Medicine That Can Help With Psychiatric Disorders

More and more people are affected by psychological problems: According to a recent study by the Robert Koch Institute, one third of adults suffer from a mental disorder every year. The treatment options are manifold and depend, among other things, on the type of mental illness, its duration and its severity. These include, first and foremost, psychotherapy, which helps those affected to actively overcome difficulties and learn new behavioural possibilities. Self-help groups and social therapy measures also have similar goals.

On the other hand, psychotropic drugs are often used to reduce symptoms and alleviate psychological suffering. In many cases it makes sense to combine psychotherapeutic and drug treatment measures. Often the medication is the basis which enables the affected person to build up relationships with other people again and to actively tackle problems. Substances that affect the psyche – i.e. our mood, our thinking, our perception and our behaviour – have basically been used for thousands of years, for example in the form of alcohol or tobacco.

However, drugs that specifically influence mental processes and are used to treat mental illness have only been available for about 60 years. For many people affected, such drugs can be helpful – for others, the side effects are so stressful that they stop using them or generally reject psychotropic drugs.

Definition: Psychotropic drugs are substances that affect the control of processes in the central nervous system and thus have an influence on various psychological functions. Most substances are used to treat mental illnesses, but some are also used in other areas, such as pain therapy or anaesthesia.

Some people are also afraid of becoming addicted to a drug, of changing their personality or of being “sedated” without the actual disease improving. The benefits of psychotropic drugs are therefore often discussed controversially and sometimes very emotionally.

It is therefore important that patients who are taking psychotropic drugs seek the advice of a specialist doctor, who will also provide them with close care during the course of their treatment. Doctors specialising in psychiatry can be identified by the terms “specialist in psychiatry and psychotherapy”, “specialist in psychosomatic medicine and psychotherapy” and “specialist in paediatric psychiatry and psychotherapy”. An expert practitioner will try to select the most suitable medication for the patient’s symptoms and life situation from the wide range of medications available. Depending on the efficacy and side effects, it may be necessary to adjust the dosage and sometimes change the medication during the course of treatment. In many cases, psychotropic drugs can help to alleviate stressful symptoms and significantly improve the quality of life.

Biological mechanism of action of psychotropic drugs

Psychopharmaceuticals influence the metabolism of the so-called neurotransmitters in the brain. Neurotransmitters are messenger substances that make it possible to transmit information from one nerve cell to another at chemical synapses. The information reaches the “transmitter cell” – the so-called presynaptic nerve cell – first in the form of electrical impulses to the synaptic cleft, the point of contact between the nerve cells. This leads to the release of biochemical messenger substances, which transmit the information via the synaptic cleft to the “recipient cell” – the so-called postsynaptic nerve cell. The neurotransmitters are then degraded in the synaptic cleft at different speeds.

Today it is assumed that many mental illnesses are caused by disturbances in the neurotransmitter household. At the same time, the density and sensitivity of the receptors – the receiving sites for the neurotransmitters in the nerve cells – can also be altered. Psychotropic drugs are used with the aim of normalizing the neurotransmitter household as much as possible. This happens, for example, by increasing or decreasing the amount of neurotransmitters in the synaptic cleft. However, psychotropic drugs can also influence the number and / or sensitivity of the receptors at the postsynaptic nerve cell.

What To Know About Antidepressants

Antidepressants, also known as thymoleptics, are a class of chemically different drugs that are used to treat depressive disorders, anxiety disorders, obsessive-compulsive disorder and chronic pain and have very different efficacy profiles. Their effect is based on a brightening of the mood and an increase in drive, which is also accompanied by a reduction in the physical symptoms of depression. In principle, there is no potential for dependence.

The first antidepressant was imipramine, which was discovered in 1957 by the Swiss psychiatrist R. Kuhn. Previously, depressive patients were treated with opium or somnifen and barbiturates to induce prolonged sleep. Since the discovery of imipramine, numerous other tricyclic, tetracycline and novel antidepressants have been launched.

Pharmacology and Biochemistry

The mechanisms of action of antidepressants were of great importance for the theoretical understanding of the development of depressive diseases. It could be shown that antidepressants increase the concentration of the neurotransmitters norepinephrine and serotonin in the synaptic cleft. This is done either by inhibiting reuptake or by inhibiting enzymatic degradation.

