Psychiatric medication

Ritalin sustained-release (SR) 20 mg tablets

A psychiatric or psychotropic medication is a 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 illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. 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][2][3][4] The recidivism or rehospitalization of the mentally ill is at a high rate in many countries and the reasons for the relapses are under research.[5][6][7][8]

History

Several significant psychiatric drugs were developed in the mid-20th century. In 1948, lithium was first used as a psychiatric medicine. One of the most important discoveries was chlorpromazine, an antipsychotic that was first given to a patient in 1952. In the same decade, Julius Axelrod carried out research into the interaction of neurotransmitters, which provided a foundation for the development of further drugs.[9] The popularity of these drugs have increased significantly since then, with millions prescribed annually.[10]

The introduction of these drugs brought profound changes to the treatment of mental illness. It meant that more patients could be treated without the need for confinement in a psychiatric hospital. It was one of the key reasons why many countries moved towards deinstitutionalization, closing many of these hospitals so that patients could be treated at home, in general hospitals and smaller facilities.[11][12] Use of physical restraints such as straitjackets also declined.

As of 2013, the 10 most prescribed psychiatric drugs by number of prescriptions were alprazolam, sertraline, citalopram, fluoxetine, lorazepam, trazodone, escitalopram, duloxetine, bupropion XL, and venlafaxine XR.[13]

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.[14] 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, suppository or depot injection supplements.[15][16]

Research

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 disorders, including depression, psychosis, and bipolar disorder, are common and gaining more acceptance in the United States. The most commonly used classes of medications for these disorders are antidepressants, antipsychotics, and lithium. Unfortunately, these medications are associated with significant neurotoxicities.

Psychiatric medications carry risk for neurotoxic adverse effects. The occurrence of neurotoxic 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, such as the possibility of a sudden or severe emergence or re-emergence of psychosis in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly.[17]

Medicine combinations with clinically untried risks

While clinical trials of psychiatric medications, like other medications, typically test medicines separately, there is a practice in psychiatry (more so than in somatic medicine) to use polypharmacy in combinations of medicines that have never been tested together in clinical trials (though all medicines involved have passed clinical trials separately). It is argued that this presents a risk of adverse effects, especially brain damage, in real-life mixed medication psychiatry that are not visible in the clinical trials of one medicine at a time (similar to mixed drug abuse causing significantly more damage than the additive effects of brain damages caused by using only one illegal drug). Outside clinical trials, there is evidence for an increase in mortality when psychiatric patients are transferred to polypharmacy with an increased number of medications being mixed.[18][19][20]

Types

There are five main groups of psychiatric medications.

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, norepinephrine, and/or dopamine. 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.[22] Another is the serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase both serotonin and norepinephrine. Antidepressants will often take 3–5 weeks to have a noticeable effect as the regulation of receptors in the brain adapts. There are multiple classes of antidepressants which have different mechanisms of action. Another type of antidepressant is a monoamine oxidase inhibitor (MAOI), 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.[22]

Common antidepressants:

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.[22] 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:

Typical antipsychotics Atypical antipsychotics

Anxiolytics and Hypnotics

Benzodiazepines are effective as hypnotics, anxiolytics, anticonvulsants, myorelaxants and amnesics.[24] Having less proclivity for overdose and toxicity, they have widely supplanted barbiturates.

Developed in the 1950s onward, benzodiazepines were originally thought to be non-addictive at therapeutic doses, but are now known to cause withdrawal symptoms similar to barbiturates and alcohol.[25] Benzodiazepines are generally recommended for short-term use.[24]

Z-drugs are a group of drugs with effects generally similar to benzodiazepines, which are used in the treatment of insomnia.

Common benzodiazepines and z-drugs include:

Benzodiazepines Z-drug hypnotics

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 non-antipsychotic mood stabilizers include:

Stimulants

A stimulant is a drug that stimulates the central nervous system, increasing arousal, attention and endurance. Stimulants are used in psychiatry to treat attention deficit-hyperactivity disorder. Because the medications can be addictive, patients with a history of drug abuse are typically monitored closely or treated with a non-stimulant.

