Psychopharmacologic Approaches to Treatment of Psychopathology

Introduction

ABSTRACT: In the last decade, a number of research have demonstrated that psychotropic drugs have potential to affect the activity of serotonin transporter (SERT) and/or reuptake of serotonin in the brain. Also, recent studies suggest that blockade of SERT may be involved in some psychiatric disorders. In this review, we summarize the evidence showing that antidepressants (e.g., SSRIs and tricyclics), antipsychotics, and mood stabilizers can increase the binding affinity of these psychotropics at SERT. The consequences affect all types of antidepressants, but there is considerable overlap among them; tricyclics seem to be better than SSRIs at blocking serotonergic action on 5-HT1A receptors.

General Principles in the Use of Psychoactive Medications

The use of psychoactive medications is an important aspect of patient care, but it needs to be done carefully and with a plan. The most important principle in this regard is that the patient should be educated about his or her treatment options and monitored closely for side effects. Dosage titration can be accomplished using either a fixed dosing schedule (such as 1 mg per day) or flexible dosing (such as every 2 hours). Patients should also be told how they will receive their medication, whether through pills, liquid doses in a glass of water, or through an injection into their arm. Finally, patients should be encouraged not to increase dosage beyond what has been prescribed unless their doctor recommends it; if you do so anyway because you think you are feeling better because your symptoms have gone away—or worse yet: if someone tells us that our medication was too strong for them!—we may consider adjusting our next dose down by half instead of stopping completely until we’ve had time for another evaluation cycle before making any changes again.”

The Use of Psychopharmacologic Agents in Depression and Anxiety Disorders

There are several medications used to treat depression, anxiety disorders, bipolar disorder and psychotic disorders.

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). SSRIs may cause weight gain in some patients; TCAs often produce a more severe withdrawal syndromes than MAOIs and can be potentially fatal if taken with certain drugs such as St. John’s Wort or phenelzine sulfate.

• Benzodiazepines: Short-acting benzodiazepines such as alprazolam or lorazepam are useful for short-term use at low doses to help control anxiety while waiting for the antidepressant effects of another treatment to kick in

The Use of Psychopharmacologic Agents in Bipolar Disorder

The use of psychopharmacologic agents in bipolar disorder has been reviewed. It is important to note that antidepressants are not effective in treating mania or bipolar depression. Antipsychotics are also ineffective in the treatment of mania, but can be used as an adjunct to lithium for prophylaxis and augmentation of mood stabilizers.

Antidepressants have limited use for the treatment of bipolar depression because they may cause hypomania or mania if taken at higher dosages than recommended by the manufacturer (e.g., 10-20 mg/day). Lithium remains the only medication approved by the FDA specifically for use in managing symptoms associated with bipolar disorder; however, its use must be carefully monitored due to its potential side effects such as weight gain and diarrhea

Psychotic Disorders

Antipsychotics are used to treat psychotic disorders, including schizophrenia. Antipsychotics can be used as a first-line treatment or as an adjunct to other treatments, such as antidepressants. They may also be used in the maintenance treatment of psychotic disorders.

Antipsychotic medications include:

Takeaway:

Psychopharmacologic agents are the cornerstone of treatment for many psychiatric disorders. In some cases, they can be used to treat both acute and chronic symptoms; in others, they are used alone or in combination with psychotherapy.

The most commonly prescribed medications include antidepressants (such as selective serotonin reuptake inhibitors), antipsychotics (such as haloperidol) and mood stabilizers such as lithium. These medications may be effective at reducing anxiety symptoms if they are taken before or just after an episode begins but do not prevent recurrence once it has started.[1]

Conclusion

Psychiatry treatment for psychiatric illness has changed with the times and new treatments are continually being researched and tested.

As mentioned previously, there is no one medication that has been proven to cure all psychiatric disorders but there are medications used in combination with psychotherapy which can be extremely useful. Some of these newer medications include, clomipramine (clomipramine hydrochloride, clomiPRAMINE HCl), fluoxetine (eosinopenicillamine, Prozac) and paroxetine (Paxil). These drugs are known as selective serotonin-reuptake inhibitors (SSRI’s) and although they don’t directly affect people’s mood or emotions they do have an effect on neurotransmitters such as serotonin, norepinephrine and dopamine.

The SSRI’s come in a variety of forms including capsules, tablets and liquid preparations. The most commonly prescribed is sertraline (Zoloft) however there are also: citalopram (Cipra), escitalopram oxalate (Lexapro), fluoxetine hydrochloride (Prozac) paroxetine hydrochloride(Paxil), fluvoxamine maleate(Luvox) venlafaxine succinate(Effexor). As well as this newer generation of antidepressants there is also bupropion oxtibum(Wellbutrin ), mirtazapine(Remeron ) or reboxetine(Wellbutrin SR). These drugs work by increasing levels of monoamines in the brain which reduces anxiety by blocking the reuptake mechanism involved in anxiety symptoms while still maintaining normal levels of mood stabilizing neurotransmitters such as serotonin.

There are many other new recent products out on the market like St John’s wort which