Chapter 6

These terms are often encountered in descriptions of psychotropic medications and mental illness.
Adjunctive Therapy.
The use of a medication to treat a problem in combination with some other medication also prescribed for that problem.
An adrenergic medication is one that increases the concentration or activity of the hormone epinephrine. The term comes from the word adrenaline, which is an alternate name for epinephrine. Epinephrine is closely related to the neurotransmitter norepinephrine.
A general term for emotion, often in reference to body language and facial expressions that indicate the emotion. Flattened affect, or blunted affect, refers to the impairment or absence of the normal range of emotion.
A chemical that simulates or amplifies the effects of another chemical. The effect of taking, say, a dopamine agonist is similar to increasing the concentration of dopamine in the brain. In essence, an agonist may serve as a substitute for the other chemical.
A condition in which the count of white blood cells is low, which increases the susceptibility to infection.
Motor restlessness, including quivering and an inability to sit still. In severe cases, akathisia makes resting and sleeping impossible. (Section 4.4.3)
Alzheimer's Disease.
A progressive brain disorder that causes dementia. The dementia produced by Alzheimer's disease is a result of the gradual destruction of brain tissue due to the accumulation of abnormal protein structures known as amyloid plaques.
Lack of energy.
The inability to feel pleasure (a typical symptom of depression), where "pleasure" refers not simply to physical sensations, but any positive emotions (happiness, joy, satisfaction, fulfillment, etc.)
Difficulty in achieving orgasm.
Impaired ability, or inability, to recognize or believe that one is ill. People who have anosognosia often refuse to take medication for their illness, believing it either unnecessary, or an attempt to harm or control them. (Chapter 4)
A chemical that suppresses the effects of another chemical. The effect of taking, say, a dopamine antagonist is similar to decreasing the concentration of dopamine in the brain.
Aplastic Anemia.
A group of related disorders characterized by the failure of bone marrow to produce all three types of blood cells: Red blood cells, white blood cells, and platelets. The symptoms include unexplained infections, unexpected bleeding, and fatigue (due to insufficient white blood cells, platelets, and red blood cells). The condition is diagnosed by measuring the blood-cell concentration, or reduction in the number of cells in the bone marrow (from blood or marrow samples, respectively).
Attention Deficit Hyperactivity Disorder (ADHD).
A disorder, which is diagnosed primarily among children, characterized by inability to pay attention or focus on tasks at hand (such as schoolwork), hyperactive physical behavior (fidgeting, extreme restlessness), and difficulty controlling impulsive behavior.
Bipolar Disorder.
An illness in which manic and depressive episodes alternate. This illness was formerly called Manic-Depressive Disorder. (Chapter 3)
The action of certain medications to decrease the level of signalling associated with a particular neurotransmitter, by binding to, and blocking, receptors associated with that neurotransmitter. Dopamine blockade, for example, is the primary mechanism of antipsychotic medications (Section 4.1.1)
A psychiatric condition most commonly described as a state of stupor. The stupor type of catatonia is an apathetic state, and often physically frozen or rigid state, in which the person is either oblivious to, or does not react to, external stimuli (such as attempts to communicate). A second type of catatonia, known as catatonic excitement, is characterized by constant agitation and excitation, a type of hyperactivity that is also purposeless.
Central Nervous System (CNS).
The brain and spinal cord.
Cyclothymic Disorder.
A mild form of bipolar disorder. (Chapter 3)
A false belief; i.e., a belief that is contrary to observed fact, or extremely unrealistic. (Chapter 4)
Dementia is the name for a collection of symptoms having to do with the deterioration of mental function; namely, the progressive decline in memory, attention span, and the ability to learn, reason, make judgments, and communicate. Dementia can be produced by a variety of neurological disorders, such as Alzheimer's disease.
A persistent mood characterized by sadness, inability to feel pleasure, and other unpleasant feelings. (Chapter 2)
Depressive Episode.
A period of time during which a person's mood is characterized by depression.
An illness in which blood glucose (sugar) levels are above normal, because of an inability to metabolize glucose. The latter problem is due to insufficient production or utilization of insulin, the hormone responsible for metabolizing glucose. Diabetes is a very serious illness, which can rapidly lead to death if untreated. Treatment consists of careful diet, insulin injections, and medications to control blood-sugar levels.
