Medication, psychotropic, effects

Most attempts of using hormones as psychotropic medications were conducted with gonadal or with thyroid hormones, mainly because of the apparent mood changes associated with physiological or disorder-associated changes in levels or activity of these hormones. However, as shown in Table 17-1, current applications are broader and involve several hormones and systems. It is anticipated that, with acquired knowledge on mood effects of several other hormones, that list will continue to expand. Here, I focus on psychotropic effects of gonadal and thyroid hormones. Cortisol and melatonin are only briefly discussed. 

Psvchopharmaceutieals are medications that can affect the behavior and subjective state of man and are used therapeutically on account of these psychotropic effects. Apart from psychopharmaceuticals, there are man) other substances with psychotropic action, such as alcohol, nicotine, cocaine and heroin, which are characterized as social or addictive products and have no generally recognized therapeutic applications in Western medicine. Analgesics and members of other drug classes also have direct or indirect actions on subjective state and behavior but are not considered to be psychopharmaceuticals because they are not used primarily for their psychotropic effects. 

Position of recognized psychotropic effect Medications having a therapeutic action Substances having no recognized therapeutic action... 

Many medications have indirect psychotropic effects in that they relieve pain and other complaints and so improve well-being. Analgesics, antipyretics and anti-inflammatory products are the best-known examples. They are not considered to be psychotropic substances because they have no direct action on behavior and subjective state when given in therapeutic doses. 

In this appendix we discuss a potentially problematic area the identification of, and response to, psychotropic-induced side effects. The most obvious danger of failing to accurately differentiate medication side effects from a disease process is the possibility that one might increase the dose of the very medication responsible for the the side effects. Similarly, unwarranted diagnoses may be assigned or unnecessary medications added. 

Bendy, K. J., Walsh, J. (19%). The social worker and psychotropic medication Toward effective collaboration with mental health clients, families, and providers. Pacific Grove, CA Brooks/Cole. 

Currently there is renewed interest in the therapeutic potential of cannabinoids as antitussives (Chung 2005). Non-selective cannabinoids have been shown to have wide therapeutic applications for a number of important medical conditions, including pain, anxiety, glaucoma, nausea, emesis, muscle spasms and wasting diseases however, associated side effects such as sedation, cogifitive dysfunction, tachycardia and psychotropic effects have hampered the use of these compounds in the clinic (Porter and Felder 2001). 

Psychotropic medication side effects, e.g. metabolic syndrome from antipsychotics. 

Fig. 6.2. The Cannabis plant, from a Byzantine manuscript of Dioscorides Materia Medica (I century A.D.). Dioscorides was not aware of the psychotropic effects of Cannabis, but later medical writers, such as Oribasius (IV century A. D.), described them quite accurately.

Ethnic differences in CYP2D6 have been more thoroughly documented than with the other isoenzyme (Bradford, 2002). Over 70% of Caucasians but only about half of Asians, Sub-Saharan Africans, and African Americans have fully functional CYP2D6 alleles - alleles that code for normal metabolic activity. Approximately 50% of Asian and people of African ancestry have reduced function or nonfunctioning alleles. As a consequence, many older psychotropic medications are metabolized more slowly and plasma levels would be higher. Thus individuals of African and Asian ancestry would have an increased risk of side effects and should receive lower dose for a therapeutic response when compared to Caucasians of European descent (Lin, 2001 Lawson, 2000). 

Bailey, R. K. (2003). Atypical psychotropic medications and their adverse effects a review for the African-American primary care physician. /. Natl. Med. Assoc., 95, 37—-14. 

Sociocultural, illness, and biological factors affect individual attitudes towards psychotropic medications. Health beliefs or explanatory models, particularly causal attributions regarding the illness and the treatment options afforded within such models, exert a profound influence on patients attitudes and behavior regarding medications (Smith, Lin Mendoza, 1993). Such effects can be subtle and can occur during the course of treatment even if there has been initial successful negotiation about the nature of the illness and treatment. In psychiatric illness little research has been leveled at the personal meaning that patients bring to treatment practices such as electro-convulsive therapy (ECT), oral medications, and depot injections, or to the transition between different administrative routes and types of medications. 

