Psychoactive Drug Classifications

Psychoactive Drug Classifications

What is a Psychoactive Drug?

A psychoactive drug is any chemical substance that acts primarily upon the central nervous system to alter perception, mood, consciousness, or behavior. Only those drug classes that are used by medical doctors at the prescription level will be discussed in this fact sheet. Many illegal street drugs are also psychoactive.

Antidepressant – Noradrenergic/Serotonergic Agents

This is a newer class of antidepressants. They have been designed to actually stimulate the brain to create more serotonin (or norepinephrine) rather than causing reuptake inhibition. The most popular drugs in this class are: Remeron, Avanza, Zispin, and Tolvon.

The mechanism by which this drug acts is to block the presynaptic alpha-2 adrenergic receptors while at the same time blocking certain serotonin receptors. Significant side effects have been reported from these drugs and those side effects can be too troublesome for some to continue use of the drug. Additionally, there are reports of significant negative withdrawals when an individual misses a dose (within just a few hours). Some have reported quasi-psychotic symptoms as one of the withdrawal effects if proper titration is not used to exit drug use.

Antidepressant – Monoamine Oxidase Inhibitors (MAOI)

This class of depression fighting drugs is used as sparingly as possible by medical doctors. Although it has powerful affects fighting severe depression and atypical depression, it also has serious and often deadly interactions between many foods and other drugs. This is a drug of last resort when all attempts to employ SSRI agents and Tricyclics have failed. This drug class has shown effectiveness against Social Anxiety Disorder and Agoraphobia – something that SSRI drugs typically cannot affect.

This entire class of drugs contains an FDA Black Box warning for food and drugs lethality.

Antidepressant – Selective Serotonin Reuptake Inhibitor (SSRI)

It has been hypothesized by some that one of the reasons for Major Depressive Disorder is an abnormal reduction of the neurotransmitter serotonin. It is scientifically unclear why serotonin is improperly balanced in the brain. And, it is questionable whether the method employed by SSRI drugs is efficacious for resolving the issue. Some research indicates that when an SSRI antidepressant is administered, over time the decreased serotonin level returns – thus, the drug becomes ineffectual in treatment of depression (no more than a placebo effect).

The response to this problem by the pharmaceutical community (the continued reduction of serotonin over time) has been to add another drug to the situation. That drug is usually Abilify – which is an antipsychotic agent. This is a dubious solution to the problem since Major Depressive Disorder is far from a psychotic episode.

The mechanism associated with SSRI drugs is to cause the serotonin that currently exists in the brain to “stall” in the middle of the synaptic gap, rather than to cause the production of more serotonin (a simple increase in serotonin introduced into the body is not efficient since serotonin itself will not cross the blood-barrier – it is only synthesized in the brain). Typically, if serotonin is to be “created” in a patient the substance of choice would need to be a derivative of tryptophan (which the brain can use to create serotonin).

Approximately 66% of all people who use an SSRI antidepressant report that over time their depression returns to the same state it was before they began treatment. Thus, the SSRI antidepressant method of treating major depression is largely ineffectual. Side effects of the drug cause significant questions about its continued use for treatment of depression.

This entire class of drugs contains an FDA Black Box warning for increased suicidal ideation and suicide attempts.

Antidepressant – Selective Serotonin/Norepinephrine Reuptake Inhibitor (SSNRI)

This drug class is close to the SSRI class with the addition of the reuptake modification of norepinephrine in addition to the reuptake modification of serotonin. All of the information related to SSRI antidepressants also relates to this drug class.

This entire class of drugs contains an FDA Black Box warning for increased suicidal ideation and suicide attempts.

Antidepressant – Tetracyclic Antidepressants

This is an older class of antidepressants and is currently being replaced by the SSRI class. It is still used in individuals who are resistant to the effects of SSRI drugs. The abuse potential for tetracyclics is very low. This is not a drug of abuse. Side effects are one of the reasons that the drug is being replaced by the more modern SSRI drugs. Tetracyclics are more broad-based in their effective range of treatment than newer SSRI drugs.

This drug is called a tetracyclic because it contains four rings of atoms in its chemical structure.

Antidepressant – Tricyclic Antidepressants

This drug class is very similar to tetracyclics in chemical structure and applicability. Instead of containing four rings of atoms in its chemical structure, tricyclics contain only three rings. Other information related to tetracyclics applies to tricyclics.

[There are other classes of Antidepressant drugs. Those drugs are not used as often as the classes of drugs found on this list.]

Antipsychotic

This class of drugs is also called neuroleptics. They are primarily used to manage and reduce symptoms of psychosis, especially delusional states and hallucinations. They are most effective when used with Schizophrenia and Bipolar I Disorder.

