudotel).

The mechanism of action of benzodiazepine tranquilizers: in the body, on the territory of the above CNS zones, benzodiazepines interact with the so-called benzodiazepine receptors, which are closely associated with GABA receptors (GABA - gamma-aminobutyric acid - an inhibitory CNS mediator, inhibitory; glycine is also an inhibitory CNS mediator ; L-glutamic acid is an excitatory neurotransmitter). Upon stimulation of benzodiazepine receptors, activation of GABA receptors is observed. Therefore, the interaction of benzodiazepines with the same receptors manifests itself in the form of a GABA-mimetic effect.

All benzodiazepines that eliminate the feeling of emotional tension have similar properties, but differ in pharmacokinetics. More often than other drugs, diazepam or sibazon is used.

PHARMACOLOGICAL EFFECTS OF TRANQUILIZERS

(on the example of sibazon)

1) The main one is their tranquilizing or anxiolytic effect, which manifests itself in the ability to reduce the state of internal tension, anxiety, mild fear. They reduce aggression and induce a state of calm. At the same time, they eliminate both situational (associated with any event, specific action) and non-situational reactions. In addition, they have a pronounced sedative effect.

2) The next effect is their muscle relaxant effect, although the muscle relaxant effect of tranquilizers is weak. This effect is realized mainly due to the central action, but they also cause inhibition of spinal polysynaptic reflexes.

3) By increasing the threshold of convulsive reaction, tranquilizers have anticonvulsant activity. It is believed that the anticonvulsant and muscle relaxant activity of tranquilizers is associated with GABAergic action.

4) All benzodiazepine tranquilizers have a mild hypnotic effect, and the benzodiazepine tranquilizer NITRAZEPAM has such a powerful hypnotic effect that it rightfully belongs to the group of hypnotics on this basis.

5) Potentiating effect (enhance the effect of drugs that depress the central nervous system and analgesics). Benzodiazepines reduce blood pressure, reduce respiratory rate, stimulate appetite.

INDICATIONS FOR USE:

1) as a remedy for the treatment of patients with primary neuroses (antineurotic agents);

2) with neurosis on the basis of somatic diseases (myocardial infarction, peptic ulcer);

3) for premedication in anesthesiology, as well as in the postoperative period; in dentistry;

4) with local spasms of skeletal muscles ("tic");

5) sibazon in injections (in / in, in / m); with convulsions as an anticonvulsant of various origins and with status epilepticus, muscle hypertonicity;

6) as a mild sleeping pill for some forms of insomnia;

7) with alcohol withdrawal syndrome in persons suffering from chronic alcoholism.

SIDE EFFECTS

1) Benzodiazepines cause drowsiness during the day, lethargy, adynamia, slight lethargy, decreased attention, absent-mindedness. Therefore, they cannot be assigned to transport drivers, operators, pilots, students. Tranquilizers are best taken at night (in any case, 2/3 of the daily dose at night, and 1/3 of the dose for the day).

2) Benzodiazepine tranquilizers can cause muscle weakness, ataxia.

3) Tolerance and physical dependence may develop.

4) A withdrawal syndrome may develop, characterized by insomnia, agitation, depression.

5) Drugs can cause allergies, photosensitivity, dizziness, headache, sexual dysfunction, menstrual cycle, accommodation.

6) Tranquilizers have a cumulative ability.

Habituation and development of addiction is a reason for the abuse of tranquilizers. This is their main shortcoming and a big misfortune.

In view of the above undesirable effects, the so-called "daytime tranquilizers" have now been created, which have a much less pronounced muscle relaxant and general depressant effect. These include MEZAPAM (rudotel, Germany). They act weaker in their tranquilizing effect, but most importantly, they cause side effects to a lesser extent. They have a sedative, anticonvulsant, muscle relaxant effect. Used to treat patients with neurosis, alcoholism. Therefore, they are considered as "daytime" tranquilizers, less disturbing performance during the day (Table 0, 01).

Another drug - PHENAZEPAM (tab. 2.5 mg, 0.0005, 0.001) is a very strong drug, as an anxiolytic, as a tranquilizer superior to other drugs. In terms of duration of action, it ranks 1st among the above benzodiazepines, in terms of action it is close even to neuroleptics. For phenazepam, it has been shown that its decrease in blood plasma by 50% occurs after 24-72 hours (1-3 days). It is prescribed for very severe neurosis, which brings it closer to neuroleptics.

It is indicated for neurosis-like, psychopathic and psychopathic conditions, accompanied by anxiety, fear, emotional lability. It is indicated for obsessions, phobias, hypochondriacal syndromes. Used to stop alcohol withdrawal.

Propanediol derivatives, MEPROBAMAT or MEPROTAN, have similar properties to benzodiazepines. Inferior to the tranquilizer phenazepam. It has a sedative, muscle relaxant and anticonvulsant effect. Enhances the inhibitory effect of anesthetics, sleeping pills, ethyl alcohol, narcotic analgesics. Well absorbed from the gastrointestinal tract. It inhibits fast-wave sleep, causes a strong aftereffect, is toxic, depresses the respiratory center, disrupts coordination. Affects the blood, causes allergies.

The third group of psychotropic drugs are NEUROLEPTICS or ANTIPSYCHOTIC DRUGS (neuron - nerve, leptos - tender, thin - Greek). Synonyms: major tranquilizers, neuroplegics. These are drugs for the treatment of patients with psychosis.

