Mood alteration

Enkephalins and Endorphins. Morphine (142), an alkaloid found in opium, was first isolated in the early nineteenth century and widely used in patent medicines of that eta. It is pharmacologically potent and includes analgesic and mood altering effects. Endogenous opiates, the enkephalins, endorphins, and dynotphins were identified in the mid-1970s (3,51) (see Opioids, endogenous). Enkephalins and endorphins ate Hsted in Table 9. 

Consider these findings from studies that assess whether fragrance is a powerful mood-altering substance (9) ... 

All barbiturates have essentially die same mode of action. Depending on the dose given, tiiese drags are capable of producing central nervous system (CNS) depression and mood alteration ranging from mild excitation to mild sedation, hypnosis (sleep), and deep coma These drugs also are respiratory depressants the degree of depression... 

In addition to the aetions of MDMA and other derivatives at 5-HT2 serotonin reeeptors. some of the effeets on serotonergic systems could be mediated via S-HTja reeeptors, at whieh MDMA has a moderate affinity. Direct agonist effects at this site might eontribute to the mood-altering and calming effects of the drug, sinee similar effects have been reported for novel anxiolyties sueh as ipsaperone and buspirone, which interact with 5-HTia serotonin reeeptors. 

While brain serotonin systems may play a key role in mediating some of the effects of MDMA on analgesia and body temperature as well as in the reported anxiolytic-like and mood-altering subjective effects of the drug, additional neurotransmitter systems may contribute to some of the unique subjective experiences reported for MDMA and other drugs in this class. 

Tricyclic antidepressants (TCAs) such as amitriptyline and doxepin have been used with some success in the treatment of IBS-related pain (Table 18-5). They modulate pain principally through their effect on neurotransmitter reuptake, especially norepinephrine and serotonin. Their helpfulness in functional gastrointestinal disorders seems independent of mood-altering effects normally associated with these agents. Low-dose TCAs (e.g., amitriptyline, desipramine, or doxepin 10 to 25 mg daily) may help patients with IBS who predominantly experience diarrhea or pain. 

Nerve signals from the thalamus and the reticular formation are transmitted to the limbic system as well as the hypothalamus. Together, these regions of the brain are responsible for behavioral and emotional responses to pain. The limbic system, in particular, may be involved with the mood-altering and attention-narrowing effect of pain. 

Physicians who have drug problems sometimes use a process called harvesting in order to obtain the medications for their own personal use. Harvesting occurs when a physician (seemingly innocendy) asks a patient to return any unused pain or other type of mood-altering medications to the physician. The physician will tell a patient that this is for his or her protection to take away the threat of accidental use of the medicines by someone in the household. The physician will offer to dispose of the medicine properly so that it is out of the household. However, the medicines will likely be used by the physician instead of being wasted. Patients should understand that since they have paid for (or their insurance has paid for) those medicines, it is unethical for a physician to ask for them in the first place, and such a request should warn of a problem. 

Tablet combination therapy Adverse reactions occurring in at least 3% of patients include the following Abdominal pain alopecia anemia anorexia anxiety arthralgia back pain bacterial infection blurred vision concentration impairment cough depression dermatitis diarrhea dizziness dry mouth/skin dyspepsia dyspnea eczema fatigue/asthenia headache hypothyroidism increased sweating injection site reaction insomnia irhtability/anxiety/nervousness lymphopenia memory impairment mood alteration myalgia nausea neutropenia pain pruritus pyrexia rash resistance mechanism disorders rigors thrombocytopenia vomiting weight decrease.

Fleischhacker WW, Barnas C, Gunther V, et at Mood-altering effects of biperiden in healthy volunteers. J Affect Disord i987 i2 i53-i57. 

Because of this range of symptoms, people with PTSD find it very difficult to maintain jobs or relationships. They often abuse alcohol or other mood-altering drugs to help them deal with their symptoms. 

Breggin, Peter. Medication Madness A Psychiatrist Exposes the Dangers of Mood-Altering Medications. New York St. Martin s Press, 2008. The psychiatrist author describes how psychiatric medicines can cause suicide, violence, crime, and emotional breakdowns. He argues that the FDA, pharmaceutical industry, and medical establishment encourage overuse of psychiatric drugs and fail to adequately protect the consumer. Breggin... 

Mood alteration (over and above euphoria and dysphoria from use and abstinence)... 

Side-effects The compound has prominent K-type adverse reactions like anxiety, hallucinations and dysphoric mood alterations and is no longer used clinically (Lattin, 1976). 

The compulsive use of drugs for non-medical purpose. It is characterised by a craving for mood-altering drug effects, not painrelief. Addiction refers to a dysfunctional behaviour as opposed to the improved function and quality of life that result from pain relief. In cancer patients who use opioids for long-term pain relief addiction is extremely rare. 

The stimulating and mood-altering effects of amphetamines give them a high abuse potential. Side effects include insomnia, irritability, loss of appetite, and paranoia. Amphetamines take a particularly hard toll on the heart. Hyperactive heart muscles are prone to tearing. Subsequent scarring of tissue ultimately leads to a weaker heart. Furthermore, amphetamines cause blood vessels to constrict and blood pressure to rise, conditions that increase the likelihood of heart attack or stroke. 

In summarizing the relationship between availability and abuse, we need to recognize that there is no formula to predict exactly how much abuse will occur, and that the relationship may wax and wane over time, as discussed below in the case studies. Still, there are a few rules of thumb. Given equal availability, drugs that produce more positive mood effects are more likely to be abused than those with less positive effects. However, all psychoactive drugs, even those with minimal positive mood effects, have the potential for abuse, even if only for their mood-altering effects. 

When tamoxifen is used in men (28), common adverse effects have included weight gain (25%), mood alterations (21%), hot flushes (21%), reduced libido (29%), and deep vein thrombosis (4%). The hot flushes respond well to oral clonidine 0.1 mg/day (29). 

In Great Britain, the Medicines Act deems it illegal to sell amyl nitrite without a prescription. However, possession or use without a prescription is not a crime. Most other nitrates sold as poppers have escaped prosecution under the Medicines Act since distributors claimed they were room deodorizers and not marketed as medicine. However, the European Union (EU), of which Great Britain is a member, has issued a directive that any substance for sale that has a mood-altering or psychoactive effect can be classified as a medicine even if it is not labeled or marketed as such. The Medicines Control Agency, which administers the Medicines Act, has concurred with the EU directive, although as of early 2002, there was no move to control or ban poppers. 

---