There are two groups of antipsychotic drugs: typical and atypical antipsychotics. The typical antipsychotics are older and are slowly being replaced by atypical antipsychotics. Both groups block dopamine as their primary mechanism (although other receptors are also engaged).
Use of antipsychotic drugs comes with a price. Most users experience significant side effects – some of them mental and psychological, and others that are physical (including lowered life expectancy and diabetes). The mental, emotional and psychological side effects are often significant and cause individuals who experience psychosis to periodically stop using the drug to get away from the side effects of the drug. This, of course, results in the reappearance of the symptoms of the psychotic disorder. The individual typically battles with either the side effects of the drug of the delusions and hallucinations of their disorder.

Attempts are being made to formulate antipsychotic drugs that have lesser side effects but still result in lowered symptoms of an individual’s disease. These efforts are difficult and slow-going.

Azaspirodecanedione

This class of psychoactive drug is an anxiolytic designed to treat anxiety symptoms, and especially Generalized Anxiety Disorder. This drug class is not usually used for a broad spectrum of Anxiety Disorders including Obsessive-Compulsive Disorder, Social Anxiety Disorder, and others. It has been found to be ineffectual in those cases. It is only rarely scripted for treatment of depression, and then usually in conjunction with elevated anxiety symptoms. It is not prescribed in cases of psychosis.

Side effects are numerous and it appears that there are significant withdrawals from sustained use over a prolonged period of time (although manufacturers state that the drug class is not addictive).

This is a newer class of drugs for treatment of anxiety states. It is an effort to replace the benzodiazepine class of drugs due to their extreme addiction potential.

Benzodiazepine

This drug class is used for relief of anxiety symptoms and for major Anxiety Disorders. It is also used at times for depression. It is not prescribed for psychosis. Benzodiazepines are an older class of drugs designed to curb anxiety. There is growing concern regarding their highly addictive qualities. Benzodiazepines attach to the GABAa receptor site – a locus of significant addictive potential. Among the benzodiazepines, both Xanax and Klonopin have become street-level drugs of abuse as scripted individuals abuse the drug and run out of their prescribed medications too early.

Due to the almost certain addictive qualities of the drug, both the manufacturers and watchdog drug groups indicate that benzodiazepines should only be used for a short period of time. Some studies indicate that at least some benzodiazepines are highly addictive after only fifteen days of use in some patients. Most users are addicted by the end of two months. Withdrawals can be significant and may even include seizures and significant mood and personality alterations.
Some benzodiazepines are also used as anti-seizure medication to supplement other anti-seizure meds that a person may be taking. Klonopin is the most common used for this purpose.

Hypnotic

Sometimes this drug class is also called a sedative or a sedative-hypnotic. Hypnotics are typically used as sleep-inducing agents. The most common drug in this class is Ambien. All hypnotic drugs are habit-forming. One of the most common withdrawals from a hypnotic drug is insomnia – the very thing that the hypnotic was prescribed for in the first place. This increases the psychological need for the drug. Some studies have indicated that the insomnia associated with withdrawals may last as long as three months, making it very difficult for the drug user to part with the drug. This is especially true if the drug has been over-scripted. Most hypnotics should not be scripted for an elongated period of time (more than a month). This is due to the addictive properties of the drug.

Medical doctors who prescribe hypnotics (such as Ambien) for prolonged periods of time will create a seriously addicted patient who will find it difficult and troubling to remove themselves from the drug. As a result, some medical doctors have supplemented hypnotics with benzodiazepines for sleeping medication. Each drug would be switched off on a regular basis to (hopefully) prevent addiction. This process, however, often results in duel addiction to both the hypnotic and the benzodiazepine.

Halcion, Xanax, and Valium are common benzodiazepines that are used for sleeping disorders.

Narcotic

Most literally, narcotics are opiates and have morphine-like affects. Codeine is the most commonly prescribed narcotic. The human body does not directly use codeine but converts codeine into morphine. (Methylmorphine is the active agent.) All narcotics are extremely addicting and are strictly controlled by DEA regulations. Codeine is a Schedule #2 controlled substance. Heroin is the most widely abused narcotic on the streets.

Narcotics are typically used for reduction of pain. However, they contain psychoactive qualities, and, thus, they are included in this fact sheet. They are not typically used for any psychological or mental condition. They do, however, result in significant life-altering qualities when an individual becomes addicted to them. The typical reason for addiction is due to the psychoactive properties of the drug and not due to its pain killing capabilities. Often, people tend to continue using narcotics long after the pain condition is gone.

A significant number of narcotics contain codeine. The destructive properties of codeine are often underestimated. Codeine is far more lethal than is published. A lethal dose of codeine may be contained in a simple ten-day script for the drug (depending on dosage). LD50 for codeine is 800mg. Used in conjunction with alcohol the lethality of the drug is greatly magnified. Addiction ensues very rapidly after an individual starts taking a narcotic substance (in most cases).