PSYCHOSIS - a state characterized by a distortion of reality (that is, delusions, hallucinations, aggressiveness, hostility, affective disorders). In general, this fits into the concept of productive symptoms.

Psychoses can be ORGANIC or ENDOGENIC (schizophrenia, manic-depressive psychosis) and REACTIVE, that is, they are not independent diseases, but a condition that has arisen in response to a shock. For example, during an earthquake in Armenia - mass

psychoses. At the heart of psychosis, a sharp

promotion

sympathetic tone in the central nervous system, that is, an excess of catecholamines (norepinephrine, dopamine or dopamine).

The discovery and introduction into practice in the middle of the century of active psychotropic drugs of the neuroleptic group is one of the greatest achievements of medicine. This fundamentally changed the strategy and tactics of treating many mental illnesses. Prior to the advent of these drugs, the treatment of patients with psychosis was very limited (electroshock or insulin coma). In addition, neuroleptics are currently used not only in psychiatry, but also in the border areas of medicine - neurology, therapy, anesthesiology, surgery. The introduction of these tools contributed to the development of fundamental research in the field of psychopharmacology, physiology, biochemistry, pathophysiology in order to understand the mechanisms of various manifestations of mental disorders.

The mechanism of the antipsychotic action of neuroleptics has not been sufficiently elucidated. It is believed that the antipsychotic effect of neuroleptics is due to the inhibition of dopamine receptors (D-receptors) of the limbic system (hippocampus, lumbar gyrus, hypothalamus).

The blocking effect on dopamine receptors is manifested by antagonism with dopamine and dopaminomimetics (apomorphine, phenamine) both in behavioral reactions and at the level of individual neurons.

On preparations of neuronal membranes, it was found that antipsychotics inhibit the binding of dopamine by its receptors.

In addition to blocking receptors sensitive to dopamine and norepinephrine, antipsychotics reduce the permeability of presynaptic membranes, disrupting the release of these biogenic amines and their reuptake (D-2 receptors). For some antipsychotics (phenothiazine derivatives) in the development of psychotropic effects, their blocking effect on serotonin receptors and M-cholinergic receptors of the brain may be important. Thus, the main mechanism of action of neuroleptics is the blockade of D-receptors.

According to the chemical structure, neuroleptics belong to the following groups:

1) phenothiazine derivatives - chlorpromazine, etaperazine, triftazine, fluorophenazine, thioproperazine or nasheptil, etc.;

2) derivatives of butyrophenone - haloperidol, droperidol;

3) derivatives of dibenzodiazepine - clozapine (leponex);

4) thioxanthene derivatives - chlorprothixene (truxal);

5) indole derivatives - carbidine;

6) rauwolfia alkaloids - reserpine.

Phenothiazine derivatives are the most widely used agents in the treatment of major psychoses.

The most typical representative of phenothiazine derivatives is AMINAZINE or largactyl (international name: chlorpro

mazin). Aminazinum (dragee 0.025; 0.05; 0.1; amp. 1.2,

ml - 25% solution).

Aminazine was the first drug of this group, synthesized in 1950. In 1952, it was introduced into clinical practice (Delay and Deniker), which marked the beginning of modern psychopharmacology. Phenothiazines have a three-ring structure in which 2 benzene rings are connected by sulfur and nitrogen atoms.

Since other antipsychotics of the phenothiazine group differ from chlorpromazine only in the strength of action and some features of the psychotropic effect, chlorpromazine should be discussed in detail.

MAIN PHARMACOLOGICAL EFFECTS OF AMINAZINE

1) Pronounced effect on the central nervous system. First of all, it is an antipsychotic effect, which can be characterized as the deepest sedative effect (super-sedative) or an overexpressed tranquilizing effect. In this regard, it is understandable why earlier this group of drugs was called "big tranquilizers."

In patients with major psychosis and arousal, aminosine causes a decrease in psychomotor activity, a decrease in motor-defensive reflexes, emotional calm, a decrease in initiative and arousal, without exerting a hypnotic effect (neuroleptic syndrome). The patient sits silently, he is indifferent to the environment and the events taking place around him, minimally reacting to external stimuli. Emotional dullness. Consciousness during this period is preserved.

This effect develops quickly, for example, with parenteral administration (in / in, in / m) after 5-10 minutes and lasts 6 hours. It is explained by the blockade of adrenoreceptors and dopamine receptors in the brain.

2) The antipsychotic effect is realized by a decrease in productive symptoms and an impact on the emotional sphere of the patient: a decrease in delirium, hallucinations, and a decrease in productive symptoms. The antipsychotic effect does not appear immediately, but gradually, after many days, mainly 1-2-3 weeks after daily intake. It is believed that this effect is caused by the blockade of D-2 receptors (dopamine presynaptic).

3) Aminazine, like all phenathiazine derivatives, has a distinct antiemetic effect associated with blocking the chemoreceptors of the trigger zone (trigger zone) located at the bottom of the IY ventricle. But it is not effective for vomiting caused by irritation of the vestibular apparatus or the gastrointestinal tract. It reverses the effect of apomorphine (a dopamine receptor stimulant) on the trigger zone in the medulla oblongata.

4) Aminazin depresses the center of thermoregulation. In this case, the final effect depends on the ambient temperature. Most often, due to the increase in heat transfer, slight hypothermia is observed.

