Chart — Mental Health
Psychiatric Medication Classes
Quick-reference chart of all major psychiatric medication classes — mechanisms, representative drugs, clinical uses, and NCLEX-focused nursing considerations for each class.
Educational use only. Always verify current prescribing information, dosing, and drug interactions using institutional references. This chart is for nursing education and NCLEX preparation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Medication Classes Reference
| Class | Examples | Common Uses | Nursing Considerations |
|---|---|---|---|
| SSRIs | Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil) | Depression, anxiety disorders, OCD, PTSD, PMDD, panic disorder | Onset 2–6 weeks; do not stop abruptly; FDA Black Box for suicidal ideation in youth; serotonin syndrome with MAOIs; monitor for GI effects, sexual dysfunction |
| SNRIs | Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq) | Depression, anxiety disorders, GAD, neuropathic pain, fibromyalgia (duloxetine), musculoskeletal pain | Monitor blood pressure (norepinephrine → ↑ BP); onset 2–6 weeks; taper to discontinue; serotonin syndrome risk; duloxetine: check LFTs (hepatotoxicity risk) |
| TCAs (Tricyclics) | Amitriptyline, nortriptyline, imipramine, clomipramine | Depression (less commonly used now), neuropathic pain, enuresis (imipramine), OCD (clomipramine) | Lethal in overdose (QT prolongation, cardiac toxicity) — dangerous in suicidal patients; anticholinergic side effects (dry mouth, urinary retention, constipation, blurred vision); orthostatic hypotension; sedation |
| MAOIs | Phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Emsam) | Treatment-resistant depression; atypical depression (rarely first-line) | Tyramine restriction required (aged cheese, cured meats, red wine → hypertensive crisis); many drug interactions; 14-day washout before starting/stopping SSRIs; selegiline patch has fewer dietary restrictions at low doses |
| Atypical Antidepressants | Bupropion (Wellbutrin), mirtazapine (Remeron), trazodone, vilazodone | Depression; bupropion also for smoking cessation and ADHD; mirtazapine for depression + insomnia + weight loss; trazodone for insomnia | Bupropion: lowers seizure threshold — avoid in eating disorders, seizure history; no sexual side effects. Mirtazapine: significant sedation, weight gain. Trazodone: priapism risk (rare) |
| Mood Stabilizers | Lithium (Eskalith), valproic acid (Depakote), lamotrigine (Lamictal), carbamazepine (Tegretol) | Bipolar disorder (mania, depression, maintenance); seizure disorders; migraine prophylaxis (valproate) | Lithium: level 0.6–1.2 mEq/L, toxicity > 1.5; hydration/sodium critical; monitor renal, thyroid. Valproate: teratogenic, LFTs, CBC. Lamotrigine: SJS risk — titrate slowly. Carbamazepine: agranulocytosis, hyponatremia |
| Typical Antipsychotics (First-Generation) | Haloperidol (Haldol), chlorpromazine, fluphenazine, perphenazine, thioridazine | Schizophrenia (positive symptoms), acute agitation, Tourette syndrome, hiccups (chlorpromazine) | High EPS risk (dystonia, akathisia, parkinsonism, tardive dyskinesia); NMS (emergency: hyperthermia, rigidity, AMS, autonomic instability); QTc prolongation; hyperprolactinemia; haloperidol available IM for acute agitation |
| Atypical Antipsychotics (Second-Generation) | Quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal), aripiprazole (Abilify), clozapine (Clozaril), ziprasidone (Geodon), lurasidone (Latuda) | Schizophrenia (positive and negative symptoms), bipolar disorder, adjunctive depression, schizoaffective disorder | Metabolic syndrome (weight, glucose, lipids) — monitor at baseline and periodically. Clozapine: agranulocytosis risk → regular ANC/CBC monitoring (weekly first 6 months; FDA eliminated the Clozapine REMS June 2025, but ANC monitoring per labeling continues). Ziprasidone: QTc prolongation. Risperidone: high hyperprolactinemia risk. Lower EPS than typical antipsychotics |
| Benzodiazepines | Lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), midazolam (Versed) | Acute anxiety, panic attacks, alcohol withdrawal, seizure management, procedural sedation, acute agitation | Respiratory depression — monitor SpO₂, RR; flumazenil reversal (short-acting). Dependence risk — never stop abruptly (withdrawal can be fatal). Falls in older adults (Beers Criteria). Additive CNS/respiratory depression with opioids (FDA Black Box). Short-term use only for anxiety |
| Buspirone | Buspirone (Buspar) | Generalized anxiety disorder (GAD) — does not provide acute relief | No dependence, no respiratory depression, no sedation; takes 2–4 weeks for anxiolytic effect; does not treat acute panic attacks; safe for long-term use; no cross-tolerance with benzodiazepines |
| Stimulants | Methylphenidate (Ritalin, Concerta), amphetamine/dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse) | ADHD, narcolepsy | Cardiovascular monitoring: HR, BP, ECG if history of cardiac disease. Assess mental health history — can exacerbate anxiety, tics, psychosis. Misuse/diversion potential (Schedule II). Monitor growth in children. Give early in day to avoid insomnia |
High-Yield NCLEX Points
- SSRIs/SNRIs: 2–6 week onset — educate patients; never abruptly discontinue; monitor for serotonin syndrome with MAOIs
- Lithium therapeutic range: 0.6–1.2 mEq/L; toxicity begins at >1.5 mEq/L — coarse tremor, GI, confusion, ataxia
- Antipsychotics: monitor for EPS (dystonia → treat with diphenhydramine or benztropine) and NMS (emergency — stop medication)
- Clozapine requires regular ANC/CBC monitoring (weekly first 6 months) — agranulocytosis is life-threatening (FDA eliminated the Clozapine REMS in June 2025; monitoring per labeling continues)
- Benzodiazepines: respiratory depression; never stop abruptly (fatal withdrawal); Beers Criteria for older adults
- MAOIs + tyramine-containing foods = hypertensive crisis; 14-day washout required with SSRIs
- Bupropion lowers seizure threshold — avoid in eating disorders and seizure history
- Lamotrigine (Lamictal): Stevens-Johnson syndrome risk — titrate slowly, report any new rash immediately
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →