25d • General discussion
Psychopharmacology
Psychopharmacology aims to restore dysregulated neurotransmitter systems that underline psychiatric symptoms. Effective prescribing requires understanding the relationship between symptom clusters, neurobiology, medication mechanisms, and safety monitoring. PMHNPs must balance efficacy with adverse effects, medical comorbidities, drug interactions, age-related considerations, and patient preferences.
Neurotransmitter Systems and Medication Targets
Serotonin Dysregulation
Serotonin pathways originating from the raphe nuclei regulate mood, anxiety, obsessive thoughts, sleep, appetite, and emotional processing. Reduced serotonergic transmission contributes to depression, generalized anxiety disorder, panic disorder, PTSD, and OCD.
Clinical Manifestations
Depressed mood, Anhedonia, Excessive worry, Rumination, Panic symptoms, Obsessions and Compulsions.
Medication Classes
SSRIs
Examples: Sertraline, Escitalopram, Fluoxetine, Paroxetine, & Citalopram
Mechanism: Block serotonin reuptake transporter (SERT), increasing serotonin availability.
First-line indications: Major depressive disorder, Generalized anxiety disorder, Panic disorder, PTSD, & OCD
Common adverse effects: Nausea, Sexual dysfunction, Insomnia, Headache
Serious risks: Serotonin syndrome, SIADH/hyponatremia, Increased bleeding risk & QT prolongation (especially citalopram)
SNRIs. Examples: Venlafaxine, Duloxetine, Desvenlafaxine
Mechanism: Increase serotonin and norepinephrine transmission.
Useful when depression coexists with: Neuropathic pain, Fibromyalgia, &Chronic pain syndromes.
Potential adverse effects: Hypertension, Sweating, Anxiety &Withdrawal symptoms
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Psychopharmacology
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