5) Typical for chlorpromazine is a decrease in motor activity (muscle relaxant effect). At sufficiently high doses, a state of catalepsy develops, when the body and limbs remain for a long time in the position that they were given. This condition is due to the inhibition of the descending facilitating influences of the reticular formation on the spinal reflexes.

6) One of the manifestations of the effect of chlorpromazine on the central nervous system is its ability to potentiate the action of analgesics, anesthetics, hypnotics. This effect is partly due to the inhibition of biotransformation processes of these drugs by chlorpromazine.

7) In large doses, chlorpromazine has a hypnotic effect (light, superficial sleep).

Aminazine, like all phenothiazines, also affects peripheral innervation.

1) First of all, chlorpromazine has pronounced alpha-blocker properties, as a result of which it eliminates some of the effects of adrenaline and norepinephrine. Against the background of chlorpromazine, the pressor reaction to adrenaline sharply decreases or a "perversion" of the effect of adrenaline sets in and blood pressure falls.

2) In addition, chlorpromazine has some M-anticholinergic (that is, atropine-like) properties. This is manifested by a slight decrease in the secretion of the salivary, bronchial and digestive glands.

Aminazine affects not only efferent, but also afferent innervation. With local action, it has a pronounced local anesthetic activity. In addition, it has a distinct antihistamine activity (blocks histamine H-1 receptors), which leads to a decrease in vascular permeability, and is also a myotropic antispasmodic.

Characteristic for chlorpromazine is the effect on the cardiovascular system. First of all, this is manifested by a decrease in blood pressure (both systolic and diastolic), mainly due to alpha-adrenergic blocking action. Marked cardiodepressive effects, antiarrhythmic effect.

Aminazine, in addition to its above-mentioned effect on the nervous system and executive organs, has pronounced pharmacological effects on metabolism.

First of all, it affects the endocrine system. In women, it causes amenorrhea and lactation. Reduces libido in men (blocking D-receptors in the hypothalamus and pituitary gland). Aminazine blocks the release of growth hormone.

Enter chlorpromazine enterally and parenterally. With a single injection, the duration of action is 6 hours.

INDICATIONS FOR USE

1) Used as an ambulance for acute psychoses. For this indication, it is administered parenterally. Aminazine and its analogues are most effective in agitating the patient, excitement, tension and other productive psychotic symptoms (hallucinations, aggression, delirium).

2) Previously used in the treatment of patients with chronic psychoses. Currently, there are more modern means, in the absence of which it can be used.

3) As an antiemetic for vomiting of central origin (during irradiation, for example, with vomiting of pregnant women). Also with persistent hiccups, in the treatment of anticancer drugs.

4) In connection with the alpha-adrenergic blocking effect, it is used in the relief of a hypertensive crisis. In neurology: in conditions with increased muscle tone (after a cerebral stroke), sometimes in status epilepticus.

5) In the treatment of drug dependence in relation to narcotic analgesics and ethyl alcohol.

6) In the treatment of patients with manic states.

7) During operations on the heart and brain (hypothermic effect), during premedication, the same effect is used to eliminate hyperthermia in children.

SIDE EFFECTS

1) First of all, it should be noted that with prolonged use of chlorpromazine, patients develop deep lethargy. This effect is so overpoweringly pronounced that as it grows, the patient eventually turns into an emotionally "stupid" person. Aminazine can change behavioral reactions, accompanied by drowsiness, impaired psychomotor functions. Lethargy, apathy develops.

2) Almost 10-14% of patients receiving chlorpromazine develop extrapyramidal disorders, extrapyramidal symptoms of parkinsonism: tremor (shaking paralysis), muscle rigidity. The development of these symptoms is due to a dopamine deficiency in the black nuclei of the brain, which occurs under the influence of a neuroleptic.

3) Frequent adverse reactions to chlorpromazine are nasal congestion, dry mouth, palpitations. Due to the anticholinergic action, phenothiazines (chlorpromazine, etc.) cause blurred visual perceptions, tachycardia, constipation, suppression of ejaculation.

4) Hypotensive crises may develop, especially in the elderly. With intravenous administration, even death can occur.

5) 0.5% of patients develop blood disorders: agranulocytosis, thrombocytopenia, aplastic anemia. A number of patients (up to 2%) have cholestatic jaundice, various hormonal disorders (gynecomastia, lactation, menstrual disorders), aggravation of diabetes, impotence.

6) Phenothiazines can cause either an increase or decrease in body temperature.

7) In psychiatric practice, one can meet the development of tolerance, especially to sedative and antihypertensive effects. The antipsychotic effect persists.

As already mentioned, chlorpromazine refers to phenothiazine derivatives. He was the first drug of this series. Subsequently, a number of compounds of this class and series were synthesized (meterazine, etaperazine, triftazil, thioproperazine or mazheptil, fluorophenazine, etc.). In general, they are similar to chlorpromazine and differ from it only in the severity of individual properties, less toxicity and fewer side effects. Therefore, chlorpromazine is gradually being replaced from clinical practice by the above-mentioned drugs.

In the last 10 years, the drug THIORIDAZINE (sonapax) has been widely used. In antipsychotic activity inferior to chlorpromazine. The drug has an antipsychotic effect combined with a calming effect without pronounced lethargy, lethargy, emotional indifference. Very rarely causes extrapyramidal disorders. Indicated: for mental and emotional disorders, fear, tension, excitement.