Complete Drug Cross Reference List

Complete Drug Cross Reference List

[Bolded drug names can be located directly under that name]

Abilify
Alprazolam – See Xanax

Ambien

Aripiprazole – See Abilify

Buspar

Buspirone – See Buspar

Celexa

Citalopram – See Celexa

Diazepam – See Valium

Edluar – See Ambien

Escitalopram – See Lexapro

Lexapro

Niravam – See Xanax

Valium

Xanax

Zolpidem – See Ambien

Buspar

Buspar

Drug Name -- Buspar

Alternate Names – Buspirone

Manufacturer – Bristol-Myers Squibb

Type – Prescription (not controlled).

Pregnancy Issues – FDA Pregnancy Class B. Buspar is not expected to cause harm to a fetus or to cause birth defects. This, however, has not been proven over time. It is not known whether or not Buspar is transplacental. It is not known whether or not Buspar transfers into breast milk. [Both the transplacental issue and the breast milk transfer issue should be very easy for the medical community/manufacturer to determine. Official studies and/or statements have not been made by Bristol-Myers Squibb. This is an irresponsible action.]

Addiction Potential – According to BMS, Buspar shows no tolerance issues, and no physical or psychological dependence issues. Buspar is not a drug of abuse. Buspar is only to be used for short-term relief. This drug should not be administered long-term except in extreme cases and under the direct care of a psychiatrist (and not from a Primary Care Physician). Buspar does not affix to the GABAa receptor complex, as does the benzodiazepine class; the manufacturer admits that they do not understand the mechanism that causes Buspar to work (and associated dangers of that mechanism); while officially BMS states that Buspar is not addicting, there appear to be consequences (withdrawals) when stopping the drug. This would indicate physical (but not psychological) dependence issues. Dr. Peter Breggin has listed the withdrawals and has classified Buspar as an addictive psychoactive drug substance by empirical studies with patients. [See withdrawals below.]

Maximum Prescription Duration – According to the manufacturer, this drug should not be taken for more than four weeks. The manufacturer has determined that there is no demonstrated effectiveness of the drug beyond four weeks of administration. It is also not advisable to prescribe Buspar to patients who have previously been given any form of benzodiazepines (including Xanax and Valium). Since it is a bromide-based drug, the effects will become toxic if administered for a sustained period of time.

Cautions – Eating grapefruit, drinking grapefruit juice or consuming grapefruit by-products may cause sudden death. Buspar should not be administered to people with kidney or liver problems, or heart problems (including medicated hypertension). In long-term cases of administration blood tests must be administered for kidney and liver functionality since Buspar diminishes kidney and liver functions; Buspar should not be taken by individuals with seizure disorders; some people report feeling “mixed up” or “messed up” in their ability to make decisions and thus they become frozen in their ability to make decisions; alcohol should not be used in conjunction with Buspar; all sleeping drugs including hypnotics should be avoided (including over-the-counter sleep medications and Ambien).

Drug Interactions/Adverse affects – MAOI drugs may cause serious or fatal reactions with Buspar. These reactions including Marplan, Nardil, Azilect, Eldepryl, Emsam, or Parnate; Cold and allergy medicines; narcotics of all types; sleeping medication (prescription and non-prescription); muscle relaxers; seizure medication; Thorazine, Haldol, Serentil, Orap, or Mellaril; Decadron or Hexadrol; erythromycin (and its derivatives); Sporanox or Nizoral; Norvir; Rifadin, Rimactane, or Rifater; Capastat, Rifadin, Rimactane, Rifater, Vancocin, or Vanocin; calcium blockers such as Tiazac, Cartia, Cardizen, Calan,Covera, Isoptin, or Verelan; seizure medications such as Carbatrol, Tegretol, Dilantin, Luminal, or Solfoton; the concomitant use of Buspar with other CNS-active drugs has not been studied and extreme caution should be used. [This list is not complete.]

Class – Azaspirodecanedione (not a benzodiazepine and not affixed to the GABAa receptor complex; this is a bromide-based drug substance that will be toxic over time. All bromides are dangerous to human life.)

Purpose – Reduction of anxiety symptoms, reduction of panic attacks, treatment of Generalized Anxiety Disorder (not deemed as effective for other Axis I Anxiety Disorders).

Side Effects – Buspar may cause illogical thinking, confusion, and illogical decision-making capabilities that may seriously effect life decisions; extreme emotional instability has been indicated in some cases (including despair that leads to suicidal ideation or suicide attempts), feelings of catastrophe and utter despair without the ability to act or react accordingly and logically; Buspar is only minimally reactive to alcohol and in its responsible use should not result in overdose symptoms; other side effects include lack of coordination; drowsiness, dizziness, blurred vision; restlessness; nausea, upset stomach, diarrhea; insomnia; since Buspar binds to dopamine receptors, it may cause dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia; cardiovascular side effects include chest pain, hypotension, hypertension, congestive heart failure, heart attack, and bradycardia; central nervous system effects include dream disturbances, depersonalization, dysphoria, noise intolerance, euphoria, akathisia, fearfulness, loss of interest in life, dissociative reaction, hallucinations, suicidal ideation, seizures, slurred speech and psychosis; gastrointestinal effects include stomach problems including diarrhea, nausea, and vomiting, extreme flatulence, rectal bleeding, increased appetite and weight gain; muscular effects include muscle cramps, muscle spasms and arthralgias; sexual/genital side effects include leaking breasts, urinary hesitancy, menstrual irregularity, enuresis, nocturia, libido dysfunctions, and impotence.

