Psychopharmacology and Somatic Treatments
Core concepts
Know mechanisms, side effects, and monitoring for major drug classes: SSRIs (GI upset, sexual dysfunction, hyponatraemia, serotonin syndrome), SNRIs (hypertension), TCAs (anticholinergic, cardiac), MAOIs (tyramine reaction), antipsychotics (metabolic, EPS, prolactin, QT), mood stabilisers (lithium, valproate - teratogenic, lamotrigine - rash/SJS), and benzodiazepines (dependence).
Somatic treatments
- ECT: indications include severe/psychotic depression, catatonia, life-threatening refusal of food/fluid; side effects are transient memory impairment.
- TMS: depression, non-invasive.
- Ketamine/esketamine: rapid antidepressant effect, dissociative side effects.
Traps
- Forgetting baseline and follow-up monitoring: weight, lipids, glucose, prolactin, ECG where indicated.
- Missing drug interactions: lithium + NSAIDs/thiazides; MAOI + tyramine/serotonergic drugs; clozapine + smoking cessation (levels rise).
- Prescribing valproate in women of childbearing age without pregnancy prevention.
- Confusing EPS (dystonia, akathisia, parkinsonism, tardive dyskinesia) with other movement disorders.
Rule of thumb
Before starting any psychotropic, document baseline parameters and a monitoring plan; review adherence and side effects at every visit.