Butyrophenone derivatives are of great interest as antipsychotics. Of this series of compounds, HALOPERIDOL (halofen) is mainly used to treat patients with mental illness.

Haloperidolum (Table 0.0015, 0.005; 10 ml vials of 0.2% - vnutr.; amp. - 1 ml - 0.5% solution). Its action sets in relatively quickly. With the introduction of the drug inside, the maximum concentration in the blood occurs after 2-6 hours and remains at a high level for 3 days.

It has a less pronounced sedative effect and an effect on the autonomic nervous system (alpha-adrenergic blocking, atropine-like and ganglion-blocking action is less). At the same time, it is stronger in antipsychotic activity than chlorpromazine, therefore it is of interest in patients with very strong arousal and mania.

The frequency of extrapyramidal reactions in the treatment of this drug is very high, so it does not have significant advantages over phenothiazines in the treatment of schizophrenia. Used in the treatment of patients with acute mental illness with symptoms of hallucinations, delusions, aggression; with irrepressible vomiting of any origin or with resistance to other antipsychotics, as well as with hypnotics, analgesics as a premedicating agent.

DROPERIDOL belongs to the same group of drugs.

Droperidolum (amp. 5 and 10 ml 0.25% solution, Hungary). It differs from haloperidol in its short-term (10-20 minutes) strong action. Possesses antishock and antiemetic action. Reduces blood pressure, has an antiarrhythmic effect. Droperidol is used mainly in anesthesiology for neuroleptanalgesia. In combination with the synthetic anesthetic fentanyl, it is part of the thalamonal preparation, which exhibits a rapid neuroleptic and analgesic effect, leads to muscle relaxation, and drowsiness. Used in psychiatry for the relief of reactive conditions. In anesthesiology: premedication during and after surgery. With endotracheal anesthesia. Contraindications: parkinsonism, hypotension, in the appointment of antihypertensive drugs.

Currently, new antipsychotics have been created that practically do not cause extrapyramidal disorders. In this regard, one of the most recent drugs, clozapine (or leponex), is of interest. It has a strong antipsychotic effect with a sedative component in the absence of symptoms of parkinsonism. When using the drug, there is no such sharp general oppression as that of chlorpromazine. Sedation that develops at the beginning of treatment, which then disappears. Clozapine is a dibenzodiazepine derivative. It has a high antipsychotic activity. Used in psychiatry for the treatment of patients with manic-depressive psychosis and schizophrenia, with psychopathy.

It is believed that clozapine and classical antipsychotics (phenothiazines and butyrophenones) interact with different types of D-receptors. In addition, clozapine has a pronounced blocking activity against M-cholinergic receptors in the brain.

Clozapine is well tolerated, but it is necessary to monitor the blood because there is a risk of developing agranulocytosis, tachycardia and collapse may develop. It should be used with caution for drivers, pilots and other categories of persons.

SULPIRIDE (eglonil) is a moderate neuroleptic. It has an antiemetic, moderate antiserotonin effect, no squeezing effect, no anticonvulsant activity, has an antidepressant effect, some stimulating effect. It is used in psychiatry (lethargy, lethargy, anergy), in therapy in the treatment of peptic ulcer, migraine, dizziness.

Psychotropic drugs are drugs that have a specific therapeutic or prophylactic effect on the mentally ill.

This or that influence on mental functions can be exerted by means used in different fields of medicine. Signs of excitation or depression of the central nervous system, impaired attention and mental performance, other central effects are often noted as side effects when using various drugs.

A distinctive feature of psychotropic drugs is their specific positive effect on mental functions, which ensures their therapeutic activity in case of disorders of the central nervous system.

The first modern psychotropic drugs were created in the early 1950s. Prior to this, the arsenal of drugs used to treat mental illness was very limited and unspecific. The main drugs used for this purpose were hypnotics and sedatives, insulin, caffeine; Corazol was used for convulsive therapy of schizophrenia. In neurasthenic disorders, mainly bromides, sedatives of plant origin, and hypnotics in small (sedative) doses were used.

In 1952, the specific efficacy of chlorpromazine (chlorpromazine) and reserpine in the treatment of mental patients was discovered. Numerous analogues of chlorpromazine and reserpine were soon synthesized and studied, and it was shown that derivatives of these and other classes of chemical compounds can have a beneficial effect in the treatment of schizophrenia and other psychoses, manic syndromes, neurotic disorders, acute alcoholic psychoses and other disorders of the central nervous system.

In 1957, the first antidepressants (iproniazid, imipramine) were discovered. Then, the tranquilizing properties of meprobamate (meprotan) and benzodiazepine derivatives were discovered.

A new group of psychotropic drugs - the first representative of which was piracetam, appeared in the early 70s.

The section of pharmacology dealing with the study of substances included in these groups was named, and the drugs of these types of action began to be called psychopharmacological agents. These funds were combined into a common group.

Currently, psychopharmacological agents mean a wide range of substances that affect mental functions, emotional state and behavior. Many of them have found application as valuable medicines in psychiatric and neurological practice, as well as in general somatic medicine. They are prescribed to patients of therapeutic, surgical, oncological and other profiles for the treatment and prevention of borderline mental disorders.

Soon after the discovery of the first psychotropic drugs, an attempt was made to classify them.