Withdrawals – Some people report that initial cessation of Buspar results in extreme confusion and complete inability to act or react to life situations; illogical and damaging decisions can be made; vacating of all emotional response to life; extreme headaches similar to migraines; nausea; life-threatening neurological reactions; extreme anxiety; extreme and pathological depression; abdominal pains; aching; agoraphobia; blurred vision; altered and bizarre perceptions; diarrhea; distended abdomen; feeling of unreality; flatulence; food cravings and extreme weight gain; hair loss; heart palpitations; insomnia; lethargy; loss of balance; metallic taste; muscle spasms; nightmares; panic attacks; paranoia and unrealistic fears; persistent and unpleasant memories; hippocampus disruption resulting in short-term memory issues (unclear if these issues are permanent); speech difficulties; sweating; and sudden suicidal ideations/suicide attempts. [See Dr. Peter Breggin’s work regarding Buspar addiction and withdrawal at www.labelmesane.com.]

Sources – Drugs.com, realmentalhealth.com, labelmesane.com. psyweb.com

[Editorial Note: In my research of psychoactive drug substances I only include indications that come from the manufacturer or reputable drug-related focus groups. I do not include personal opinion or enhancements of facts from sources. With this drug, however, I must issue a caution due to information that I discovered on personal forums dedicated to this drug and its effects on people. Individuals who had taken or were currently taking Buspar consistently complained of severe alteration of decision-making abilities to the point where the diminution of those abilities severely altered life. Individuals consistently complained, also, of even more severe cognitive and emotional disturbances when attempting to discontinue use of the drug. One individual classified this drug as a “demon in pill form” and complained that it was destroying his life. Although this information is not scientific or tempered through official sources, users should beware of these potential effects from actual users.]

Lexapro

Lexapro

Drug Name -- Lexapro

Alternate Names – Escitalopram [Lexapro is a derivative of citalopram (Celexa)]

Manufacturer – Forest Pharmaceuticals

Type – Prescription (Not Controlled). FDA Black Box Warning – Increased suicide risk for some age groups (at a minimum).

Pregnancy Issues – FDA Pregnancy Category C. No substantial research has been conducted and it must be assumed that Lexapro is transplacental and may cause damage to the fetus or birth defects. Lexapro may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. Lexapro can pass into breast milk and may harm a nursing baby.

Addiction Potential – It is not conclusive that Lexapro is psychologically addicting. It does, however, result in tolerance issues over time. The drug should not be abruptly discontinued. Consult a doctor prior to stopping Lexapro. Some researchers have indicated that there may be withdrawal symptoms when Lexapro is discontinued (this is especially true in cases of abrupt cessation).

Maximum Prescription Duration – This is a long-term prescription that usually does not take full effect for at least four weeks. Over time, the patient may experience a diminishing effect of the drug and may need to consult a medical doctor about switching to another SSRI antidepressant. The switching process is complex and demands that the patient titrate off of Lexapro over time and then resume on another SSRI antidepressant after a two-week break between drugs. Patients may experience heightened symptoms during this process.

Cautions – Lexapro may increase suicidal ideations or suicide attempts for at least the first 12 weeks that it is taken. It may cause mood or behavior changes, anxiety, panic attacks, insomnia, impulsiveness, irritability, agitation, hostility, aggressiveness, restlessness, hyperactivity, or increased depression. Do not take if you have liver or kidney disease, seizures or epilepsy, Bipolar I Disorder (Lexapro may interact negatively with a manic or hypomanic condition), or a history of suicide attempts or suicidal ideations. [This list of cautions is not complete.]

Drug Interactions/Adverse affects – Avoid all use of alcohol or other CNS depressants while taking Lexapro. Do not take with an MAOI such as Marplan, Nardil, Azilect, Eldepryl, Emsam, or Parnate. This drug interaction can be fatal. Do not take with non-steroidal anti-inflammatory drugs (NSAIDs) including Advil, Motrin, Aleve, Naprosyn, Voltaren, Feldene, Relafen, Lodine, and any other NSAIDs. Carbatrol and Tegretol; Tagamet; Lithium; blood thinners such as Coumadin; other SSRI antidepressants such as (but not limited to) Elavil, Celexa, Prozac, Sarafem, Luvox, Tofranil, Pamelor, Paxil, or Zoloft. Lexapro may also interact with Axert, Frova, Imitrex, Amerge, Maxalt, or Zomig. [This is not a complete list of drug interactions.]