Common stimulants:

Controversies

Professionals, such as David Rosenhan, Peter Breggin, Paula Caplan, Thomas Szasz and Stuart A. Kirk sustain that psychiatry engages "in the systematic medicalization of normality".[26] More recently these concerns have come from insiders who have worked for and promoted the APA (e.g., Robert Spitzer, Allen Frances).[27]: 185 

Intellectuals as Goffman, Deleuze, Rosen consider pharmacological "treatment" a lay religion:[28] a "medication" is an "eucharist", or just a concoction.[29]

Antipsychotics have been associated with decreases in brain volume over time, which may indicate a neurotoxic effect. However, untreated psychosis has also been associated with decreases in brain volume.[30][31]

Scholars, and even professionals such as Cooper, Foucalt, Szasz believe that pharmacological "treatment" is only a placebo effect,[32] and that administration of drugs is just a religion in disguise and ritualistic chemistry.[33]

See also

References

  1. ↑ Rose, Nikolas (2010). "Chapter 2 Historical changes in mental health practice". Historical changes in mental health practice. Oxford University Press. doi:10.1093/med/9780199565498.003.0012. ISBN 9780199565498.
  2. ↑ Grob, Gerald N. (2010). "Chapter 3 Mental health policy in modern America". Mental health policy in modern America. Oxford University Press. doi:10.1093/med/9780199565498.003.0014. ISBN 9780199565498.
  3. ↑ Becker, Thomas; Koesters, Markus (2010). "Chapter 16 Psychiatric outpatient clinics". Psychiatric outpatient clinics. Oxford University Press. doi:10.1093/med/9780199565498.003.0086. ISBN 9780199565498.
  4. ↑ Shaywitz, Jonathan; Marder, Stephen (2010). "Chapter 22 Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting". Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting. Oxford University Press. doi:10.1093/med/9780199565498.003.0109. ISBN 9780199565498.
  5. ↑ Jaramillo-Gonzalez, Luis Eduardo; Sanchez-Pedraza, Ricardo; Herazo, Maria Isabel (2014). "The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study". BMC Psychiatry. 14: 161. doi:10.1186/1471-244X-14-161. PMC 4059735. PMID 24888262.
  6. ↑ Oyffe I, Kurs R, Gelkopf M, Melamed Y, Bleich A (2009). "Revolving-door patients in a public psychiatric hospital in Israel: cross sectional study". Croat Med J. 50 (6): 575–82. doi:10.3325/cmj.2009.50.575. PMC 2802091. PMID 20017226.
  7. ↑ Frick U, Frick H, Langguth B, Landgrebe M, Hübner-Liebermann B, Hajak G (2013). "The revolving door phenomenon revisited: time to readmission in 17'145 [corrected] patients with 37'697 hospitalisations at a German psychiatric hospital". PLOS ONE. 8 (10): e75612. doi:10.1371/journal.pone.0075612. PMC 3792950. PMID 24116059.
  8. ↑ "Are There Schizophrenics for Whom Drugs May be Unnecessary or Contraindicated?". Authors Rappaport M, Hopkins HK, Hall, Belleza and Silverman. International Pharmacopsychiatry (Neuropsychobiology) 13:100-111 (1978)
  9. ↑ "The Julius Axelrod Papers". National Library of Medicine. Retrieved 6 May 2013.
  10. ↑ Martin, Emily; Rhodes, Lorna A. "Resources on the History of Psychiatry" (PDF). National Library of Medicine. Retrieved 6 May 2013.
  11. ↑ Stroman, Duane (2003). The Disability Rights Movement: From Deinstitutionalization to Self-determination. University Press of America.
