Reference — Mental Health
Psychiatric Medications Reference
This reference covers the major psychiatric medication classes — mechanisms, representative drugs, key side effects, and high-yield nursing considerations for NCLEX and clinical practice.
Educational use only. Always verify current dosing, interactions, and administration guidelines using institutional drug references and provider orders. This reference 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.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Mechanism: Block reuptake of serotonin in the synapse, increasing serotonin availability. First-line for depression, anxiety disorders, OCD, PTSD, and PMDD.
Key drugs: Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), paroxetine (Paxil), fluvoxamine (Luvox)
| Consideration | Details |
|---|---|
| Therapeutic onset | 2–6 weeks for full effect; educate patients not to stop early |
| Common side effects | GI upset (nausea, diarrhea), sexual dysfunction, insomnia or sedation, headache, weight changes |
| Serious risk | Serotonin syndrome: agitation, hyperthermia, diaphoresis, tachycardia, clonus, confusion — medical emergency |
| FDA Black Box Warning | Increased suicidal ideation in children, adolescents, and young adults (under 25) in the first 1–4 weeks — monitor closely |
| Discontinuation | Never stop abruptly — taper to avoid discontinuation syndrome (dizziness, electric shock sensations, flu-like symptoms) |
| Interactions | MAOIs (fatal serotonin syndrome — require 14-day washout), linezolid, tramadol, St. John's Wort |
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Mechanism: Block reuptake of both serotonin and norepinephrine. Used for depression, anxiety disorders, chronic pain, fibromyalgia, and neuropathic pain.
Key drugs: Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq), levomilnacipran (Fetzima)
- Similar to SSRIs: 2–6 week therapeutic onset; taper to discontinue; serotonin syndrome risk
- Additional monitoring: Blood pressure (norepinephrine increases BP — monitor in hypertensive patients)
- Duloxetine (Cymbalta) is also used for diabetic peripheral neuropathy, fibromyalgia, musculoskeletal pain
- Venlafaxine (Effexor) has dose-dependent BP elevation — monitor BP especially at higher doses
Mood Stabilizers
Indication: Bipolar disorder (mania, depression, maintenance); some used for epilepsy and neuropathic pain.
| Drug | Key Monitoring | Critical Nursing Points |
|---|---|---|
| Lithium | Serum level 0.6–1.2 mEq/L; renal function; thyroid function | Toxicity >1.5 mEq/L: tremor, GI, confusion, ataxia; dehydration, NSAIDs, ACE inhibitors increase toxicity risk; maintain consistent salt/fluid intake |
| Valproate (Depakote) | Serum level 50–125 mcg/mL; LFTs; CBC (platelets) | Teratogenic (neural tube defects); hepatotoxicity; thrombocytopenia; weight gain, hair loss, nausea |
| Lamotrigine (Lamictal) | Clinical monitoring (no routine serum levels) | Stevens-Johnson syndrome (SJS) — serious rash requiring immediate discontinuation; titrate slowly; preferred for bipolar depression |
| Carbamazepine (Tegretol) | CBC (agranulocytosis, aplastic anemia risk), LFTs, sodium level | SIADH/hyponatremia; teratogenic; multiple drug interactions (CYP inducer); SJS risk |
Antipsychotics
Mechanism: Block dopamine D2 receptors. Used for schizophrenia, bipolar mania, schizoaffective disorder, and adjunctive use in depression.
| Generation | Examples | Key Side Effects |
|---|---|---|
| First-generation (typical) | Haloperidol (Haldol), chlorpromazine, fluphenazine, perphenazine | High EPS risk (dystonia, akathisia, parkinsonism, tardive dyskinesia); NMS |
| Second-generation (atypical) | Quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal), aripiprazole (Abilify), clozapine (Clozaril), ziprasidone (Geodon) | Metabolic syndrome (weight gain, hyperglycemia, dyslipidemia); lower EPS risk (except risperidone); QTc prolongation (ziprasidone) |
High-Yield Nursing Considerations
- EPS (Extrapyramidal Symptoms): Dystonia (acute muscle spasm, treat with benztropine or diphenhydramine), akathisia (inner restlessness), drug-induced parkinsonism, tardive dyskinesia (late-onset involuntary movements — monitor with AIMS scale)
- Neuroleptic Malignant Syndrome (NMS): Medical emergency — hyperthermia, rigidity, altered mental status, autonomic instability; stop antipsychotic immediately
- Clozapine: Reserved for treatment-resistant schizophrenia; risk of severe neutropenia/agranulocytosis requires ANC monitoring (weekly for first 6 months, then less frequently) per the prescribing information; lowest seizure threshold; significant sedation and hypersalivation
- Metabolic monitoring: Weight, BMI, blood glucose, lipid panel at baseline and periodically
- Hyperprolactinemia: Risperidone and haloperidol most likely — gynecomastia, galactorrhea, sexual dysfunction, menstrual irregularities
Benzodiazepines
Mechanism: Enhance GABA (inhibitory neurotransmitter) activity at GABA-A receptors, producing sedation, anxiolysis, muscle relaxation, and anticonvulsant effects.
Key drugs: Lorazepam (Ativan), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), midazolam (Versed)
| Consideration | Details |
|---|---|
| Indications | Acute anxiety/panic attacks (short-term), alcohol withdrawal, seizure management, procedural sedation, acute agitation |
| Respiratory depression | Monitor oxygen saturation and respiratory rate; avoid in respiratory compromise; flumazenil reverses effects (short-acting — may re-sedate) |
| Dependence risk | Physical dependence develops with regular use; never stop abruptly — withdrawal can cause seizures and death (unlike opioid withdrawal) |
| Older adults | High fall risk; cognitive impairment; paradoxical agitation in some patients; on Beers Criteria — use with extreme caution |
| CNS depressants | Additive respiratory depression with opioids, alcohol, other sedatives — dangerous combination; FDA Black Box Warning |
Other Psychiatric Medications
- Buspirone (Buspar): Non-benzodiazepine anxiolytic; no sedation, no dependence, no respiratory depression; takes 2–4 weeks for full effect; for GAD; does not provide acute relief
- MAOIs (Phenelzine, Tranylcypromine): Older antidepressants; severe dietary restriction required (tyramine-containing foods — aged cheese, cured meats cause hypertensive crisis); many drug interactions; rarely first-line
- Bupropion (Wellbutrin): NDRI (norepinephrine-dopamine reuptake inhibitor); also used for smoking cessation; lowers seizure threshold; no sexual side effects; avoid in eating disorders (lowers seizure threshold further)
- Mirtazapine (Remeron): Atypical antidepressant; promotes appetite and sleep; useful in patients with depression, insomnia, and poor appetite; significant sedation
- Stimulants (Methylphenidate, Amphetamines): Used for ADHD; cardiovascular monitoring required (HR, BP); misuse potential; assess mental health history before starting
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 →