Class – SSRI antidepressant; FDA Black Box Warning (see above).

Purpose – Major Depressive Disorder; Generalized Anxiety Disorder.

Side Effects – Lexapro may impair your thinking or reasoning abilities. Lexapro may induce mania or manic/hypomanic episodes. Allergic reactions including skin rash or hives, difficulty breathing, swelling of the face, lips, tongue, or throat; significant mood or behavior changes, anxiety, panic attacks, insomnia, impulsiveness, irritability, agitation, hostility, aggressiveness, restlessness, hyperactivity, worsening depression, or suicidal ideations. Lexapro may also cause very rigid muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes; nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops. [This is not a complete list of side effects.]

Withdrawals – Aggression, extreme anxiety, blurred vision, concentration impairment, constipation, crying spells and increased emotionality, depersonalization, diarrhea, dizziness. fatigue, flatulence, flu-like symptoms, hallucinations, hostility, indigestion, irritability, impaired speech, insomnia, lack of coordination, lethargy, migraine headaches, nausea, nervousness, paranoia, akathasia, stomach cramps, tremors, tinnitus, tingling sensations, disturbing thoughts, hallucinations, vivid dreams, and deepening depression.

Sources – Lexapro.com, drugs.com, blackboxrx.com, psyweb.com, psychdrugtruth.com

Abilify

Abilify

Drug Name -- Abilify

Alternate Names – Aripiprazole

Manufacturer – Bristol-Myers Squibb and Otsuka America Pharmaceuticals

Type – Prescription (Not Controlled) FDA Black Box Warnings: 1) Risk of death for elderly dementia-related psychosis patients; and, 2) increased risk of suicide and suicidal ideation when mixed with SSRI antidepressants in at least some age groups (which is its recommended usage for major depression).

Pregnancy Issues – This drug should not be used by pregnant women or women who are nursing.

Addiction Potential – Low. However, tolerance appears to develop due to negative effects from abrupt cessation of the drug. Further studies need to be conducted regarding physiological dependence.

Maximum Prescription Duration – Abilify is a long-term drug. Abilify takes between two and six weeks for full effectiveness.

Cautions – It is recommended by the manufacturers that Abilify should not be administered in dementia-related cases of psychosis. Abilify may cause death in such cases. It should not be administered to individuals with kidney or liver diseases, heart disease, high blood pressure, or heart rhythm problems; those who have had a heart attack or stroke; those who have a history of low white blood count; breast cancer; seizures or epilepsy; or diabetes. Do not drink alcohol while on Abilify. Abilify can cause a sudden change in heart rate and blood pressure. It may also impair judgment and reasoning. May cause swallowing problems. The drug should not be used if a person has had a suicide attempt or has suicidal ideations.

Drug Interactions/Adverse affects – Cold or allergy medicine; narcotics; sleeping pills; muscle relaxers; and medicine for seizures. Abilify should not be use with medications to treat high blood pressure or heart conditions; Tegretol; Luminol or Solfoton; Dilantin; Mycobutin, Rifadin, Rimactane or Rifater; Nizoral; Sporanox; Cardioquin or Quinaglute; Prozac, Luvox or Paxil.

Class – Antipsychotic (alters dopamine and serotonin)

Purpose – Schizophrenia, Bipolar I Disorder, Depression (add-on used in conjunction with SSRI antidepressants – See FDA Black Box Warning above)

Side Effects – Constipation, an inner sense of restlessness or need to move (akathisia), headache, nausea, upset stomach, vomiting, agitation, anxiety, insomnia, sleepiness, lightheadedness, and tremor; very high fever, rigid muscles, shaking, confusion, sweating, or increased heart rate and blood pressure. Abilify may cause neuroleptic malignant syndrome, which could be fatal. Other side effects include abnormal or uncontrollable movements. These may be signs of a serious condition called tardive dyskinesia which may be permanent. Elderly patients experience an increased potential for stroke (especially with dementia-related psychosis). Abilify increases blood sugar levels and should not be used by diabetics. Studies have indicated that Abilify (and like drugs) can cause coma and death when administered to diabetics.

Withdrawals – The most significant reports regarding withdrawals associated with cessation of Abilify are related to the recurrence of symptoms associated with the reason for taking the drug in the first place.

Sources – Abilify.com, psyweb.com, drugs.com

Celexa

Celexa

Drug Name – Celexa

Alternate Names – Citalopram

Manufacturer – Forest Pharmaceuticals

Type – Prescription (Not Controlled). FDA Black Box Warning – Increased suicide risk for some age groups (at a minimum).

Pregnancy Issues – It is not known if Celexa affects the fetus or not; thus it is not advisable to take Celexa while pregnant. Celexa does cross into breast milk and should be avoided by nursing mothers.


