Psychopharmacology

Medical doctors called psychiatrists * prescribe medications for mental, emotional, behavioral * , and mood disorders * . These medications often are part of a treatment plan that includes psychotherapy, which typically is talk therapy either on a one-on-one or group basis.




Psychiatric medications can help correct imbalances in the neurotransmitters that affect mood and behavior. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), fit into the serotonin neuroreceptors on neuron dendrites.





Psychiatric medications can help correct imbalances in the neurotransmitters that affect mood and behavior. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), fit into the serotonin neuroreceptors on neuron dendrites. This blocks serotonin from entering the neuron and keeps it active for longer periods of time in the synaptic gaps between transmitting and receiving neurons. Serotonin (5-Hydroxytryptamine) is a calming neurotransmitter that is manufactured in nerve cells from the amino acid tryptophan. Turkey is a good source of tryptophan, which may help explain why people often feel relaxed and sleepy after Thanksgiving dinner.
Illustration by Frank Forney. © 2016 Cengage Learning®.

Psychopharmacology

Psychopharmacology (SY-ko-far-ma-KOL-o-jee) is the study of how medications affect moods, thoughts, and feelings. Psychopharmacology was mostly developed during the 20th century. Before it became a science, no medications were available to assist those who had schizophrenia * to quiet the voices in their heads and to help people who had depression to find the energy to face a new day. As of 2015, a wide and growing range of prescription medications were available, creating a transformation in the treatment of these disorders and many others.

Psychiatric medications are generally classified into categories that are based on the chemistry of how they work in the body (mechanisms of action) or the symptoms they help relieve. Many medications fall into more than one category. For example, the same medication might improve symptoms of both depression and anxiety. The following list includes some major types of psychiatric medications:

Examples of well-known psychiatric medications include the brand names Prozac and Paxil (antidepressants); Valium, Xanax, and Buspar (antianxiety medications); Tegretol (anticonvulsants); Thorazine and Haldol (antipsychotic drugs); and Ritalin and Concerta (stimulants).

How Do Psychiatric Medications Work?

Psychiatric medications target the complex arrangement of nerve cells, or neurons, and certain chemicals, called neurotransmitters * , in the brain and central nervous system * . Neurons manufacture neurotransmitters to carry messages from one nerve cell to the next. They do it by crossing a space, called the synaptic gap, between the axon (transmitting terminal) of one neuron and the dendrites (receiving terminals) of the next neuron. When the neurotransmitter reaches the new neuron, it connects with a docking port, known as a neuroreceptor. This fit between the neurotransmitter and neuroreceiver is very specific, and the neurotransmitter fits its particular neuroreceptor the way a key fits a lock. A change in a neurotransmitter's chemical structure and therefore its shape, or an imbalance at any point in this complex process, may affect emotions, moods, thoughts, behaviors, and mental states. Psychiatric medications help restore proper balance. They often target important neurotransmitters, such as serotonin (ser-O-TO-nin), dopamine * , epinephrine, norepinephrine (monoamines), acetylcholine, gamma-aminobutyric acid (GABA), glutamic acid, enkephalins, and endorphins.

Not all drugs are as clear-cut in how they work. Methylphenidate (Ritalin) is an example. For many years, scientists were unsure exactly why Ritalin was effective in treating ADHD * in children. In 2004, however, researchers announced that the drug increases levels of the neurotransmitter dopamine in the brain. They believe this dopamine upsurge leads to heightened concentration and motivation. Research on the exact mechanism of this drug, and many others, continues.

What Are the Beneficial Effects of Psychiatric Medications?

Psychiatric medications can help improve many of the most distressing symptoms of mental, emotional, and mood disorders. They can reduce the stress of living with chronic diseases and conditions, and they can improve the effectiveness of counseling and psychotherapy. Among their most beneficial effects:

Selecting the right medication and the right dosage are complicated tasks, requiring that doctors take detailed medical histories from their patients and their patients’ families. Doctors must know about other medical conditions the patient may have, other medications the patient may be taking (including aspirin, alcohol, herbal supplements, and tobacco), and the patient's diet and daily life. Doctors also must monitor patients who are taking medications to ensure that their symptoms improve and to adjust dosages or change prescriptions if side effects occur.

What Are the Adverse Effects of Psychiatric Medications?

Tardive Dyskinesia

Tardive dyskinesia (TAR-div DIS-kuhNEE-zhuh) is one of the most distressing adverse effects of antipsychotic medication. It is a disorder of the neuromuscular system that causes muscle spasms and tics, which are involuntary movements affecting the eyes, tongue, face, neck, fingers, arms, toes, or legs. Tardive dyskinesia may disappear if the medication is stopped, but sometimes it becomes a chronic condition. People who develop tardive dyskinesia often continue taking their medication, however, because the beneficial effects outweigh this serious adverse effect.

Psychiatrists and psychopharmacologists study the research on medications before prescribing them. They attend training sessions, read medical journals, and review descriptions in medical manuals that provide information on medications (how they work, how they help patients, whether they cause side effects, whether they can be used safely with a patient's regular diet and other prescription medications, and if a generic is available).

In the United States, when a new drug is developed, it is protected by a drug patent that usually runs for 17 years. The patent allows the company that developed it to manufacture and sell the medication exclusively. When the patent expires, other companies can manufacture and sell a generic version of the drug provided the generic drug has been tested and has received approval from the Food and Drug Administration.

A generic drug is the same as its brand-name counterpart in dosage, in strength, and in how it works and should be taken, as well as in safety and quality. However, a generic drug is less expensive than the brandname drug because the cost of the research and development of the original medication was undertaken by the first company.

Patients should talk to their doctors or pharmacists about the availability of generic drugs for any of their prescriptions.

