Pharmacology and Psychopharmacology

  • Rajesh R. Tampi
  • Deena J. Tampi
  • Mallika Lavakumar


Up-to-date knowledge of pathophysiological changes associated with aging and psychopharmacology are essential skills for clinicians caring for older adults with psychiatric disorders. This knowledge enables clinicians to make optimal use of psychotropic medications to treat psychiatric disorders in the older adult population. Maximizing the effectiveness of psychotropic medications and minimizing their adverse effect profile will enable older adults to have better treatment outcomes. This optimization of treatment will reduce the financial burden on an already stretched healthcare system. In this chapter we review essential aspects of geriatric pharmacology and psychopharmacology that will enable clinicians to optimize the treatment of older adults with psychiatric disorders.


Pharmacology Psychopharmacology Pharmacokinetics Pharmacodynamics Cytochrome P450 (CYP450) Antidepressants Anxiolytics Antipsychotics Mood stabilizers 


  1. 1.
    Mental health and older adults. Accessed 10 Dec 2016.
  2. 2.
    Aging Statistics. Accessed 10 Dec 2016.
  3. 3.
    Reynold K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry. 2015;14(1):74–81.CrossRefGoogle Scholar
  4. 4.
    Aparasu RR, Mort JR, Brandt H. Psychotropic prescription use by community-dwelling elderly in the United States. J Am Geriatr Soc. 2003;51(5):671–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Molinari VA, Chiriboga DA, Branch LG, et al. Reasons for psychiatric medication prescription for new nursing home residents. Aging Ment Health. 2011;15(7):904–12.CrossRefPubMedGoogle Scholar
  6. 6.
    García-Gollarte F, Baleriola-Júlvez J, Ferrero-López I, Cruz-Jentoft AJ. Inappropriate drug prescription at nursing home admission. J Am Med Dir Assoc. 2012;13(1):83.e9–15.CrossRefGoogle Scholar
  7. 7.
    Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000;109(2):87–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Hartikainen S, Lönnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007;62(10):1172–81.CrossRefPubMedGoogle Scholar
  9. 9.
    Peron EP, Gray SL, Hanlon JT. Medication use and functional status decline in older adults: a narrative review. Am J Geriatr Pharmacother. 2011;9(6):378–91.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tampi RR, Williamson D, Mittal V, et al. Behavioral and psychological symptoms of dementia: part I—epidemiology, neurobiology, heritability, and evaluation. Clin Geriatr. 2011;19(5):41–6.Google Scholar
  11. 11.
    Tampi RR, Williamson D, Mittal V, et al. Behavioral and psychological symptoms of dementia: part II—treatment. Clin Geriatr. 2011;19(6):31–40.Google Scholar
  12. 12.
    By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  13. 13.
    Pollock B, Forsyth C, Bies R. The critical role of clinical pharmacology in geriatric psychopharmacology. Clin Pharmacol Ther. 2009;85(1):89–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Golan DE, Tashjian AH, Armstrong AJ, Armstrong AW, editors. Principles of pharmacology: the pathophysiologic basis of drug therapy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 19–49.Google Scholar
  15. 15.
    von Moltke LL, Abernethy DR, Greenblatt DJ. Kinetics and dynamics of psychotropic drugs in the elderly. In: Salzman C, editor. Clinical geriatric psychopharmacology. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004. p. 87–114.Google Scholar
  16. 16.
    Madhusoodanan S, Velama U, Parmar J, Goia D, Brenner R. A current review of cytochrome P450 interactions of psychotropic drugs. Ann Clin Psychiatry. 2014;26(2):120–38.PubMedGoogle Scholar
  17. 17.
    Caley CF. Interpreting and applying CYP450 genomic test results to psychotropic medications. J Pharm Pract. 2011;24(5):439–46.CrossRefPubMedGoogle Scholar
  18. 18.
    Lynch T, Price A. The effect of cytochrome P450 metabolism on drug response, interactions, and adverse effects. Am Fam Physician. 2007;76(3):391–6.PubMedGoogle Scholar
  19. 19.
    Eap CB. Personalized prescribing: a new medical model for clinical implementation of psychotropic drugs. Dialogues Clin Neurosci. 2016;18(3):313–22.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Albers LJ, Hahn RK, Reist C. Handbook of psychiatric drugs. Blue Jay: Current Clinical Strategies Publishing; 2011. p. 8–110.Google Scholar
  21. 21.
    Labbate LA, Fava M, Rosenbaum JF, Arana GW. Handbook of psychiatric drug therapy. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 1–254.Google Scholar
  22. 22.
    Perry R, Cassagnol M. Desvenlafaxine: a new serotonin-norepinephrine reuptake inhibitor for the treatment of adults with major depressive disorder. Clin Ther. 2009;31(Pt 1):1374–404.CrossRefPubMedGoogle Scholar
  23. 23.
    Asnis GM, Henderson MA. Levomilnacipran for the treatment of major depressive disorder: a review. Neuropsychiatr Dis Treat. 2015;11:125–35.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    McCormack PL. Vilazodone: a review in major depressive disorder in adults. Drugs. 2015;75(16):1915–23.CrossRefPubMedGoogle Scholar
  25. 25.
    Connolly KR, Thase ME. Vortioxetine: a new treatment for major depressive disorder. Expert Opin Pharmacother. 2016;17(3):421–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Jacobson LH, Callander GE, Hoyer D. Suvorexant for the treatment of insomnia. Expert Rev Clin Pharmacol. 2014;7(6):711–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Castillo EG, Stroup TS. Effectiveness of long-acting injectable antipsychotics: a clinical perspective. Evid Based Ment Health. 2015;18(2):36–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Reus VI, Fochtmann LJ, Eyler AE, Hilty DM, Horvitz-Lennon M, Jibson MD, Lopez OL, Mahoney J, Pasic J, Tan ZS, Wills CD, Rhoads R, Yager J. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Rajesh R. Tampi
    • 1
  • Deena J. Tampi
    • 2
  • Mallika Lavakumar
    • 1
  1. 1.Case Western Reserve University School of Medicine and MetrohealthClevelandUSA
  2. 2.Diamond HealthcareRichmondUSA

Personalised recommendations