In 1967, the Congress of Psychiatrists in Zurich proposed to divide these drugs into two groups: a) antipsychotics, used mainly for severe disorders of the central nervous system (psychosis), and b) tranquilizing substances, used for less severe disorders of the central nervous system, mainly with neurosis with a state of mental stress and fear. Antipsychotic substances according to this classification include chlorpromazine and other phenothiazine derivatives, reserpine; to tranquilizers - derivatives of propanediol (meprotan, etc.) and derivatives of diphenylmethane (amizil, etc.).

Antipsychotics were originally called. The term (nervous system blocking agents) was proposed to denote substances that cause controlled inhibition of the neurovegetative system and are used for artificial sleep with body cooling (hibernation). The term corresponds to the concept. Tranquilizers were also designated as, etc. The Greek word means, (hence). The term, or, is associated with the ability of certain drugs to have a calming effect in pathological conditions accompanied by fear and emotional tension.

In 1966, a WHO scientific group proposed the following classification for psychotropic drugs:

• BUT. Antipsychotics, they are also previously referred to as big tranquilizers, or; these include derivatives of phenothiazine, butyrophenone, thioxanthene, reserpine and similar substances. These substances have a therapeutic effect in psychosis and other mental disorders. A characteristic side effect caused by these substances is extrapyramidal symptoms.


• B. Anxiolytic sedatives, previously called, reducing pathological fear, tension, arousal; they usually have anticonvulsant activity, do not cause vegetative and extrapyramidal side effects; may be addictive. These include meprobamate (meprotan) and its analogues, diazepoxide (benzodiazepine) derivatives, including chlordiazepoxide (chlozepid), diazepam (sibazon), etc.


• AT. Antidepressants - Substances used in the treatment of pathological depressive conditions. Sometimes they are also called. This group includes the MAO inhibitors, imipramine (imizin) and other tricyclic antidepressants.


• G. Psychostimulants, which include phenamine and its analogues, caffeine.


• D. Psychodysleptics (hallucinogens), also called. This group includes lysergic acid diethylamide, mescaline, psilocybin, etc.

From the point of view of practical medicine, it is more appropriate to divide psychotropic drugs into the following main groups: a) neuroleptics (antipsychotics); b) tranquilizers; c) sedatives; d) antidepressants; e) normothymic means; f) nootropics; g) psychostimulants.

Each of these groups of psychotropic drugs is divided into subgroups depending on the chemical structure, mechanism of action, pharmacological properties and therapeutic use of the drugs included in these groups.

Psychomimetic substances, or hallucinogens, that have a strong psychotropic effect, but have no use as medicines, are not included in this classification of psychotropic drugs.

Psychotropic drugs are used for various serious pathologies of the psyche. But many of them have strong side effects and negative health effects. Therefore, they are dispensed by prescription or completely prohibited. Medicines that are freely available also require a doctor's consultation before purchase. Only a specialist can choose the required dosage and prescribe an adequate treatment regimen.

• Show all

  General concept and scope

  Psychotropic drugs are drugs that affect the mental functioning of the brain.

  In a healthy state, the human nervous system is in balance. But under the influence of adverse factors, such as stress, emotional overload, and many others, they can unbalance the processes of excitation and inhibition. In this case, neuroses develop, which are characterized by mental disorders:

  • Anxiety.
  • Intrusive ideas.
  • Hysteria.
  • Behavioral disorder.

  There are more severe conditions - mental illness, in which the patient is not aware of the presence of pathology. Symptoms:

  • Impaired thinking and judgment.
  • Rave.
  • hallucinations.
  • Memory impairment.

  Mental illness occurs in different ways. It depends on what processes of the nervous system prevail:

  1. 1. When excited, it is noted:
  • Manic state.
  • Physical activity.
  • Rave.
  1. 2. Braking is characterized by:
  • Depressive state.
  • Depressed mood.
  • Violation of thinking.
  • Suicidal tendencies.

  Psychotropic drugs are widely used to treat such disorders.

  Classification

  Currently, all psychotropic drugs are conditionally divided into two large groups:

  1. 1. Psycholeptic.
  2. 2. Psychoanaleptic.

  They are considered conditional, since there are transitional preparations that include the properties of both groups.

  

  Psycholeptic drugs

  Medicines of this group have a depressing and calming effect on the psyche. They include several classes:

  1. 1. Antipsychotics.
  2. 2. Anxiolytics and sleeping pills.
  3. 3. Sedatives.
  4. 4. Normotimics.

  

  Antipsychotics

  They are also called antipsychotics or major tranquilizers. These are the main drugs in the treatment of severe mental pathology.

  Indications for use are:

  • Psychoses of acute or chronic course.
  • Psychomotor agitation of various types (manic, psychotic, psychopathic, anxious).
  • Schizophrenia.
  • Obsessive neurosis or obsessive-compulsive disorder.
  • Motor hyperkinetic disorders (Tourette's syndrome, hemiballismus, Huntington's chorea).
  • Behavioral disorders.
  • Somatoform and psychosomatic disorders, manifested by the presence of various complaints in patients in the absence of pathology of internal organs (pain syndrome).
  • Persistent insomnia.
  • Premedication before anesthesia.
  • Indomitable vomiting.

  Despite the large number of indications, almost 90% of cases of antipsychotic use are associated with the treatment of schizophrenia or the removal of manic arousal.