A neurotransmitter. (Section 1.3.1)
Dopamine Agonist(DA).
A chemical that acts as a substitute for dopamine. (Section 2.7)
Dopamine Reuptake Inhibitor (DRI).
An antidepressant that increases the concentration of dopamine. (Section 2.5.10)
Double Depression
Major Depression experienced on top of dysthymia.
Mild chronic depression, which is not episodic, but remains steady over time.
Any sustained and involuntary contraction of the muscles, which leads to twisted and distorted posture. (Section 4.4.3)
Electroconvulsive Therapy (ECT).
A technique for treating depression, bipolar disorder, schizophrenia, and catatonia. External electrodes are used to stimulate parts of the brain with an electric current, in order to trigger seizures that alleviate the symptoms of these illnesses. (Section 1.7.2)
Enzyme-Inducing Anti-Epileptic Drug. This is a category of medication used in the treatment of seizures and bipolar disorder, so named because they cause the liver to increase production of the CYP450 enzyme. (Section 3.6)
Erectile dysfunction.
Endogenous Depression.
A state of depression for which there is no apparent precipitating cause.
Extrapyramidal Symptoms (EPS).
Any of a variety of movement disorders, including Parkinsonism, Dystonia, Akathisia, and Tardive Dyskinesia. These disorders are often induced by medication that suppress dopamine activity in the Extrapyramidal System, such as antipsychotics (see Section 4.4.3). The Extrapyramidal System is part of the brain's motor system, and is involved in the coordination of movement.
Erectile Dysfunction (ED).
Difficulty achieving or maintaining a satisfactory erection. (Chapter 5)
(As in dopaminergic, serotonergic, GABA-ergic). A medication is said to be XXX-ergic if it increases the concentration of XXX, or has an effect on the brain and body similar to what an increase in XXX would have. (The term is often used to refer to side effects of medications, e.g., "serotonergic effects such as decrease of libido," "anticholinergic effects such as low blood pressure," etc.)
Food and Drug Administration (FDA).
The United States government agency responsible for approving medications for prescription use.
Gamma Aminobutyric Acid (GABA).
A neurotransmitter. (Section 1.3.2, and Section 3.2)
GABA Analog (GA).
A chemical that increases the concentration or effects of the neurotransmitter GABA. GABA analogs are used to treat bipolar disorder. (Section 3.7)
GABA Reuptake Inhibitor (GRI).
A mood stabilizer that increases the concentration of GABA. (Section 3.7)
A neurotransmitter. (Section 1.3.3)
Half Life.
The time required for the body to eliminate (metabolize or expel) half of the total amount of the medication it currently contains.
Any subjective sensory perception that does not arise from an external stimulus, such as voices or images that are not actually present. Hallucinations may involve any of the senses, and be simple (e.g., a taste) or complex (e.g., complete conversations). (Chapter 4)
A disorder characterized by excess amounts of the hormone prolactin in the blood. Excess prolactin can cause a variety of symptoms, including depression, sexual dysfunction, and loss of libido. Women may have a variety of menstrual problems, infertility, hirsutism, or obesity. Men may have low, or no, sperm production. The major causes of hyperprolactinemia are pituitary-gland tumors, hypothyroidism, hypothalamic disease, chronic kidney failure, cirrhosis, and antipsychotic medications.
High blood pressure, which is high enough to be a health risk.
Hypertensive Crisis.
A sudden, dramatic increase in blood pressure, great enough to be dangerous. A hypertensive crisis may cause discomfort, severe headache, permanent injury, or even death.
Hypoactive Sexual Desire (HSD).
Also known as low libido, or Inadequate Sexual Desire (ISD), this term refers to the condition of having a level of sexual desire that is low enough to be considered a problem by the person or couple affected.
A milder form of mania, typically of shorter duration, which is characterized primarily by euphoria or irritability.
Low sodium concentration in the blood. This condition most commonly occurs when people are doing strenuous work in hot environments, where they lose a great deal of salt through perspiration. but don't replace it by consuming enough salt in the diet. When low in sodium, the brain cells absorb too much water, and the brain swells, pushing against the skull. The condition can cause nausea, vomiting, fatigue, dulled thinking, clumsiness, seizures, coma, and even death. It is very serious, but also easily treatable.
