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💊 Clozapine is an FDA-approved atypical antipsychotic medication for treatment-resistant schizophrenia. ⁠

❌ Clozapine is not the first-line drug of choice due to its range of adverse effects including agranulocytosis (a serious condition with a severely low number of neutrophils – a type of white blood cell).⁠

⭐️ Due to this adverse effect, a patient must be enrolled in the clozapine REMS registry by a certified clinician in order to receive treatment. ⁠

⚖️ Clozapine is also associated with significant weight gain, diabetes type 2, diabetic ketoacidosis, and increased lipid levels-all due to increased insulin resistance.⁠

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💊 Lithium is a common ‘mood stabilizer’ used to treat the manic episodes of bipolar disorder, a mood disorder that is characterized by episodes of mania, hypomania, and depression. ⁠⠀
🤔 The exact cause of bipolar disorder is unknown but is highly linked to family history, genetics, and abnormalities in neurotransmitters. This makes it tricky to pinpoint exactly how lithium works to treat bipolar but there are many proposed mechanisms of action. ⁠⠀
🧠 Whenever you see the medication lithium, always think SALT as lithium (Li+) is located close to sodium (Na+) on the periodic table and they share similar structures. Because of this, lithium levels are often affected by salt and water balance as well as renal function (excreted mainly through kidneys). ⁠⠀
💦 Dehydration can cause lithium levels to increase while increasing sodium intake can cause lithium levels to decrease. Medications that affect water and salt balance (ex: diuretics, NSAIDs, ACEI) can also alter lithium concentrations. ⁠⠀
🗓️ The starting dose of lithium is 300 mg two or three times a day (The brand name is Lithobid to help you remember that it can be given BID or twice daily)⁠⠀
🤰🏻Lithium is considered teratogenic due to the potential for fetal cardiac defects. The risks and benefits should be discussed with a healthcare provider before starting it in women of childbearing age.⁠⠀
⭐ Lithium is a popular drug that often shows up on tests due to its narrow therapeutic index and many side effects. ⁠⠀

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🌧️ Major depressive disorder (MDD) is a mood disorder characterized by persistent feelings of sadness and loss of interest that interferes with normal daily functioning.⁠

⭐️ The exact chemical basis for depression is poorly understood but is thought to be linked to decreased levels of the neurotransmitters, serotonin, dopamine, and norepinephrine. This cause is also known as the monoamine hypothesis.⁠

👉🏻 Because of this, the drugs developed to treat MDD selectively target the reuptake of serotonin and norepinephrine, increasing levels of these neurotransmitters in the synapse and enhancing NT signaling.⁠

⭐️ SSRIs are generally first-line due to their improved tolerability compared to the others (TCAs and MOAIs) and relative safety in cases of overdose.⁠

⭐️ Studies have shown equivalent efficacy among antidepressants, therefore the initial choice is made empirically based on patient factors and the nuances of each drug.⁠

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💊 Antipsychotics, also known as neuroleptics, are a class of medications primarily used to manage psychosis in schizophrenia or bipolar disorder, hence the name anti-PSYCHOTICS or anti-PSYCHOSIS (including delusions, hallucinations, paranoia, or disordered thought) 👹⁠ ⁠ They are broken down into two generations which differ by their side effect profiles: ⁠ ⁠ 1️⃣ 1st generation also called typical antipsychotics are associated with significant extrapyramidal side effects (movement disorder). ⁠ 2️⃣ 2nd generation also called atypical antipsychotics have decreased risks of EPS side effects as compared to 1st generation antipsychotics but are associated with significant weight gain and the development of metabolic syndrome.⁠ ⁠ In addition, all of the antipsychotics block the following receptors with varying degrees leading to the common side effects seen: ⁠ ⁠ ⭐ Dopamine: EPS symptoms⁠ ⭐ Alpha: hypotension⁠ ⭐ Muscarinic: anticholinergic side effects ⭐ Histamine: sedation⁠ ⁠ 🧠 MOA: In schizophrenia, dopamine is tied to hallucinations and delusions. Certain areas in the brain that ‘run off’ of dopamine may become overactive leading to symptoms of psychosis. Both generations block dopamine receptors, but second generations tend to act on serotonin receptors as well.

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SNRI Side Effects

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressants that work by blocking serotonin and norepinephrine reuptake in the synapse (as the name suggests). ⁠ ⁠ 🗒️ It is important to educate patients that there is an increased risk of suicidal thinking and behavior in children, adolescents, and young adults during the first few months of therapy and it may take up to 8 weeks before therapeutic effects are recognized.⁠

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SSRIs Side Effects

💊 Selective serotonin reuptake inhibitors (SSRIs) work by inhibiting 5-HT reuptake by the presynaptic cleft, thus increasing serotonin levels in the synapse.⁠ It is commonly used to treat depression, a condition thought to be linked to low levels of serotonin, dopamine, and norepinephrine. ⁠ ⁠ ⭐ As you can see, this mnemonic is similar to the mnemonic on the side effects of SNRIs. Since they both block serotonin reuptake, they exhibit very similar side effect profiles except SNRIs can also impact blood pressure (increase or decrease) due to the norepinephrine reuptake inhibition. SSRIs do not affect blood pressure. ⁠ ⁠ In addition, SSRIs can cause weight gain in adults on long-term therapy, while SNRIs cause less of this long-term weight gain and are more associated with weight loss. ⁠

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