  Contraindications:

  • Intolerance to drug components.
  • Toxic agranulocytosis.
  • Parkinson's disease, porphyria, pheochromocytoma.
  • BPH.
  • Angle-closure glaucoma.
  • Allergic reactions to antipsychotics in the past.
  • Fever.
  • Cardiovascular diseases in the stage of decompensation.
  • Coma.
  • Intoxication with substances that have a depressant effect on the central nervous system.
  • Pregnancy and lactation period.

  Classification and list of medicines:

  1. 1. Phenothiazine derivatives are typical antipsychotics, which include all the properties of drugs of this class:

  Name	Analogues	Release form	Peculiarities
  Aminazine	Chlorpromazine	Dragee, tablets, ampoules	Soothes Eliminates vomiting Reduces temperature Relieves muscle tone and motor excitation Has a weak anti-inflammatory and antihistamine effect
  Triftazin	Stelazine, Trifluoperazine	Tablets, ampoules	Along with an antipsychotic effect, it has an energizing effect. Eliminates vomiting Used in the treatment of diseases characterized by delusions and hallucinations
  Fluorphenazine	Liorodin, Fluphenazine, Moditen	Oil solution ampoules	Has a strong antipsychotic and activating effect Has a sedative effect at high doses Has a long lasting effect
  Etaperazine	Perphenazine	Tablets	Lowers muscle tone Eliminates vomiting Remove mental arousal
  Levomepromazine	Tizercin	Tablets, ampoules	Relieves pain Quickly soothes and eliminates mental affect
  Alimemazine	Teralen	Tablets, ampoules, drops	Has antihistamine action Soothes Has mild antipsychotic effects
  Meterazine	Stemethyl, Maleate, Prochlorperazine, Chlorperazine	Tablets	It is used in the treatment of schizophrenia and diseases with a predominance of apathy, lethargy, asthenia phenomena.
  Thioproperazine	Mazeptil	Tablets, ampoules	Eliminates vomiting Removes mental arousal Has a stimulating effect
  Thioridazine	Melleril, Sonapax	Dragee	Has a mild antipsychotic effect Has a moderate stimulating effect uplifting Eliminates depression

  1. 2. Derivatives of diphenylbutylpiperidine and butyrophenone:

  Name	Analogues	Release form	Peculiarities
  Haloperidol	Halofen	Tablets, ampoules, vials	Has a clear sedative and antipsychotic effect Eliminates vomiting
  Droperidol		Ampoules	Characterized by instant and pronounced action It is used for temporary painful mental disorders The main direction is the relief of pain syndrome (anesthesia)
  Trifluperidol	Trisedyl	Tablets, vials, ampoules	Has a pronounced neuroleptic effect Used to relieve mental arousal
  fluspirilene		Ampoules	Similar in action to Haloperidol, but has a long-term effect (within seven days)

  1. 3. Thioxanthene derivatives:
  1. 4. Derivatives of indole:
  1. 5. Antipsychotics of various chemical groups:

  Name	Analogues	Release form	Peculiarities
  Clozapine	Azaleptin, Leponex	Tablets, ampoules	Has an impressive antipsychotic effect Has a sedative and hypnotic effect
  Sulpiride	Eglonil, Dogmatil	Capsules, ampoules, vials	Has antiemetic activity Reduces arousal uplifting Has a stimulating effect
  Tiapride	Doparid, Delpral, Tridal	Tablets, ampoules	Close to Sulpiride. Used in the treatment of drug and alcohol addiction, as well as temporary behavioral disorders

  Clinical varieties of neuroleptics:

  Group	Preparations	Action
  Sedatives	Levomepromazine, Promazine, Chlorpromazine, Alimemazine, Chlorprothixene, Periciazine, etc.	Have an inhibitory effect, regardless of dose
  Incisive	Haloperidol, Pipothiazine, Zuclopenthixol, Trifluoperazine, Thioproperazine, Fluphenazine, etc.	In small doses, they have an activating effect, with increasing doses they fight manic and psychotic (hallucinations, delusions) signs
  Disinhibiting	Carbidine, Sulpiride and others	Have a relaxing and activating effect
  Atypical	Olanzapine, Clozapine, Risperidone, Amisulpride, Quetiapine, Ziprasidone and others	They are characterized by a pronounced antipsychotic effect, can cause dose-dependent disturbances in motor activity, eliminate the pathology of external perception in schizophrenia

  Undesirable effects of neuroleptics:

  Side effects	Percentage of the total number of patients taking antipsychotics
  Disorders of motor activity, changes in muscle tone, twitching and immobilization	50 to 75%
  Acute disorders of motor activity in the first days of treatment	40 to 50%
  Development of parkinsonism	30 to 40%
  Anxiety, restlessness, suicidal tendencies	50%
  Malignant neuroleptic syndrome, accompanied by fever, impaired pulse and breathing, confusion, instability of blood pressure, coma. Possible death in 15-30% of cases	1 to 3%
  Late movement disorders, twitching (tremor)	10 to 20%

  Anxiolytics and hypnotics

  The drugs of this group have alternative names - small tranquilizers, ataractics, anti-neurotic and psychosedatives.

  Mechanism of action:

  • Anxiolytic (reduction of anxiety, fear, emotional tension).
  • Muscle relaxant (decreased muscle tone, lethargy, fatigue, weakness).
  • Sedative (lethargy, drowsiness, decreased reaction rate, reduced concentration).
  • Hypnotic.
  • Anticonvulsant.
  • Stabilizing the work of the autonomic and somatic nervous system.
  • Some tranquilizers have a psychostimulant effect, elevate mood and reduce panic disorders and phobias.