Addiction Potential – After eight weeks of continuous treatment patients suffered from consistent and identifiable withdrawal symptoms. Although SSRI antidepressants are not typically a drug of abuse, tolerance over time would be a significant indicator of physical addiction, especially with the presence of specific withdrawal symptoms with abrupt cessation. See Withdrawals below for a list of symptoms.

Maximum Prescription Duration – This is a long-term prescription that usually does not take full effect for at least four months. Over time, the patient may experience a diminishing effect of the drug and may need to consult a medical doctor about switching to another SSRI antidepressant.

Cautions – Celexa should not be taken with liver or kidney problems (Celexa diminishes both liver and kidney functionality and may damage both over time); by those who suffer from seizures, mania, Bipolar I Disorder, or who have suicidal thoughts or a history of suicidal attempts; contact a doctor immediately if you experience mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), if you feel more depressed, if you have had a previous suicide attempt or if you have thoughts about hurting yourself. Get emergency medical help if you have any of these signs of an allergic reaction including skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Drug Interactions/Adverse affects – Do not take with MAOIs such as Marplan, Nardil, or Parnate; any other SSRI antidepressants; any tricyclic antidepressant such as Elavil, Tofranil, Sinequan, or Pamelor; Tegretol or Felbatol; Tagamet, Zantac, or Prilosec; any antibiotic containing erythromycin; antifungals including Diflucan, Sporano or Nizoral; migraine medication such as Axert, Relpax, Frova, Amerge, Maxalt, Imitrex, or Zomig; asthma medication such as Accolate, Eskalith, Lithobid, or Lithonate; NSAID drugs such as Advil, Motrin, Aleve, Naprosyn, Voltaren, Feldene, Relafen, Lodine, and others (NSAID drugs are FDA Black Box drugs); or lithium. Celexa should not be taken in conjunction with Lexapro or by those who are allergic to Lexapro. [This list is not complete.]

Class – SSRI antidepressant; FDA Black Box Drug (see advisory above).

Purpose – Treatment of major depressive disorder.

Side effects – Abdominal pain, agitation, anxiety, diarrhea, drowsiness, dry mouth, ejaculation disorders, fatigue, impotence, indigestion, insomnia, loss of appetite, nausea, painful menstruation, respiratory tract infection, sinus or inflammation, sweating, tremor, and/or, vomiting, amnesia, attempted suicide, confusion, coughing, decreased sexual drive, depression, excessive urination, fever, gas, impaired concentration, increased appetite, increased salivation, itching, joint pain, lack of emotion, loss of menstruation, low blood pressure, migraine, muscle pain, rapid heartbeat, rash, skin tingling, taste disturbances, visual disturbances, weight gain, weight loss, yawning. Seek immediate medical attention if you experience very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes; nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops. [This list is not complete.]

Withdrawals – Withdrawals from any SSRI antidepressant can begin within eight hours of missing any dosage of the drug. The withdrawal symptoms can last for eight weeks or more – thus, becoming troubling to the patient. The persistence of withdrawal symptoms often leads to rebound depression that can be worse than the original depressive episode. The most prevalent symptoms include dizziness, nausea, fatigue, headache, gait instability and insomnia. SSRI withdrawal symptoms include a list of at least fifty effects (some more common and persistent than others).

Sources – Celexa.com (website contains the complete FDA Black Box information), drugs.com, psyweb.com, psychdrugtruth.com.

What is a Black Box Drug?

An FDA Black Box Drug is a drug that the Food and Drug Administration has deemed as a significant danger due to dangerous or troubling side effects. The FDA mandates that the manufacturer of the drug place the dangerous side effects in a “black box” in all literature and labeling associated with the drug. The dangerous side effects are supposed to appear on the manufacturer’s web site – again, in a “black box” (many drug manufacturers are slow to post this information).

The FDA Black Box information for Celexa is an appropriate example of how FDA Black Box information should appear on the web site and on packaging. This information can be located at www.celexa.com. [The information below appears in a bold, black framed box to emphasize its importance.]

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of Celexa or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Celexa is not approved for use in pediatric patients. (See WARNINGS: Clinical Worsening and Suicide Risk, PRECAUTIONS: Information for Patients, and PRECAUTIONS: Pediatric Use.)

Drug Fact Sheets

I am in the process of slowly adding drug fact sheets to the Counsel TxP Blog. I will continue to add these fact sheets according to the directions that users of the Blog give me. I want to add those drugs and classes of drugs that are most important to you.

I know that some of you have told me that you now investigate the drugs that a client is using, even though you may not have control of those drug administrations. It is always wise to know what drugs a client is using since many times the drugs themselves can interfere with therapy.

I am using eight different sites to accumulate the drug information. I don’t use all of the sites for each drug since a lot of the information is redundant. I always attempt to locate the manufacturer’s site for the drug so that I can verify the information that I am finding elsewhere. Some drugs are hard to locate, however.