* symptoms if the medication is stopped, and accidental overdoses. People who use psychiatric medications must see their doctors regularly and report side effects as soon as they notice them.

What Is Next in Psychopharmacology?

The science of psychopharmacology began in the middle of the 20th century, and researchers in the early 2000s were still making discoveries at a rapid pace. They were developing new medications that target more than one neurotransmitter at the same time, in order to improve symptoms in multiple categories at once. They were trying to learn why some drugs are effective, so they could use the knowledge to make them work better or to create new medications altogether, and they were also developing and running clinical trials on newer medications with fewer adverse effects, reduced risk of addiction and withdrawal symptoms, and less chance for tardive dyskinesia.

Psychiatric medications are most effective when the people who take them work with psychiatrists and medical doctors to update their prescriptions as often as necessary.

See also Alcoholism • Anxiety and Anxiety Disorders: Overview • Attention Deficit Hyperactivity Disorder (ADHD) • Bipolar Disorder • Depressive Disorders: Overview • Postpartum Depression • Psychosis • Schizophrenia • Tourette Syndrome

Resources

Books and Articles

Friedman, Richard A. “A Call for Caution on Antipsychotic Drugs.” The New York Times. September 24, 2012. http://www.nytimes.com/2012/09/25/health/a-call-for-caution-in-the-use-of-antipsychoticdrugs.html (accessed August 24, 2015).

Levinthal, Charles F. Drugs, Behavior, and Modern Society, 8th ed. Boston, MA: Pearson, 2013.

Merikangas, Kathleen R., Jian-Ping He, Judith Rapoport, Benedetto Vitiello, and Mark Olfson. “Medication Use in US Youth with Mental Disorders.” JAMA Pediatrics. February 2013: 141–48. http://archpedi.jamanetwork.com/article.aspx?articleid=1465762 (accessed November 13, 2015).

Preston, John, and James Johnson. Clinical Psychopharmacology Made Ridiculously Simple, 8th ed. Fort Lauderdale, FL: Medmaster, 2014.

Stahl, Stephen M. Prescriber's Guide: Stahl's Essential Psychopharmacology, 5th ed. Cambridge, UK: Cambridge University Press, 2014.

Websites

National Alliance on Mental Health. “Mental Health Medications.” https://www.nami.org/Learn-More/Treatment/Mental-HealthMedications (accessed November 13, 2015).

National Institute of Mental Health. “Mental Health Medications.” National Institutes of Health. http://www.nimh.nih.gov/health/topics/mental-health-medications/mental-health-medications.shtml (accessed November 13, 2015).

Organizations

American Academy of Child & Adolescent Psychiatry. 3615 Wisconsin Ave. NW, Washington, DC 20016. Telephone: 202-966-7300. Website: http://www.aacap.org (accessed August 12, 2015).

American Psychiatric Association. 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209. Toll-free: 888-357-7924. Website: http://www.psych.org (accessed August 12, 2015).

American Society of Clinical Psychopharmacology. 5034-AThoroughbred Lane, Brentwood, TN 37027. Telephone: 615-6493085. Website: https://www.ascpp.org (accessed November 13, 2015).

National Alliance on Mental Health. 3803 N. Fairfax Dr., Suite 100, Arlington, VA 22203. Telephone: 703-524-7600. Website: https://www.nami.org (accessed November 13, 2015).

National Institute of Mental Health. Science Writing, Press, and Dissemination Branch, 6001 Executive Blvd., Room 8184, MSC 9663, Bethesda, MD 20892-9663. Toll-free: 866-615-6464. Website: http://www.nimh.nih.gov (accessed August 12, 2015).

* psychiatrists (sy-KY-uh-trist) are medical doctors who have completed specialized training in the diagnosis and treatment of mental illness. Psychiatrists can diagnose mental illnesses, provide mental health counseling, and prescribe medications.

* behavioral means related to the way a person acts.

* mood disorders are mental disorders that involve a disturbance in the person's internal emotional state. Depressive disorders, bipolar disorders, and mood disorders are associated with the use of drugs or medical illnesses.

* schizophrenia (skit-so-FREE-neeah) is a serious mental disorder that causes people to experience hallucinations, delusions, and other confusing thoughts and behaviors, which distort their view of reality.

* antidepressant medications are used for the treatment and prevention of depression.

* serotonin (ser-o-TO-nin) is a neurotransmitter, a substance that helps transmit information from one nerve cell to another in the brain. It is associated with feelings of well-being.

* norepinephrine (NOR-e-pi-nefrin) is a body chemical that can increase the arousal response, heart rate, and blood pressure.

* anticonvulsants (an-tie-konVUL-sents) are medications that affect the electrical activity in the brain and are given to prevent or stop seizures.

* antipsychotic medications are medications that counteract or reduce the symptoms of a severe mental disorder such as schizophrenia.

* stimulant (STIM-yoo-lunt) is a drug that produces a temporary feeling of alertness, energy, and euphoria.

* neurotransmitters (NUR-o-tranzmit-erz) are chemical substances that transmit nerve impulses, or messages, throughout the brain and nervous system and are involved in the control of thought, movement, and other body functions.

* central nervous system (SEN-trul NER-vus SIS-tem) is the part of the nervous system that includes the brain and spinal cord.

* dopamine (DOE-puh-meen) is a neurotransmitter in the brain that is involved in the brain structures that control motor activity (movement).

* ADHD, or Attention Deficit Hyperactivity Disorder, is a condition that makes it hard for a person to pay attention, sit still, or think before acting.

* withdrawal is a group of symptoms that occurs when a drug that causes physical or psychological dependence is regularlyused for a long time and then is suddenly discontinued or decreased in dosage

Disclaimer:   This information is not a tool for self-diagnosis or a substitute for professional care.

(MLA 8th Edition)