Psychotropic medications with anticholinergic effects should be avoided because they may worsen cognition. 

Klotz U, Avant GR, Hoyumpa Aet al. (1975) The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest 55(2) 347-359 Kompoliti K and Goetz CG (1998) Neuropharmacology in the elderly. Neurol Clin 16(3) 599-610 Lanctot KL, Best TS, Mittmann N et al. (1998) Efficacy and safety of antipsychotics in behavioral disorders associated with dementia. J Clin Psychiatry 59(10) 550-561 Landi F, Onder G, Cesari M et al. (2005) Psychotropic medications and risk for falls among community-dwelling frail older people an observational study. J Gerontol A Biol Sci Med Sci 60(5) 622-626... 

First, you will learn about the human nervous system and how it works when it is healthy. This will include an introduction to the structure (anatomy) of the nervous system and the function (physiology) of the nervous system. Next, we ll describe the things that can go wrong. We ll look at how the system breaks down and malfunctions. Then we ll show you how these breakdowns can result in psychiatric illness. Finally, we ll introduce you to the medications used to treat psychiatric illness. You will learn where these medications work and our best guess of how they work. The presumed mechanism of action of many medications is just that, presumed. In contrast to antibiotics, in which we know quite a lot about the ways that they kill bacteria or stop them from reproducing and how these mechanisms ultimately effect a cure for an infectious disease, less is known about how psychotropic medicines work. Oh, we pretty well understand what psychotropic medicines do when they reach the nerve cell. For example, most of the antidepressants used today block the reuptake of serotonin at the nerve cell, but we re still not sure why blocking serotonin reuptake gradually improves mood in someone with depression. This will lead to a tour, if you will, of what happens to a medication from the time the pill is swallowed, until it exerts its therapeutic effect. 

What Is a Side Effect This chapter picks up where Chapters 1 and 2 left off. As we discussed in the earlier chapters, all medications, psychiatric and otherwise, have multiple effects. One takes a medication to achieve a therapeutic effect. Occasionally, a single medication may have more than one therapeutic effect. All other effects are side effects. Different medications may have differing therapeutic and side effects depending on the intended use. For example, trazodone and quetiapine are often prescribed to aid in sleep, and in this instance sedation is the desired effect, yet when used as an antidepressant and antipsychotic, respectively, the sedation is often an unwanted effect. Psychotropic medications typically have multiple effects. First, they usually interact with more than one nerve cell protein, be it a transporter or a receptor. Quite often, one of the medication s receptor or transporter interactions produces the therapeutic effect. The other interactions tend to not be involved in the therapeutic effect and only serve to produce side effects. Sometimes a neurotransmitter will have multiple different receptor types, but the medication interacts with... 

As we move forward with our discussion, we ll devote a section of this chapter to each of the key neurotransmitter systems that psychotropic medications interact with. We will discuss the following systems norepinephrine, dopamine, serotonin, GABA, acetylcholine, and histamine. Within each of the sections is a description of the effects that can be anticipated when a medication enhances the activity of that transmitter (reuptake inhibitors or agonists), and the effects to expect when a medication interferes (receptor antagonists) with the activity of that same transmitter. We will then describe strategies that can be implemented to help minimize and/or manage these side effects. 

Parkinsonism. As will be discussed later, dopamine-blocking antipsychotics and rarely other psychotropic medications can produce symptoms that resemble Parkinson s disease. This includes an expressionless face, slowed movement, and a stooped posture. In many respects, medication-induced parkinsonism resembles both depression and the negative symptoms of schizophrenia. Again, one must decide if it is the illness or the medication. Do you decrease the medication to remedy the side effect Or do you increase the medication to treat the illness, anticipating that a higher dose may prove more beneficial (though this is not always what is found) ... 

The placebo is useful in (a) distinguishing the pharmacod)mamic effects of a drug from the psychological impact of the medication and the environment in which it is given (the "halo" effect of the enthusiastic, or pessimistic, research clinician). It is well known, for example, that the placebo effect in major depression is as high as 30% while that of an effective antidepressant is approximately 60% of the optimal response. This statistic illustrates the importance of placebo-based studies in evaluating the efficacy of a new psychotropic drug. 

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