Studies have shown that the neurotransmitters norepinephrine and serotonin are present in a disbalance or lowered in some of the depressive patients. The long-term application of antidepressants also leads to changes in the sensitivity of the postsynaptic receptors, in the sense of a β down regulation or 5-HT up regulation. This could also explain the clinical effect of antidepressants. The connections between the influenced transmitter system and the acute effect are not always clear. Imipramine seems to inhibit the reuptake of norepinephrine and thus contribute to an increase in propulsion.

In amitriptyline, on the other hand, the inhibition of serotonin reuptake is in the foreground, which seems to be responsible for the attenuating effect. Fluoxetine, however, is a selective serotonin reuptake inhibitor and does not have a sedative effect.

Tricyclic antidepressants

The name tricyclic antidepressants is based on their hydrophobic three-member ring system. The group of tricyclic and tetracyclic antidepressants has no selective affinity to a specific neurochemical transmitter system, but acts on the norepinephrine and serotonin system in other ways. They also act on peripheral receptors for acetylcholine and histamine. Typically, tricyclic antidepressants are classified according to their clinical-therapeutic profile.

Dual mechanism antidepressants
This group includes modern antidepressants whose mode of action is based on a serotonin and norepinephrine reuptake inhibition, a norepinephrine serotonin-specific effect or a dual-serotonergic effect.

Venlafaxine inhibits the reuptake of serotonin, norepinephrine and also dopamine. It is interesting to note that serotonin reuptake inhibition is predominant in the low dose range and norepinephrine reuptake is additionally blocked in higher doses. Therefore, high doses of venlafaxine are particularly suitable for the treatment of depression in combination with an anxiety disorder.

Mirtazapine inhibits central α2-noradrenergic receptors, which indirectly increases noradrenergic and serotonergic neurotransmission. On the other hand, a postsynaptic serotonin receptor antagonism causes an increased release of serotonin. Mirtazapine is traditionally taken before sleep, as it has a dampening effect and regulates the rhythm of sleep.

Substances: serotonin noradrenalin reuptake inhibitors: venlafaxine; serotonin noradrenalin-specific antidepressants: mianserin, mirtazapine.

Duloxetine a serotonin noradrenaline reuptake inhibitor with special position

Duloxetine is intended for a relatively specific indication, namely urinary incontinence in depressive women due to stress. The effect is based on influencing the onus nucleus in the sacral marrow, which is the area of origin of the motor fibres of the pudendal nerve.

Monoamine oxidase inhibitors

Monoamine oxidases catalyse the breakdown of neuroactive and vasoactive amines. Monoamine oxidase A deaminates norepinephrine, serotonin and dopamine, monoamine oxidase B deaminates phenylethylamine, benzylamine and dopamine. A distinction is made between irreversible nonselective and reversible selective monoamine oxidase inhibitors. The non-selective MAO inhibitors inhibit monoamine oxidase A and B and are particularly rich in side effects, so they should only be considered as the second choice.

Furthermore, the intake of tyramine must be restricted during ingestion, otherwise serotonin syndrome with fever, muscle twitching, hypertensive derailment, sweating, nausea and hallucinations may occur. Foods containing tyramine include chocolate, red wine, bananas and mature cheese, which is why they are called the cheese-effect. In the case of reversible MAO inhibitors, the symptoms caused by the intake of tyramine cannot be observed, as they only inhibit the monoamine oxidase A. The MAO inhibitors are also known as the cheese effect.

MAO inhibitors have a predominantly drive-increasing effect – not a mood-enhancing effect, which is why they are also called thymeretics. The area of indication is limited to depressions with a severe lack of drive and depression in old age.

General Psychopathology Factor May Describe Structure of Psychiatric Disorders

Mental disorders have traditionally been viewed as distinct categorical entities, but the high incidence of comorbid, or co-occurring, disorders challenges this view.

As researchers Terrie Moffitt, Avshalom Caspi, and colleagues observe in their new article in Clinical Psychological Science, about half of the people who meet diagnostic criteria for one disorder also meet the diagnostic criteria for another disorder at the same time.