Low blood pressure, which may cause dizziness or fainting. Orthostatic hypotension refers to a sudden decrease in blood pressure when rising after sitting or lying down.
The capacity for sexual desire.
Major Depression, or Major Depressive Disorder.
Severe depression, which may be episodic, last for weeks or months, and recur after months or years. (Chapter 2)
A mood characterized by excess, as in some combination of the following: Excessive energy, excessively rapid speech or thinking, excessive elation, excessive self-confidence (leading to poor judgment and grandiose plans), excessive wakefulness, and excessive elation, irritability, or anger. (Chapter 3)
Manic-Depressive Disorder.
The obsolete name for what is now called bipolar disorder.
Manic Episode.
A period of time during which a person's mood is characterized by mania.
A chemical produced by the metabolic transformation (metabolization) of another chemical. Metabolite is the opposite of precursor. If chemical A is metabolized to produce chemical B, then A is a precursor of B, and B is a metabolite of A.
Monoamine Oxidase.
A family of enzymes (chemicals that break down other chemicals) that metabolize (destroy) neurotransmitters. (Section 2.4)
Monoamine Oxidase Inhibitor (MAOI).
An antidepressant that works by disabling monoamine oxidase molecules. (Section 2.4)
The use of a single medication to treat a medical problem.
Pain, intermittent or steady, often severe, extending along a nerve or group of nerves.
A medication that blockades the dopamine D2 receptor. The word essentially means "calming," but the primary use of these medications is in the treatment of psychosis, arising from schizophrenia or other conditions. When used in the context of treating psychosis, neuroleptic is an outdated term, and the term antipsychotic is preferred in current usage. However, the term neuroleptic applies to medications that have this mechanism but are used for purposes other than the treatment of psychosis, such as the control of serious vomiting.
Neuroleptic Malignant Syndrome (NMS).
A rare, but life threatening reaction to neuroleptic (anti-psychotic) medication, consisting of fever, muscular rigidity, altered mental status, and dysfunction of the autonomic nervous system. Much less common than tardive dyskinesia. (Section 4.3.3 and www.emedicine.com)
An impulse- (signal-) conducting cell. The brain, spinal column, and nerves are comprised of neurons. (Section 1.3)
A chemical that conveys a signal from one neuron to another, by propagating across a synaptic gap. Many types of neurotransmitters are known. (Section 1.3)
A noradrenergic medication is one that increases the concentration or activity of the neurotransmitter norepinephrine. The terms comes from the word noradrenalin, which is an alternate name for norepinephrine. Norepinephrine is closely related to the hormone epinephrine.
Noradrenergic/Specific Serotonergic Antidepressan (NaSSA).
An antidepressant that increases the release of norepinephrine and serotonin. (Section 2.5.8)
A neurotransmitter. (Section 1.3.4)
Norepinephrine-Dopamine Reuptake Inhibitor (NDRI).
An antidepressant that increases the concentration of both norepinephrine and dopamine. (Section 2.5.7)
Norepinephrine Reuptake Inhibitor (NRI).
A medication that increases the concentration of norepinephrine, used to treat ADHD and depression. (Section 2.5.6)
Off-Label, On-Label.
The on-label uses of a medication are those which the FDA (Food and Drug Administration of the United States) has officially approved, meaning for which it has found the medication to be effective. The off-label uses are any for which the FDA has not declared a medication to be effective. The lack of FDA approval doesn't mean the medication doesn't work for off-label conditions; it simply means that the FDA hasn't issued an official finding supporting the effectiveness of the medication for those uses. Off-label uses of psychotropic medications are common, and not infrequently lead to subsequent FDA-approved studies and approvals. The use of anticonvulsive medications to treat bipolar disorder is a good example of migration from off-label to on-label status.
Extreme distrust of others, to the point of believing that others are trying to harm or control one. (Chapter 4)
A condition, often induced by antipsychotic medications, whose symptoms resemble those of Parkinson's disease (Section 4.4.3). Symptoms include muscular rigidity, tremor, and impaired motor control (i.e., difficulty grasping and manipulating objects, walking in a straight line, and so forth).
Parkinson's Disease.
A chronic, and progressive, disease of the Central Nervous System, in which the brain cells that produce dopamine gradually die off. The steady reduction in dopamine levels in the brain leads to steady worsening of the symptoms, namely tremors, muscle stiffness, slowness of movement, poor balance and coordiation, depression, sleeping, and numerous other problems.