I know that some of you use various sites for drug information. This list, however, accumulates a wide variety of informational sources. This will save you time and effect. All of the information included on the drug fact sheets includes sources at the bottom of the page so that you can research the drugs on those sites, if you wish to verify information.

If you have requests for specific drug research, please contact me and I will put your request at the top of my list. I would prefer to work on drugs that are of importance to everyone. Please give me some direction.

Bob at Counsel TxP
Author and Founder
maretcounseling@yahoo.com
708-446-3352

Valium

Valium

Drug Name -- Valium

Alternate Names – diazepam

Manufacturer – LaRoche Laboratories

Type – Prescription (DEA Schedule IV Controlled Substance)

Pregnancy Issues – Valium is transplacental and may cause serious birth defects. Valium should not be taken during pregnancy. Nursing mothers should not use Valium.

Addiction Potential – Extremely Strong (LaRoshe states that Valium should not be used for more than four months consecutively). Dependency occurs as soon as two weeks.

Maximum Prescription Duration – Four weeks according to professional studies (this is already beyond the threshold of addiction for a segment of the population). LaRoshe claims that the drug diminished in its effectiveness after four months due to tolerance issues (LaRoshe Laboratories).

Cautions – Do not use if you have liver or kidney function issues; do not use if you have had a stroke, have multiple sclerosis, Alzheimer’s disease, chronic obstructive pulmonary disorder (COPD), myasthenia gravis, or sleep apnea, or if you are seriously depressed; do not take if you have asthma, bronchitis, emphysema or other respiratory diseases; do not take if you have had suicidal thoughts.

Drug Interactions/Adverse affects – Alcohol has an additive affect; do not take in conjunction with narcotics, sleeping pills, sedatives, or other benzodiazepines; do not take with antacids; do not take with SSRI antidepressants, antihistamines, pain relievers, seizure medications or muscle relaxants; antipsychotic drugs; barbiturates; Tagamet; Nizoral; Lanoxin; Antabuse; Rifamate; Dilantin; Amytal, Butisol, Mebaral, Seconal, Luminal, or Solfoton; Azilect, Eldepryl, Emsam, or Parnate; Abilify, Thorazine, Haldol, Serentil, Compazine, Compro, Pentazine, Phenergan, Phenadoz, or Promethegan; Duragesic, Actiq, Lortab, Vicodin, Dilaudid, Dolophine, Methadose, morphine, OxyContin; MAO inhibitors; Prilosec; oral contraceptives; Darvon; Zantac; or Rifadin.

Class – Benzodiazepine

Purpose – Anxiety disorders; reduction of anxiety symptoms; reduction of alcohol addiction withdrawal symptoms

Side Effects – Valium has been determined to be a carcinogen; may cause or worsen glaucoma; may cause confusion, abdominal cramps, blurred vision, dry mouth, racing heartbeat / palpitations, shaking / slurred speech, urination problems, headache; convulsions, hallucinations, memory loss, trouble breathing or staggering, trembling; allergic reactions (difficulty breathing, closing of your throat, swelling of your lips, face, or tongue or hives); sores in the mouth or throat, yellowing of the skin or eyes; a rash, or hallucinations; unusual risk-taking behavior, decreased inhibitions, no fear of danger; depressed mood, thoughts of suicide or hurting yourself; hyperactivity, anxiety, agitation, hostility.

Withdrawals – vomiting, and unusual thoughts or behavior; seizures, heightened sensory perception, impaired concentration, confusion, dysosmia, clouded sensorium, paresthesias, muscle cramps, muscle twitch, diarrhea, blurred vision, appetite decrease, and weight loss. Other symptoms, such as extreme anxiety and insomnia, were frequently seen during discontinuation.

Sources – LaRoshe Laboratories Fact Sheets; psyweb.com; drugs.com; adrugrecall.com

Ambien

Ambien

Drug Name -- Ambien

Alternate Names – Zolpidem, Edluar

Manufacturer – Sanfi Aventis Pharmaceuticals

Type – Prescription (DEA Schedule IV controlled substance)

Pregnancy Issues – Ambien is transplacental and may cause harm to the fetus. It should not be taken while pregnant. Ambien should not be taken by nursing mothers.

Addiction Potential – Moderate to strong after two weeks of use. Addiction ensues in almost all cases of extended use with significant withdrawals. This drug is to be used for short-term relief of insomnia only (two weeks or less). Abuse is indicated when an individual takes more than 10mg per day.

Maximum Prescription Duration – Four to five weeks, maximum; no more than seven to ten days without a break.