  12. ↑ Eisenberg, Leon; Guttmacher, Laurence (August 2010). "Were we all asleep at the switch? A personal reminiscence of psychiatry from 1940 to 2010". Acta Psychiatrica Scandinavica. 122 (2): 89–102. doi:10.1111/j.1600-0447.2010.01544.x. PMID 20618173.
  13. ↑ Top 25 Psychiatric Medication Prescriptions for 2013 Author John M. Grohol, Psy.D..Psych Central.
  14. ↑ Murray, Bridget (October 2003). "A Brief History of RxP". APA Monitor. Retrieved 11 April 2007.
  15. ↑ DeVane, C. Lindsay. "New Methods for the Administration of Psychiatric Medicine". Medscape. Retrieved 6 May 2013.
  16. ↑ Brissos, Sofia; Veguilla, Miguel Ruiz; Taylor, David; Balanzá-Martinez, Vicent (2014). "The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal". Therapeutic Advances in Psychopharmacology. 4 (5): 198–219. doi:10.1177/2045125314540297. ISSN 2045-1253. PMC 4212490. PMID 25360245.
  17. ↑ 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. 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. ISSN 1600-0447. PMID 16774655. S2CID 6267180. Archived from the original on 5 January 2013. Retrieved 3 May 2009.
  18. ↑ Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume I: Multiple Medication Use Strategies"
  19. ↑ Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume II: Use of Polypharmacy in the "Real World""
  20. ↑ Otto Benkert, Wolfgang Maier, Karl Rickels (2012) "Methodology of the Evaluation of Psychotropic Drugs"
  21. ↑ Schatzberg, A.F. (2000). "New indications for antidepressants". Journal of Clinical Psychiatry. 61 (11): 9–17. PMID 10926050.
  22. 1 2 3 Stahl, S. M. (2008). Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.
  23. ↑ Stephen M. Stahl, M.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. {{cite journal}}: Cite journal requires |journal= (help)
  24. 1 2 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. S2CID 46966796.
  25. ↑ 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.
  26. ↑ Kirk, Stuart (2013). Mad science : psychiatric coercion, diagnosis, and drugs. New Brunswick, N.J: Transaction Publishers. p. 185. ISBN 978-1-4128-4976-0. OCLC 808769553.
  27. ↑ Kirk, Stuart A. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers.
  28. ↑ Szasz, Thomas S, 1920- (1992). The myth of mental illness. PALADIN. ISBN 0-586-08087-2. OCLC 1036255128.{{cite book}}: CS1 maint: multiple names: authors list (link)
  29. ↑ Szasz, Thomas Stephen. Lawson, Robin (2013), The Myth of Psychotherapy Mental Healing As Religion, Rhetoric, and Repression., Blackstone Audio Inc, ISBN 978-1-4551-1730-7, OCLC 825761022{{citation}}: CS1 maint: multiple names: authors list (link)
  30. ↑ Ho, Beng-Choon; Andreasen, Nancy C.; Ziebell, Steven; Pierson, Ronald; Magnotta, Vincent (February 2011). "Long-term Antipsychotic Treatment and Brain Volumes". Archives of General Psychiatry. 68 (2): 128–137. doi:10.1001/archgenpsychiatry.2010.199. ISSN 0003-990X. PMC 3476840. PMID 21300943.
  31. ↑ "Antipsychotics and the Shrinking Brain". Psychiatric Times. Retrieved 2020-07-25.
  32. ↑ Szasz, Thomas Stephen (2003). Ceremonial chemistry : the ritual persecution of drugs, addicts, and pushers. Syracuse Univ. Press. ISBN 0-8156-0768-7. OCLC 834790127.
  33. ↑ Szasz, Thomas S. (October 1974). "The Myth of Psychotherapy". American Journal of Psychotherapy. 28 (4): 517–526. doi:10.1176/appi.psychotherapy.1974.28.4.517. ISSN 0002-9564. PMID 4429160.
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