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Psychiatric medication

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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. A number of natural remedies exist for many different
psychiatric disorders. For example, many suggest that
saffron
is an effective alternative treatment for depression.[2]
The
Reuptake Hypothesis by Julius Axelrod involves the interaction among
neurotransmitters, and forms the cornerstone of the development of
modern psychotropic drugs.
[3] 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.
[4]
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.[5]
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.
[6]
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. Recently there have been more studies into the field
of
psychedelics; this is due to the fact that this class of drugs has
recently been found, or at least has been admitted, to be beneficial in
psychiatry.
Adverse and withdrawal effects
Like any other medication, psychiatric medications have the potential
for
adverse effects. Whitfield has referred to psychiatric medications
as potential agents of trauma
[7] 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 psychotic features, may appear when
the drugs are discontinued, or discontinued too rapidly.[8]
Well-documented side effects of psychiatric medications include
psychosis,
mania,
depersonalization,
hallucinations,
heart attack,
suicidal ideation,
stroke,
and
sudden death.
[9]
Types
There are six main groups of psychiatric medications.
-
Antidepressants, which treat disparate disorders such as
clinical depression,
dysthymia,
anxiety,
eating disorders and
borderline personality disorder.[10]
-
Stimulants, which treat disorders such as
attention deficit hyperactivity disorder and
narcolepsy, and
to suppress the appetite.
-
Antipsychotics, which treat
psychotic disorders such as
schizophrenia and
psychotic symptoms occurring in the context of other disorders
such as
mood disorders.
-
Mood stabilizers, which treat
bipolar disorder and
schizoaffective disorder.
-
Anxiolytics, which treat
anxiety disorders.
-
Depressants, which are used as
hypnotics,
sedatives, and
anesthetics.
Hallucinogens have been used in psychiatric medication in the past,
and are currently being reevaluated for several uses.
Antipsychotics
Main article:
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
is
major depressive disorder.[11]
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:[12][not
in citation given]
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.[11]
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[citation
needed]. 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.[11]
Common antidepressants:[13][not
in citation given]
-
Fluoxetine (Prozac), SSRI
-
Paroxetine (Paxil, Seroxat), SSRI
-
Citalopram (Celexa), SSRI
-
Escitalopram (Lexapro), SSRI
-
Sertraline (Zoloft), SSRI
-
Duloxetine (Cymbalta),
SNRI
-
Venlafaxine (Effexor),
SNRI
-
Bupropion (Wellbutrin),
NDRI[14]
-
Mirtazapine (Remeron),
NaSSA
-
Isocarboxazid (Marplan), MAOI
-
Phenelzine (Nardil), MAOI
Hallucinogens
Main article:
Hallucinogens
Hallucinogens have been used as psychiatric medication in the past,
and are currently being reevaluated for several uses. Contrary to their
public image, many hallucinogens and
psychedelics have shown potential for curing mental diseases that
current medications only temporarily fix[citation
needed]. Hallucinogens used for psychiatric
medication include:
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:[citation
needed]
-
Lithium carbonate (Carbolith), first and typical mood stabilizer
-
Carbamazepine (Tegretol), anticonvulsant and mood stabilizer
-
Oxcarbazepine (Trileptal), anticonvulsant and mood stabilizer
-
Valproic acid, and Valproic acid salts (Depakine, Depakote),
anticonvulsant and mood stabilizer
-
Lamotrigine (Lamictal), atypical anticonvulsant and mood
stabilizer
-
Gabapentin, atypical
GABA-related anticonvulsant and mood stabilizer
-
Pregabalin, atypical GABA-ergic anticonvulsant and mood
stabilizer
-
Topiramate,
GABA-receptor related anticonvulsant and mood-stabilizer
-
Olanzapine, atypical antipsychotic and mood stabilizer
Stimulants
Stimulants are some of the most widely prescribed drugs today[citation
needed]. 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:
-
Caffeine, typical methylxanthine stimulant, found in many
edibles worldwide
-
Methylphenidate (Ritalin, Concerta), atypical stimulant[citation
needed]
-
Dexmethylphenidate (Focalin), active D-isomer of methylphenidate
-
Dextroamphetamine (Dexedrine), more active amphetamine isomer
-
Dextroamphetamine &
levoamphetamine (Adderall), D,L -Amphetamine salt mix
-
Methamphetamine (Desoxyn), potent amphetamphetamine-based
stimulant
-
Modafinil (Provigil), a stimulant related to sildenafil (Viagra)
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.[15]
They have widely supplanted
barbiturates because of 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,[16]
and a severe
withdrawal syndrome may last for months and years in approximately
15% of users.[17]
Common benzodiazepines and derivatives include:
-
Diazepam (Valium), benzodiazepine derivative, anxiolytic
-
Nitrazepam (Mogadon), benzodiazepine derivative, hypnotic
-
Zolpidem (Ambien, Stilnox), an
imidazopyridine, non-benzodiazepine hypnotic
-
Zopiclone (Imovan), non-benzodiazepine hypnotic ("Z-drug")
-
Zaleplon (Sonata), non-benzodiazepine hypnotic ("Z-drug")
-
Chlordiazepoxide (Librium), benzodiazepine derivative,
anxiolytic
-
Alprazolam (Xanax), benzodiazepine derivative, anxiolytic
-
Temazepam (Restoril), benzodiazepine derivative
-
Clonazepam (Klonopin), benzodiazepine derivative
-
Lorazepam (Ativan), benzodiazepine derivative, anxiolytic
See also
References
-
^ T.L. Brink. (2008)
Psychology: A Student Friendly Approach. "Unit 11: Clinical
Psychology." pp. 226
[1]
-
^
Hall-Flavin, Daniel.
"Natural Remedies for Depression". Mayo Clinic.
Retrieved 6 May 2013.
-
^
"The Julius Axelrod Papers". National Library of Medicine.
Retrieved 6 May 2013.
-
^
Martin, Emily.
"Resources on the History of Psychiatry". National Library of
Medicine. Retrieved 6 May 2013.
-
^
Murray, Bridget (October 2003).
"A Brief History of RxP". APA Monitor.
Retrieved 4/11/2007.
-
^
DeVane, C. Lindsay.
"New Methods for the Administration of Psychiatric Medicine".
Medscape. Retrieved 6 May 2013.
-
^
Whitfield, Charles (2010).
"Psychiatric drugs as agents of Trauma". The International
Journal of Risk and Safety in Medicine 22 (4): 195–207.
Retrieved 5 December 2012.
-
^
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.
-
^
"Side Effects". Citizens Commission on Human Rights.
Retrieved 6 May 2013.
-
^
Schatzberg, A.F. (2000). "New
indications for antidepressants". Journal of Clinical Psychiatry
61 (11): 9–17.
PMID 10926050.
- ^
a
b
c
Stahl, S. M. (2008). Stahl's
Essential Psychopharmacology: Neuroscientific basis and practical
applications. Cambridge University Press.
-
^
"Tardive dyskinesia".
-
^
"Monoamine Oxidase Inhibitors".
-
^
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.
-
^
Ashton, Heather (July 1994).
"Guidelines for the rational use of benzodiazepines. When and what
to use.". Drugs 48 (1): 25–40.
Retrieved 5 December 2012.
-
^
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.
-
^
Ashton, Heather (1991).
"Protracted withdrawal syndromes from benzodiazepines". J
Subst Abuse Treat. 8: 19–28.
Retrieved 5 December 2012.
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