“The high rates of comorbidity observed among mental disorders suggest that there may be a more parsimonious structure to psychopathology than implied by current nosologies that identify many separate and distinct disorders,” Moffitt, Caspi, and co-authors write.

To test this hypothesis, the researchers looked at longitudinal data collected from participants in the Dunedin Multidisciplinary Health and Development Study who were between the ages of 18 and 38. The researchers examined the participants’ mental health data, testing several possible statistical models to see which model best accounted for the data.

Confirmatory factor analysis revealed that the structure of mental disorders could be summarized by three core dimensions: an “internalizing” liability to depression and anxiety, an “externalizing” liability to antisocial and substance-use disorders, and a “thought disorder” liability to symptoms of psychosis.

Furthermore, analyses suggested that the propensity to develop any and all forms of common psychopathologies could be summarized by one general underlying dimension. Higher scores on this dimension, which the researchers call the “p factor,” were associated with greater life impairment, greater familiality, worse developmental histories, and more compromised brain function in early life.

“We propose that p influences present/absent performance on hundreds of psychiatric symptoms, which are typically aggregated into dozens of distinct diagnoses, which further aggregate into two overarching Externalizing versus Internalizing domains, which finally aggregate into one normally distributed dimension of psychopathology from low to high: p,” the researchers conclude.

One way to think about the p factor is in relation to the structure of cognitive abilities:

“These abilities are dissociable into separate abilities, such as verbal skills, visuospatial skills, working memory, or processing speed,” say the researchers. “Nonetheless, the general factor in intelligence (called the g factor) summarizes the observation that individuals who do well on one type of cognitive test tend to do well on all other types of cognitive tests.”

While there are specific factors that account for variation in each test, the g factor accounts for the positive correlation among all test scores, suggesting that there may be a common etiology that influences or contributes in some way to all cognitive functions.

The new findings suggest that, just as there is a general factor of cognitive ability, there may also be a general factor of psychopathology. This general factor may, in turn, help to explain why researchers have had difficulty finding distinct causes, biomarkers, and treatments for individual mental disorders.

Moffitt, Caspi, and colleagues hope that these initial findings generate “further tests, extensions, and discussions about the structure of common mental disorders.”

Benefits Of Treating Anxiety With Medication

How many patients have their symptoms improved after 8 to 28 weeks of treatment?

Medicine against anxiety

Anxiety meds work well. In just over half of the patients treated with an anxiety medication, the symptoms (worries, tremors, tachycardia, dizziness, nausea, muscle tension) have improved. In patients who received a placebo, it was a smaller proportion.

Other benefits:

  • Anxiety medications work relatively quickly compared to psychotherapy – after just two to three weeks. (In psychotherapy, the effect occurs after about four to fifteen weeks).
  • Compared to psychotherapy, the treatment takes less time.
  • Studies also show that both treatment with medication and cognitive behavioural therapy (psychotherapy) are equally effective in patients with a generalised anxiety disorder.

Risks and Disadvantages of Drug Treatment

How likely is there to be a relapse if treatment is continued?
To see if it helps to continue taking anxiety medications that worked in the acute phase after the symptoms have subsided, patients were given either the anxiety medication (SSRI or SNRI) for 6 months or a placebo.

 Drug treatment for anxiety

The figures show that fewer patients who were treated with an anxiety medication relapsed than patients who were treated with a placebo.
Anxiety medications, like all drugs, can have adverse effects. Talk to your doctor about possible side effects (including dry mouth, drowsiness, insomnia, etc.). By individually selecting a suitable drug, it is often possible to ensure that the treatment is carried out with few or no side effects.

Even if patients are better again, the medication should continue to be taken. If the symptoms have disappeared completely, it is nevertheless helpful to continue taking the anxiety medication for at least half a year to prevent a relapse.

  • Anxiety medications work well with generalized anxiety disorder.
  • The effect sets in quickly – usually after 2-3 weeks.
  • Drug therapy is about as effective as psychotherapy.
  • Side effects may occur.

It is important to continue taking the anxiety medication for at least six months after the anxiety symptoms have subsided so that relapses can be avoided more safely.

Patients may not receive guidance/support on how to deal with emerging anxieties and worries.