Psychotropic Drugs – Salvation or Destiny?

Substances that influence the central nervous system and thus change perception, mood and behavior have been known since primeval times and were mainly used for cult and religious purposes. For about 50 years such “psychoactive” substances,  psychotropic drugs , have been used to treat psychiatric disorders. Public opinion alternates between euphoria and condemnation – hardly any other drug is discussed so controversially and emotionally.

Chlorpromazine: The first of all psychotropic drugs

At the end of the 19th century, Emil Kraepelin, one of the pioneers of modern psychiatry and its diagnostics, dealt with how substances such as alcohol,  tea  and morphine influence simple mental processes. A first step towards the therapy of psychiatric disorders by means of medication was thus taken.

In 1950, the substance chlorpromazine was synthesized and its unexpected effect on  schizophrenia  discovered. The first psychotropic drug was born – and was quickly followed in the 1950s by others that could be used to treat states of excitement,  depression  and other mental disorders.

Substances with side effects

The initial euphoria of finally being able to do something about mental illness quickly turned into the opposite. Most of these substances had strong side effects, some becoming addictive. The widespread practice, especially in the 1960s, of generally “sedating” patients in psychiatric institutions with such substances did not exactly contribute to public trust. The negative opinions have never died down since then, but psychotropic drugs are part of the standard therapy in psychiatry.

In recent years, they have again come under fire from criticism – the frequency of prescriptions has increased massively not only in the USA but also in Germany. Since ADHD – the “fidgety fidgety syndrome” – has been increasingly diagnosed, a substance has been increasingly used  , methylphenidate , better known by its trade name Ritalin®. It is estimated that it is prescribed 40 times more often than it was 5 years ago. Opipramol , an  antidepressant , was prescribed almost 2 million times in Germany in 2003, and a total of around 50 million boxes of psychotropic drugs were sold over the counter in pharmacies.

Despite all the criticism  , a distinction must be made as to whether, on the one hand, the benefits, risks, and side effects are in an acceptable relationship and, on the other hand, how far use and prescription are adequate and responsible, exhausting all other options. Just because a drug isn’t always used sensibly doesn’t mean it doesn’t have legitimacy and benefit in certain cases.

List of psychotropic drugs

  • Neuroleptics:  have a calming and dampening effect, sometimes antipsychotic; they are used in schizophrenia in the acute attack and for long-term treatment. A distinction is made between high and low potency, atypical and depot neuroleptics.
  • Antidepressants:  have a mood-enhancing and drive-enhancing effect or anxiolytic and drive-dampening; Use in various forms of depression. A distinction is made between tri-, tetra- and non-tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI) and monoamine oxidase (MAO) inhibitors.
  • Tranquilizers:  have a calming, anxiolytic (“anxiolytic”), sleep-inducing and sometimes muscle-relaxing effect; they can be prescribed – only for a limited time due to the potential for addiction – for states of anxiety and tension.
  • Phase prophylactics:  the recurrence-preventing drugs lithium and antiepileptics (primarily carbamazepine), which are mainly used for depressive disorders.

In addition to these main groups, substances that have a positive effect on higher brain functions such as concentration, memory and attention are also classified as psychotropic drugs in a broader sense, such as:

  • sleeping pills  (hypnotics) and
  • tranquilizers (sedatives),
  • opiates and other painkillers,
  • Psychostimulants (e.g. cocaine) and
  • Hallucinogens  (e.g. LSD) as well
  • Nootropic

In addition to being classified according to their clinical effects, psychotropic drugs can also be differentiated according to the location of their point of attack in the brain and the type of biochemical mechanism of action.

effect and side effects

Even if their individual effects have only been partially clarified, the psychotropic drugs available today have a firm place in the treatment of severe mental illnesses. Indications are in particular schizophrenia, depression and mania as well as acute states of anxiety and tension. They are also used temporarily for drug withdrawal. The spectrum of possible side effects is large and also varies within the upper groups. Attempts have been and are being made to develop new generation tablets with fewer side effects, which has so far only been partially successful.

Below is a selection of possible side effects:

  • Neuroleptics:  so-called “extrapyramidal motor symptoms”, i.e. movement disorders (“dyskinesias”) originating in the central nervous system. These can occur shortly after the start of treatment, for example as tongue and eye spasms, or only manifest themselves after long-term use. In addition, there can also be a strong urge to move and Parkinson’s syndrome, as well as similar symptoms as with antidepressants.
  • Antidepressants:  dryness of mucous membranes,  constipation , weight gain,  low blood pressurecardiac arrhythmias , tremors, lust and  erectile dysfunction , hallucinations.
  • Tranquilizer:  Undesirable effects are tiredness, dizziness,  drowsiness , limited ability to react, in the elderly also states of excitement and confusion. The most commonly used active ingredients – benzodiazepines (e.g. Valium®) – carry the risk of dependency if taken over a longer period of time and may therefore only be prescribed and taken for a limited period of time. The effect and side effects are increased when alcohol or some painkillers are taken at the same time. If larger amounts are ingested, there is a risk of potentially fatal poisoning.
  • Phase prophylactics:  Lithium must be taken regularly and under close blood control, as therapeutic and toxic doses are close together. Undesirable effects are, for example  , nausea ,  dry mouth , muscle weakness and tremors, weight gain, goiter.

Help, but no cure

It is always true that psychotropic drugs do not eliminate the illness, but they can help to alleviate distressing symptoms or even make them disappear. They can improve the patient’s quality of life and, in the best case, allow him or her to carry on with a normal everyday life. They are just tools – crutches that make walking easier.

Wichtig ist die kompetente Betreuung des Betroffenen. Um die Entscheidung für oder gegen eine medikamentöse Behandlung treffen zu können, ist großes Fachwissen nötig. Aus der Liste möglicher Medikamente muss dasjenige ausgewählt werden, das der individuellen Situation am besten gerecht wird. Psychopharmaka sind keine Medikamente, die “einfach so” verschrieben werden sollten und der Patient muss im Verlauf engmaschig untersucht werden.

Also:  Medication in tablet form should not be chosen as the only form of therapy, but should be given equal weight alongside psychotherapeutic and sociotherapeutic measures. The drugs help to get the acute situation under control and create the possibility for the patient to build up a stable relationship with the therapist – a neurologist, psychiatrist or psychologist. Not only conversations serve to cope with the illness, the affected person can also learn through behavioral training how to deal with different situations in everyday life, in the social environment and in interpersonal relationships.

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