Psychiatric medication

Ritalin Slow-Release (SR) 20 mg tablets.

A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at least naturally derived. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization therefore lowering the cost of mental health care.[1]

History

Modern psychiatric medication has advanced greatly in the past century. The Reuptake Hypothesis by Julius Axelrod involves the interaction among neurotransmitters, and forms the cornerstone of the development of modern psychotropic drugs.[2] His work allowed researchers to further advance their studies into the effects of psychiatric medication. Mental health medications were first introduced in the mid-20th century with the widespread introduction of chlorpromazine, an antipsychotic. The popularity of these drugs have skyrocketed since then, with millions prescribed annually.[3]

Administration

Psychiatric medications are prescription medications, requiring a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner, PMHNP, before they can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology.[4] In addition to the familiar dosage in pill form, psychiatric medications are evolving into more novel methods of drug delivery. New technologies include transdermal, transmucosal, inhalation, and suppository supplements.[5]

Research

Main article: Psychopharmacology

Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs, and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactive drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions within the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology.

Adverse and withdrawal effects

Psychiatric medications carry risk for adverse effects. The occurrence of adverse effects can potentially reduce drug compliance. Some adverse effects can be treated symptomatically by using adjunct medications such as anticholinergics (antimuscarinics). Some rebound or withdrawal adverse effects, including the possibility of a sudden or severe emergence or re-emergence of psychosis, may appear when the drugs are discontinued, or discontinued too rapidly.[6]

Types

There are six main groups of psychiatric medications.

Antipsychotics

Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or schizophrenia. Atypical antipsychotics are also used as mood stabilizers in the treatment of bipolar disorder, and they can augment the action of antidepressants in major depressive disorder.[8] Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers".

There are two categories of antipsychotics: typical antipsychotics and atypical antipsychotics. Most antipsychotics are available only by prescription.

Common antipsychotics:[9]

Typical antipsychotics

Atypical antipsychotics

Antidepressants

Antidepressants are drugs used to treat clinical depression, and they are also often used for anxiety and other disorders. Most antidepressants will hinder the breakdown of serotonin or norepinephrine or both. A commonly used class of antidepressants are called selective serotonin reuptake inhibitors (SSRIs), which act on serotonin transporters in the brain to increase levels of serotonin in the synaptic cleft.[8] SSRIs will often take 3–5 weeks to have a noticeable effect, as the regulation of receptors in the brain adapts. Bi-functional SSRIs are currently being researched, which will occupy the autoreceptors instead of 'throttling' serotonin . There are multiple classes of antidepressants which have different mechanisms of action Another type of antidepressant is a monoamine oxidase inhibitor, which is thought to block the action of Monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. MAOIs are not used as first-line treatment due to the risk of hypertensive crisis related to the consumption of foods containing the amino acid tyramine.[8]

Common antidepressants:[10]

Mood stabilizers

In 1949, the Australian John Cade discovered that lithium salts could control mania, reducing the frequency and severity of manic episodes. This introduced the now popular drug lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. Food & Drug Administration. Besides lithium, several anticonvulsants and atypical antipsychotics have mood stabilizing activity. The mechanism of action of mood stabilizers is not well understood.

Common mood stabilizers:

Stimulants

Stimulants are some of the most widely prescribed drugs today . A stimulant is any drug that stimulates the central nervous system. Adderall, a collection of amphetamine salts, is one of the most prescribed pharmaceuticals in the treatment of attention-deficit hyperactivity disorder (ADHD). Stimulants can be addictive, and patients with a history of drug abuse are typically monitored closely or even barred from use and given an alternative. Discontinuing treatment without tapering the dose can cause psychological withdrawal symptoms such as anxiety and drug craving. Many stimulants are not physiologically addictive.

Common stimulants:

Anxiolytics & hypnotics

See also: List of benzodiazepines, benzodiazepines

Benzodiazepines are effective as hypnotics, anxiolytics, anticonvulsants, myorelaxants and amnesics, but are generally recommended for short-term use.[12] They have widely supplanted barbiturates because they have less proclivity for overdose and toxicity.

Developed in the 1950s onward, they were originally thought to be non-addictive at therapeutic doses. They are now known to cause withdrawal symptoms similar to barbiturate and alcohol withdrawal,[13] and a severe withdrawal syndrome may last for months and years in approximately 15% of users.[14]

Common benzodiazepines and derivatives include:

See also

References

  1. ↑ T.L. Brink. (2008) Psychology: A Student Friendly Approach. "Unit 11: Clinical Psychology." pp. 226
  2. ↑ "The Julius Axelrod Papers". National Library of Medicine. Retrieved 6 May 2013.
  3. ↑ Martin, Emily; Rhodes, Lorna A. "Resources on the History of Psychiatry" (PDF). National Library of Medicine. Retrieved 6 May 2013.
  4. ↑ Murray, Bridget (October 2003). "A Brief History of RxP". APA Monitor. Retrieved 4/11/2007. Check date values in: |accessdate= (help)
  5. ↑ DeVane, C. Lindsay. "New Methods for the Administration of Psychiatric Medicine". Medscape. Retrieved 6 May 2013.
  6. ↑ Moncrieff, Joanna (23 March 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatrica Scandinavica (John Wiley & Sons A/S) 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. ISSN 1600-0447. PMID 16774655. Retrieved 3 May 2009.
  7. ↑ Schatzberg, A.F. (2000). "New indications for antidepressants". Journal of Clinical Psychiatry 61 (11): 9–17. PMID 10926050.
  8. ↑ 8.0 8.1 8.2 Stahl, S. M. (2008). Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.
  9. ↑ "Tardive dyskinesia".
  10. ↑ "Monoamine Oxidase Inhibitors".
  11. ↑ Stephen M. Stahl, M.D., Ph.D.; et al. (2004). "A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor" (PDF). Journal of Clinical Psychiatry; 6(04) 159-166 2004 PHYSICIANS POSTGRADUATE PRESS, INC. Retrieved 2006-09-02.
  12. ↑ Ashton, Heather (July 1994). "Guidelines for the rational use of benzodiazepines. When and what to use". Drugs 48 (1): 25–40. doi:10.2165/00003495-199448010-00004. PMID 7525193. Retrieved 5 December 2012.
  13. ↑ MacKinnon GL, Parker WA (1982). "Benzodiazepine withdrawal syndrome: a literature review and evaluation". Am J Drug Alcohol Abuse 9 (1): 19–33. doi:10.3109/00952998209002608. PMID 6133446.
  14. ↑ Ashton, Heather (1991). "Protracted withdrawal syndromes from benzodiazepines". J Subst Abuse Treat. 8 (1–2): 19–28. doi:10.1016/0740-5472(91)90023-4. PMID 1675688. Retrieved 5 December 2012.

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