A pathway in the brain is is a bundle of nerve fibers that follow a particular path, often associated with the activity of a particular neurotransmitter.
A chemical that is converted into another chemical of interest. A serotonin precursor, for example, is a chemical that is converted (at least partially) into serotonin. Precursor is the opposite of metabolite. If chemical A is metabolized to produce chemical B, then A is a precursor of B, and B is a metabolite of A.
For men only. A sustained and dangerous erection that can last for a day or more. It constitutes a medical emergency, and must be treated quickly by medication or surgery, to avoid permanent damage to the penis.
The study of medications used to treat different kinds of mental illness.
An extremely serious mental illness characterized by one or more of the following: visual, auditory, or olfactory hallucinations; delusions (beliefs that clearly contradict reality); inability to think coherently; and inability to realize that one has any of these problems (anosognosia). People suffering from psychosis are described as psychotic, and may have discussions with people who don't exist, and exhibit bizarre and irrational behavior, including verbal and (rarely) physical violence. Types of psychotic disorders (psychoses) include Schizophrenia, Schizoaffective Disorder, Delusional or Paranoid Disorder, and Psychotic Depression. (Chapter 4)
A medication that affects the functioning of the brain, often by modifying neurotransmitter chemistry.
QT Interval.
The duration of electrical activity that controls contraction of the heart muscle. The QT interval is measured by an EKG device.
QT Prolongation
Prolongation of the QT interval by medication, such as the typical antipsychotics, which can cause a serious heart-rhythm problem called Torsades de Pointes. The latter condition can cause fainting or death. (See www.arizonacert.org and Section 4.3.4 for details.)
A receptor is a localized region on the surface of a neuron that receives a signal from another neuron (in the form of a pulse of neurotransmitter molecules squirted across the synaptic gap between the neurons), and initiates some activity in the receiving neuron. Each receptor responds to a particular neurotransmitter, and there are usually multiple sub-types of receptor for each neurotransmitter. (Section 1.3)
Reversible MAO Inhibitor (RIMA).
A type of MAO inhibitor that does not disable the enzyme monoamine oxidase permanently. The disabling reaction is reversible, a characteristic that reduces problems with food and drug interactions.
An illness characterised by psychosis (a collection of symptoms that includes hallucinations, delusions, and anosognosia), cognitive impairment, and inability to feel pleasure or satisfaction. (Chapter 4)
A neurotransmitter. (Section 1.3.5)
Serotonin Agonist/Reuptake Inhibitor (SARI).
An antidepressant that increases the concentration of serotonin, and promotes the conversion of the serotonin precursor 5HT to serotonin. (Section 2.5.4)
Serotonin/Norepinephrine Reuptake Inhibitor (SNRI).
An antidepressant that increases the concentration of both serotonin and norepinephrine. (Section 2.5.5)
Serotonin Reuptake Accelerator (SRA).
An antidepressant that decreases the concentration of serotonin. (Section 2.5.9)
Selective Serotonin Reuptake Inhibitor (SSRI).
An antidepressant that increases the concentration of serotonin. (Section 2.5.3)
Serotonin Syndrome.
A condition resulting from excessive levels of serotonin, caused by taking an excess of medications that increase serotonin concentration. The condition is characterized by the presence of at least one abnormal symptom in each of these three categories: disturbance of mental status (anxiety, agitation, confusion, restlessness, hypomania, hallucinations and coma); motor changes (tremor, involuntary twitching, loss of coordination, and muscle tightness and stiffness, especially in the legs); and disturbance of the autonomic nervous system (fever, sweating, nausea, vomiting, diarrhea and hypertension). Life-threatening complications include coma, seizures, blood coagulation, and breakdown of muscle tissue, which can cause kidney damage. While Serotonin Syndrome can be very dangerous, and must be treated promptly by a physician, most cases that occur are mild, and quickly disappear when the offending medication is halted. Benzodiazepines (excluding Clonazepam), as in Section 3.9, may be used to relieve the symptoms. More severe cases can be treated with serotonin antagonists such as Cyproheptadine (Section 5.3.5), methysergide, and beta blockers such as Propranolol. (Section 2.2.4)
Sexual Dysfunction.
Any problem that impairs or prevents satisfactory sexual functioning. (Chapter 5)
Somatoform Disorder.