  Classification by chemical structure:

  1. 1. Diphenylmethane derivatives:
  1. 2. Benzodiazepine derivatives:

  Name	Analogues	Release form	Peculiarities
  Diazepam	Seduxen, Sibazon, Relanium	Tablets, ampoules	A typical tranquilizer that has all the properties of this class
  Chlosepides	Elenium, Chlordiazepoxide	Tablets, dragees, ampoules	Typical tranquilizer
  Clobazam	Frizium	Tablets	Has a pronounced anticonvulsant and tranquilizing effect
  Lorazepam	Ativan, Tavor	Tablets	Relieves stress Reduces anxiety and fear
  Nozepam	Oxazepam, Tazepam	Tablets	Typical tranquilizer
  Phenazepam		Tablets, ampoules	Has a pronounced tranquilizing and anti-anxiety effect Similar to neuroleptics in sedative activity Has anticonvulsant, hypnotic and muscle relaxant action
  Medazepam	Nobrium, Mezapam, Rudotel	Tablets	Soothes Eliminates cramps Relieves muscle tension
  Alprazolam	Xanax, Neurol, Zolomax, Helix	Tablets	Has an activating activity Used for depression and anxiety
  temazepam	Signopam	Tablets	Promotes sleep. Relaxes muscles. Has an analgesic effect
  Gidazepam		Tablets	It is characterized by all anxiolytic properties Applied during the daytime
  Bromazepam		Tablets	Relieves stress Eliminates feelings of anxiety and arousal

  1. 3. Propanediol carbamates:
  1. 4. Tranquilizers of various chemical groups:

  Indications for use:

  1. 1. Neuroses and neurosis-like states.
  2. 2. Insomnia.
  3. 3. Premedication.
  4. 4. Emotional stress.
  5. 5. Arterial hypertension, epilepsy, angina pectoris (as a combined treatment).

  Contraindication is the use in people in whose professional activities there is a need for an immediate motor or mental reaction.

  Side effects are expressed in the following symptoms:

  1. 1. Drug addiction.
  2. 2. Lethargy.
  3. 3. Nausea.
  4. 4. Drowsiness.

  Sedatives

  This group includes preparations of synthetic and herbal origin, which have a calming activity. Their main action is to increase the inhibition of the processes of the nervous system and reduce excitation. Characteristic features are considered to be an increase in the action of hypnotics, painkillers and other sedatives, an improvement in falling asleep and a deepening of sleep.

  Indications:

  1. 1. Neuroses and mild neurasthenia.
  2. 2. Hypertension in the initial stage.
  3. 3. Spasms of the gastrointestinal tract.
  4. 2. Insomnia.

  Classification:

  1. 1. Bromine preparations:
  1. 2. Herbal remedies:
  1. 3. Combined medicines:

  Normotimics

  This group includes drugs that regulate mood swings and prevent manic and depressive states. The second name is thymoisoleptics.

  Classification:

  1. 1. Lithium salts:
  1. 2. Carmbazipine derivatives:
  1. 3. Derivatives of valproic acid:

  Name	Preparations	Peculiarities
  Sodium salt of valproic acid	Konvuleks, Depakine, Valparin, Everiden, Acediprol, Apilepsin, Encorate	Has an anticonvulsant effect, is used in epilepsy
  Calcium salt of valproic acid	Convulsofin	Antiepileptic
  Magnesium salt of valproic acid	Dipromal	Anticonvulsant and antiepileptic drug
  Dipropylacetamide	Depamid	Eliminates aggression Used to prevent manic-depressive psychosis Combined treatment of epilepsy
  Divalproex sodium	Depakote	Treatment of mania and depression

  1. 4. Calcium channel blockers:

  Side effects:

  1. 1. Tremor (trembling) of hands, eyelids, tongue.
  2. 2. Fatigue, weakness.
  3. 3. Deterioration of memory.
  4. 4. Decreased libido.
  5. 5. Disorder of attention and concentration.
  6. 6. Weight gain.
  7. 7. Increased appetite.
  8. 8. Diabetes insipidus.
  9. 9. Thirst.
  10. 10. Edema and others.

  Psychoanaleptics

  Preparations of this group have a stimulating, exciting, activating effect. They include several subgroups:

  1. 1. Antidepressants.
  2. 2. Psychostimulants.
  3. 3. Neurometabolic stimulants.

  Antidepressants

  These drugs are characterized by an increase in pathologically reduced mood, depression and depressive affect. In healthy people, they do not cause a euphoric state.

  Antidepressants bind to receptors in the central and peripheral nervous systems. But their use in the treatment of somatic diseases is rare.

  Indications:

  1. 1. Various depressive states.
  2. 2. Panic disorders.
  3. 3. Social phobia.
  4. 4. Bulimia.
  5. 5. Nervous exhaustion.
  6. 6. Somatoform disorders.
  7. 7. Narcolepsy.

  Contraindications:

  1. 1. Excitation.
  2. 2. Acute confusion.
  3. 3. Seizures.
  4. 4. Severe pathologies of the kidneys and liver.
  5. 5. Persistent pressure reduction.
  6. 6. Pregnancy.
  7. 7. Hypersensitivity.
  8. 8. Violation of blood circulation.