Cautions – Ambien may cause a severe allergic reaction. These include: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Some people using this drug have engaged in activity such as driving, eating, or making phone calls and later having no memory of the activity. Recent studies indicate that long-term use of Ambien damages memory storage and recall in the hippocampus. This damage may be permanent; Do not take Ambien if you have any of the following conditions: kidney disease; liver disease; lung disease such as asthma, bronchitis, emphysema, or chronic obstructive pulmonary disease (COPD); sleep apnea (breathing stops during sleep); myasthenia gravis; a history of depression, mental illness, or suicidal thoughts; or a history of drug or alcohol addiction.

Drug Interactions/Adverse affects – Alcohol; contains lactose and should not be used by those who are lactose-intolerant; cold medicines, pain medication, muscle relaxants, and drugs for anxiety issues; Thorazine; Sporanox, Nizoral; Rifadin, Rimactane, Rifater; SSRI antidepressants. [This list is not complete. Ambien is very reactive with a large number of drugs and the user should consult a qualified pharmacist regarding interactive potential of the drug.]

Class – Hypnotic/Sedative

Purpose – Short-term insomnia relief only.

Side effects – Ambien can cause side effects that may impair logical thinking or reactions; amnesia; depressed mood, thoughts of hurting yourself; unusual thoughts, risk-taking behavior, decreased inhibitions, no fear of danger; anxiety, aggression, feeling restless or agitated; hallucinations, confusion, loss of personality; daytime drowsiness, dizziness, weakness, feeling "drugged" or light-headed; lack of coordination; amnesia, forgetfulness; vivid or abnormal dreams; nausea, constipation; sore throat; headache, muscle pain; or blurred vision. [This is not a complete list of side effects.]

Withdrawals – Behavior changes, stomach pain, muscle cramps, nausea, vomiting, sweating, anxiety, panic attacks, tremors, and seizure (convulsions); confusion; impulsiveness; potential long-term impairment of logical reasoning (some say this may be somewhat permanent); agitation; suicide or suicidal ideations; severe depression; hallucinations; delusional disorder; aggressive behavior; loss of personal identity; and insomnia (for an extended period of time). The insomnia suffered from withdrawals will likely be worse than the individual’s initial insomnia.

Sources – drugs.com, wrongdiagnosis.com, addictionsearch.com (The manufacturer’s webpage offers little or no substantial and quantitative information concern the drug).

Xanax

Xanax

Drug Name -- Xanax

Alternate Names – Alprazolam, Niravam

Manufacturer – Pfizer Pharmaceuticals

Type -- Prescription

Pregnancy Issues – Do not use if pregnant or nursing. This medication may cause birth defects.

Addiction Potential – Strong (dependency threshold indicated at 12 weeks by Pfizer Pharmaceuticals)

Maximum Prescription Duration – 12 weeks

Cautions – Do not take if you have asthma, emphysema, bronchitis, chronic obstructive pulmonary disorder (COPD), or other breathing problems, glaucoma, kidney or liver disease (especially alcoholic liver disease), a history of depression or suicidal thoughts or behavior or a history of drug or alcohol addiction. Do not eat grapefruit or grapefruit products while taking Xanax. This may have deadly effects.

Drug Interactions/Adverse affects – Not recommended for use with alcohol and other benzodiazepines; cold or allergy drugs; pain medicine; sleeping pills; muscle relaxers; medicine for seizures, depression, or anxiety; birth control pills; Sporanox, Tagamet, Tiazac, Cartia, Cardizem; IsonaRif, Rifamate; Darvon, Darvocet; Diflucan, Sporanox, or Nizoral; acetaminophen (Tylenol), or any SSRI antidepressant drugs. Do not use if allergic to Nizoral, Librium, Tranxene, Valium, Ativan, or Serax. [This list may not be complete. Consult with a pharmacist for complete information.]

Class -- Benzodiazepine

Purpose – Anxiety reduction, panic attack reduction, Generalized Anxiety Disorder treatment.

Side Effects – Inter-dose effects include heightened anxiety and panic attacks. Serious and moderately serious side effects include hives; difficulty breathing; swelling of face, lips, tongue, or throat; unusual risk-taking behavior, decreased inhibitions, no fear of danger; depressed mood, thoughts of suicide or hurting yourself; hyperactivity, agitation, hostility, hallucinations; feeling light-headed, fainting; seizure (convulsions); urinating less than usual or not at all; muscle twitching, tremor; jaundice (yellowing of the skin eyes); amnesia or forgetfulness, trouble concentrating; sleep problems (insomnia); muscle weakness, lack of balance or coordination, slurred speech; blurred vision; and nausea, vomiting, constipation, appetite or weight changes.

Withdrawals – Seizures, heightened sensory perception, impaired concentration, confusion, dysosmia, clouded sensorium, paresthesias, muscle cramps, muscle twitch, diarrhea, blurred vision, appetite decrease, and weight loss. Other symptoms, such as anxiety and insomnia, were frequently seen during discontinuation (Pfizer documentation).

Sources – Pfizer Pharmaceuticals, Drugs.com

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