Therapy with psychotropic drugs
Substances that influence certain metabolic processes in the brain and thus change mental state are called psychotropic drugs. The active agents of the drug have an effect on the body either directly or indirectly via their metabolic products. In particular, psychotropic drugs play an important role in therapy because their effects often lay the foundations for accompanying psychotherapy.
Psychotropic drugs can usually be classified into different substance Groups:
Antidepressants are a group of drugs that improve a person's mood during depression and normalize sleep and motivation. Physical side effects such as headaches or digestive problems are also often relieved by the medication. Their effect is usually based on influencing the neurotransmitters serotonin and norepinephrine in the brain, which transmit nerve impulses from one nerve cell to another and the metabolism of which is disturbed in the case of depression. An antidepressant increases the concentration and duration of effect of the body's own messenger substances.
Antidepressants do not cause any addiction, even if taken for an extended period of time.
So-called antidementia drugs are used to improve brain performance and delay mental deterioration. Although they cannot stop the degenerative process, especially senile dementia, they do temporarily increase memory function and improve the ability to concentrate, learn, and think.
The substances mainly influence the metabolism of the body's own neurotransmitters acetylcholine and glutamate in the brain. The concentration of acetylcholine is increased by preventing its decomposition. The effect of the body's own glutamate, on the other hand, is weakened by reducing its binding capacity and thus its ability to transmit impulses at the nerve endings.
Antidementia drugs do not cause any addiction, even when taken for an extended period of time.
The effect of antipsychotics, formerly known as neuroleptics, can mainly be utilized for delusions and hallucinations. These drugs are the treatment of choice particularly for schizophrenia.
The classic antipsychotics inhibit the body's own neurotransmitter dopamine in the brain and thus selectively reduce the transmission of information by the nerve cells that need dopamine as a stimulus. More modern antipsychotics influence various other neurotransmitters, such as serotonin. Their use allows thought processes to be structured and perception to be ordered.
Antipsychotics do not lead to addiction even if taken for a longer period of time. However, undesirable side effects such as weight gain, disorders and lack of control in the Patterns of movement, and motor restlessness can occur.
Anti-anxiety drugs, hypnotics, and sleep-inducing medications are used nowadays mainly to treat depression or psychosis. Because of their calming effect, they are also called tranquilizers or sedatives. As they facilitate the process of falling asleep, they are sometimes also used as sleeping pills.
They work by increasing the signal transmission of those nerve cells in the brain that are stimulated by gamma-aminobutyric acid (GABA). This endogenous messenger substance has an inhibitory effect in the brain and reduces the ability to react. This initiates relaxation processes and reduces states of agitation.
Among the best-known anti-anxiety drugs are the benzodiazepines lorazepam and diazepam, both of which can lead to dependence. Benzodiazepines are therefore only prescribed over the short term.
Probably the best known psychostimulant is methylphenidate. The main use of methylphenidate is to treat attention deficit hyperactivity disorder (ADHD).
In its stimulating effect, it influences the body's own neurotransmitters dopamine and norepinephrine, whose concentration it increases by preventing their breakdown.
Owing to the pleasant effects of dopamine, there is a risk of substance abuse and it being taken even without any indication.
Mood stabilizers / phase prophylactics
Some medications are taken on a long-term basis to prevent relapses, but also for acute treatment of depression or bipolar affective disorders. The most common substance is lithium. Although its mode of action has not yet been sufficiently understood, it has a proven positive influence on the course of the disease. In addition, anticonvulsants - seizure-relieving agents originally approved for the treatment of epilepsy - and frequently antipsychotics are used to stabilize the mood.
Mood stabilizers do not lead to dependency even when taken for a long time.
Like all drugs, psychotropic drugs may have side effects and interactions with other drugs. Therefore, they can only be used under medical supervision. Depending on the effectiveness and patient's tolerance, the optimum dose has to be determined individually, usually by gradually increasing it. With some groups of substances, undesirable drug effects may occur temporarily, especially during the dose determination phase, even before the desired therapeutic effect occurs. Therefore, cooperation based on trust between the patient and the attending physician is important.
Therapeutic Drug Monitoring
In order to optimize psychopharmacotherapy, we perform therapeutic drug monitoring as standard in our department. By regularly determining the concentration of the active substance in the blood, it is possible to avoid over or underdosing and to determine the best individual amount to be taken as a maintenance dose.
How long will the treatment last?
Some medications help to overcome a psychological crisis and can be gradually discontinued after a short while. Other drugs must be taken permanently to avoid relapses. It is always important to discuss the pros and cons of psychotropic drug treatment with your doctor and make a joint decision.
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Prof. Dr. Jürgen Deckert
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