A condition characterized by a variety of physical symptoms, typically lasting for several years, that cannot be attributed to other illnesses. Symptoms include frequent headaches, back pain, abdominal cramping and pelvic pain, pain in the joints, legs and arms, chest or abdominal pain, gastrointestinal problems (nausea, bloating, vomiting, diarrhea and food intolerance), painful urination, and sexual dysfunction. Somatoform disorder is difficult to diagnose, because its symptoms are similar to many other illnesses. Its cause is not known, but may be related to abnormalities of signal propagation in the nervous system.
Stevens-Johnson Syndrome.
An allergic reaction to medication characterized by painful blistering of the mucous membranes (e.g. in and around the mouth, throat, anus, genitals, vagina, and eyes), and patchy areas of rash, often preceded by flu-like symptoms and high fever. Blistered skin peels off very easily. This illness is very serious, and can be fatal.
Synapse, or Synaptic Gap.
The gap between the signal-transmitting region (an axon terminal) of one neuron, and the signal-receiving portion (receptors) of an adjacent neuron. (Section 1.3)
Tardive Dyskinesia (TD).
Involuntary movements of the tongue, lips, face, upper body, and extremities. Although the condition may occur naturally, it most often occurs as a result of treatment with neuroleptic (anti-psychotic) medications (e.g., dopamine antagonists). It is a very serious condition, which may or may not go away when medication is stopped. It is a principle risk in the use of antipsychotic medications. (Section 4.3.1 and www.emedicine.com)
Tricyclic Antidepressant (TCA).
An antidepressant medication that increases the concentration norepinephrine and serotonin, named for the tricyclic chemical structure shared by members of this family (although one such medication, Maprotiline, actually has a tetracyclic structure). (Section 2.5.2)
Torsades de Pointes.
A type of cardiac arrhythmia (abnormal heartbeat) that can cause fainting or death. It can be caused by medications that prolong the QT interval, such as the typical antipsychotics. (Section 4.3.4 and www.arizonacert.org)
Tourette's Disorder.
A neurological disorder, characterized by involuntary movements, and vocal outbursts (known as tics), which have persisted for at least 12 months.
Toxic Epidermal Necrolysis.
An allergic reaction to medication, very similar to Stevens-Johnson Syndrome, with the additional symptom that large areas of skin may blister and peel off (even 30% or more of the skin, in many cases). This illness is very serious, and can be fatal.
Transcranial Magnetic Stimulation (TMS).
A technique for treating depression by stimulating parts of the brain with time-varying, externally-generated magnetic-fields. It is also abbreviated as "rTMS," for repetitive TMS. (Section 2.2.2)
A skin patch. This is a plastic patch, coated with adhesive on one side, which sticks to the skin. The medication stored in the patch flows slowly through the skin into the blood stream.
A common amino acid, found in food and in the body, which affects blood pressure. An excess of tyramine causes high blood pressure, and associated symptoms such as headaches. A sufficiently large excess can cause a dangerous hypertensive crisis. The digestive tract normally eliminates excess tyramine by destroying it with the enzyme Monoamine Oxidase A(MAO-A). Medications that inhibit MAO-A impair this regulatory mechanism, and consumption of tyramine while taking these medications can produce a hypertensive crisis.
Common foods that contain high levels of tyramine include aged cheeses, any aged or preserved meats (bacon, sausage), red wines, miso soup, brewer's yeast, and most yeast-containing products. Baker's yeast, used to make bread and other leavened foods, does not contain tyramine.
Tyramine accumulates naturally in foods as they age. Aged foods of any kind, including refrigerated leftovers more than a day old, may contain high levels of tyramine.
Unipolar Depression.
A synonym for depression, used to distinguish it from the depressive episodes of bipolar disorder.
Vagus Nerve Stimulation (VNS).
A technique for treating seizure disorders and depression by electrically stimulating the Vagus Nerve. (Section 2.2.1)
A chamber in a neuron, which stores neurotransmitter molecules. Some neurotransmitters are synthesized inside vesicles, while others are synthesized elsewhere in the neuron, and piped into vesicles for storage. (Section 1.3)
Washout Time.
The time from termination of medication until another, potentially conflicting one can be used; or, equivalently, the time from termination until the medication is effectively gone from the body. Often taken to be five half-lives.