Psychiatric medication

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, thereby 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

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

Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of

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

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.

• anxiety disorders, eating disorders and borderline personality disorder.^[21]
• psychotic symptoms occurring in the context of other disorders such as mood disorders
  . They are also used for the treatment of bipolar disorder.
• Anxiolytics, which treat anxiety disorders, and include hypnotics and sedatives
• Mood stabilizers, which treat bipolar disorder and schizoaffective disorder.
• Stimulants, which treat disorders such as attention deficit hyperactivity disorder and narcolepsy.

Antidepressants

Antidepressants are drugs used to treat

• Fluoxetine (Prozac), SSRI
• Paroxetine (Paxil, Seroxat), SSRI
• Citalopram (Celexa), SSRI
• Escitalopram (Lexapro), SSRI
• Sertraline (Zoloft), SSRI
• Duloxetine (Cymbalta), SNRI
• Venlafaxine (Effexor), SNRI
• NDRI^[23]
• NaSSA
• Isocarboxazid (Marplan), MAOI
• Phenelzine (Nardil), MAOI
• Tranylcypromine (Parnate), MAOI
• Amitriptyline (Elavil), TCA

Antipsychotics

Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or

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

Common 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, although barbiturates (such as pentobarbital) are still used for euthanasia.^[25][26]

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.^[27] Benzodiazepines are generally recommended for short-term use.^[24]

Common benzodiazepines and z-drugs include:

Mood stabilizers

In 1949, the Australian

• Lithium (Lithobid, Eskalith), the oldest mood stabilizer
• Anticonvulsants
  • Carbamazepine (Tegretol) and the related compound oxcarbazepine (Trileptal)
  • Valproic acid
    , and salts (Depakene, Depakote)
  • Lamotrigine (Lamictal)

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:

• norepinephrine-dopamine reuptake inhibitor
• Dexmethylphenidate (Focalin), the active dextro-enantiomer of methylphenidate
• Serdexmethylphenidate/dexmethylphenidate (Azstarys)
• Mixed amphetamine salts (Adderall), a 3:1 mix of dextro/levo-enantiomers of amphetamine
• Dextroamphetamine (Dexedrine), the dextro-enantiomer of amphetamine
• Lisdexamfetamine (Vyvanse), a prodrug containing the dextro-enantiomer of amphetamine
• Methamphetamine (Desoxyn), a potent but infrequently prescribed amphetamine

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".^[28] More recently these concerns have come from insiders who have worked for and promoted the APA (e.g., Robert Spitzer, Allen Frances).^[29]: 185

Scholars such as Cooper, Foucalt, Goffman, Deleuze and Szasz and believe that pharmacological "treatment" is only a placebo effect,^[30] and that administration of drugs is just a religion in disguise and ritualistic chemistry.^[31] Other scholars^[who?] have argued against psychiatric medication in that significant aspects of mental illness are related to the psyche or environmental factors, but medication works exclusively on a pharmacological basis.

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 and treatments have been shown improve cognitive functioning.^{[32][33][34][35]}

See also

• List of long term side effects of antipsychotics
• Medication
• Medicine
• Psychopharmacology

References