  There is a classification of antidepressants according to the chemical structure:

  1. 1. Tricyclic antidepressants.
  2. 2. Four-cycle.
  3. 3. Hydrazine derivatives.
  4. 4. Derivatives of chlorobenzamide.
  5. 5. Preparations of different chemical groups.

  But a more rational classification is the division according to the mechanism of action:

  1. 1. Reversible monoamine oxidase inhibitors (MAOIs):
  • Reversible:
  • Irreversible:
  1. 2. Neuronal uptake inhibitors:
  • Electoral:
  • Indiscriminate:

  Name	Analogues	Peculiarities
  Imipramine	Melipramine, Imizin	uplifting Has an activating effect Has a psychostimulating effect
  Desipramine hydrochloride	Peptylyl, Desmethylimipramine	Similar in action to Imipramine
  Clomipramine hydrochloride	Anafranil	Used for phobias and obsessive-compulsive disorders
  Opipramol	Pramolan	Fights depression Has a sedative effect Eliminates vomiting
  Amitriptyline hydrochloride	Triptizol	Has antihistamine activity Has no sedative effect
  Azafen	Pipofezina hydrochloride	Used for depression characterized by anxiety

  1. 3. Different groups of antidepressants:

  Antidepressants should not be stopped abruptly. Otherwise, various pathological conditions may develop, such as withdrawal syndrome, relapse of depression, a state of complacency, and others.

  Unwanted effects:

  1. 1. Pressure reduction.
  2. 2. Difficulty urinating.
  3. 3. Dryness of the oral mucosa.
  4. 4. Blurred vision.
  5. 5. Atony of the intestine.
  6. 6. Increased anxiety and others.

  Psychostimulants

  Preparations of this group are distinguished by an increase in mental and physical performance:

  Name	Analogues	Peculiarities
  Phenamine		Eliminates the need for sleep Provides a temporary performance boost Reduces the feeling of hunger
  Meridil	Centedrin	Used for mental fatigue Fights apathy and lethargy
  Sidnocarb	Mesocarb	Eliminates lethargy and apathy in schizophrenia Recommended for asthenic conditions
  Caffeine		Reduces the need for sleep Increases performance
  Mildronate		Eliminates the phenomena of physical overvoltage Reduces fatigue
  Bemitil		Increases resistance to increased physical activity Restores and maintains the ability to work

  Purpose of application:

  1. 1. Overcoming fatigue.
  2. 2. Increasing mental and physical performance.
  3. 3. Treatment of asthenic conditions such as lethargy, lethargy, drowsiness.

  Contraindications:

  1. 1. Psychomotor agitation.
  2. 2. Anxiety.
  3. 3. Pathologies of the cardiovascular system.
  4. 4. Alcoholism.
  5. 5. High blood pressure.
  6. 6. Hyperthyroidism.
  7. 7. Violation of the liver and kidneys, and others.

  Side effects:

  1. 1. Drug dependence with long-term use.
  2. 2. Arrhythmia.
  3. 2. Insomnia.
  4. 4. Irritability.
  5. 5. Constipation.
  6. 6. Loss of appetite and others.

  Neurometabolic stimulants

  Such drugs are also called nootropics or cerebroprotectors. They are used to normalize metabolic processes in the brain and saturate cells with oxygen.

  Nootropics:

  Indications:

  1. 1. Cerebral-organic insufficiency.
  2. 2. Cognitive disorders.
  3. 3. Asthenia.
  4. 4. Decreased activity.

  Contraindication according to the instructions is individual intolerance.

  Side effects:

  1. 2. Anxiety.
  2. 2. Sleep disturbance.
  3. 4. Irritability.
  4. 4. Motor excitation.
  5. 5. Seizures.

  Prohibited drugs

  Some psychotropic drugs are banned in the Russian Federation. This is due to their ability to cause strong dependence and adversely affect human health.

  The Decree of the legislation of the Russian Federation, edited on July 29, 2017, adopted a list of prohibited psychotropic drugs. These include the following, in alphabetical order:

  1. 1. 2-Amino-1 (4-bromo-2,5-dimethoxyphenyl) ethanone.
  2. 2. Amphetamine.
  3. 3. Katin.
  4. 4. Cathinon.
  5. 5. Mecloqualone.
  6. 6. Methaqualone.
  7. 7. 4-methylaminorex.
  8. 8. Methylphenidate or Ritalin.
  9. 9. 2-Morpholin-4-ylethyl.
  10. 10. Fenetylline.
  11. 11. 1-Phenyl-2-propanone.

  Both the substances themselves and their derivatives are subject to the ban.

  OTC drugs

  Over-the-counter drugs:

  1. 1. Azafen.
  2. 2. Alprazolam (Alzolam, Xanax).
  3. 3. Afobazole.
  4. 4. Barboval.
  5. 5. Gidazepam.
  6. 6. Glycine.
  7. 7. Donormil.
  8. 8. Lorazepam (Lorafen).
  9. 9. Maprotiline.
  10. 10. Medazepam (Rudotel).
  11. 11. Novo-passit.
  12. 12. Noofen.
  13. 13. Oxazepam (Tazepam).
  14. 14. Persen.
  15. 15. Piracetam.
  16. 16. Prozac.
  17. 17. Tenoten.
  18. 18. Trioxazine.
  19. 19. Phenotropil.
  20. 20. Phenibut and many others.