It happens that the very name "psychotropic drugs" evokes unpleasant associations in patients. Such fears are not fully justified - some measures included in this group are used not only in the treatment of psychiatric diseases, but also, for example, in the treatment of certain types of pain. The reluctance of patients may also result from the beliefs about unpleasant side effects of psychotropic drugs - however, thanks to the introduction of newer generations of drugs, they are an increasingly rare problem. Doubts may also arise when using these agents during pregnancy or combining them with alcohol. Do you really need to be concerned about psychotropic drugs?

Psychotropic drugsare preparations with the ability to exceed the so-called blood-brain barriers and influencing the functioning of the central nervous system. Due to the large number of such agents, psychotropic drugs can be used in many disease states. It is also worth knowing that the use of psychotropics, contrary to appearances, does not only cover the treatment of mental diseases and disorders.

Types of psychotropic drugs and their use

There are at least several different classification systems for psychotropic drugs, one of the most commonly used is the following classification:

  • antidepressant (thymoleptic),
  • antipsychotic (neuroleptic),
  • normotymic,
  • anxiolytic (anxiolytic),
  • sleeping pills,
  • pro-cognitive (nootropic).

Psychotropic drugs - antidepressants

The most numerous and probably the best known group of psychotropic drugs are antidepressants. Their history is quite interesting, because the first discoveries related to these preparations (dating back to the 1950s) were based on observations concerning the treatment of people suffering from tuberculosis. However, many years have passed since those times, during which a number of various antidepressants appeared on the medical market, acting in a different way on the neurotransmitter systems within the brain.

Currently, the following are distinguished :

  • tricyclic antidepressants (TLPDs, which non-selectively inhibit the reuptake of norepinephrine and serotonin, and alsoantihistamine and cholinolytic),
  • selective serotonin reuptake inhibitors (SSRIs, currently the most popular group of antidepressants),
  • serotonin-norepinephrine reuptake inhibitors (SNRIs),
  • monoamine oxidase inhibitors (an enzyme that breaks down neurotransmitters, including serotonin - inhibition of its activity results in an increase in the amount of neurotransmitters in the brain structures).

Despite their name, antidepressants are used not only in the treatment of mood disorders. Patients with anxiety disorders, patients with eating disorders (e.g. anorexia) or people suffering from obsessive-compulsive disorder may also benefit from their use.

Some of these medications, such as tricyclic antidepressants, are also useful outside of psychiatry - these medications can provide relief to people experiencing neuropathic pain.

Psychotropic drugs - antipsychotics

The history of antipsychotic drugs began when chlorpromazine was introduced. This drug is still used ( although nowadays rarely) and, along with several other substances, is classified as the so-called classical neuroleptics. Next to them, there are newer preparations, known as atypical neuroleptic drugs.

Drugs from these groups, as the name suggests, are used mainly in the treatment of various types of psychoses (e.g. those occurring in the course of schizophrenia, but also other conditions related to the patient's experience of delusions or hallucinations), and their action is conditioned is mainly dopamine-blocking.

Psychotropic drugs - mood stabilizers

Mood stabilizers are those drugs that are characterized by the ability to stabilize the mood of patients. The main representative of this group is lithium carbonate, along with drugs typically used in epilepsy, such as carbamazepine and valproic acid compounds.

The mood-stabilizing drugs also include atypical neuroleptics. The purpose of using the above-mentioned preparations is to restore a stable mood in patients experiencing its elevated mood - mood stabilizers are intended in particular for the treatment and prevention of manic episodes in patients with bipolar disorder.

Psychotropic drugs - anxiolytics

Benzodiazepines are among the most commonly used psychotropic anxiolytics. Their activity depends on the stimulation of GABA receptors, the activity of which is related to the inhibitory effect on cell activitynervous. The effect of using benzodiazepines is to reduce the severity of anxiety, but also have a hypnotic and sedative effect. In addition to these drugs, anxiolytics also include, inter alia, hydroxyzine (a milder preparation that blocks histamine receptors) and buspirone (a drug with a long-acting anxiolytic effect, which at the same time does not have a sedative effect).

Psychotropic drugs - sleeping pills

Some medications classified as anxiolytics are sometimes used as hypnotics, but also preparations intended for short-term treatment of sleep disorders. The second group includes zolpidem, zopiclone, zaleplon, which act on receptor systems similarly to benzodiazepines, but to a much lesser extent.

Psychotropic drugs - nootropics

Pro-cognitive drugs are those psychotropic preparations that have the ability to improve cognitive functions, in particular memory and concentration. This category includes both agents that improve cerebral blood flow (e.g. vinpocetine) and inhibitors of the enzyme that breaks down acetylcholine (e.g. rivastigmine, used in dementia).

Important

Can psychotropic drugs be used during pregnancy?

Pregnancy is a special period in a woman's life, but also a condition that requires the increased attention of doctors - before using any medications in patients, it is necessary to carefully analyze the benefits and possible risks associated with the therapy.

In the case of psychotropic drugs, the situation is special: as an example, it suffices to mention that, in principle, all antidepressants are classified as category C (this means that the studies did not exclude the possibility of a harmful effect of the drug on the developing fetus). Among antipsychotics, there are those classified as category B, i.e. a group of drugs that have not been shown to be harmful to the human fetus; as an example here can be clozapine.

Generally speaking, psychotropic drugs should be taken only when absolutely necessary. In patients who have not used this type of drugs before, they are avoided, in the case of patients who regularly take such preparations, it may be necessary to discontinue them or modify their treatment - the decision in such cases is made by the attending physician.

Whenever possible, the use of psychotropic drugs in pregnant women is avoided - psychotherapy is preferred in this period. This may seem surprising, but sometimes the safer alternative to pharmacotherapy is treating mental illnesses in pregnancy withusing electroshock.

Side effects of psychotropic drugs

Psychotropic drugs - like basically all pharmacological preparations - have their own side effects. In the case of these measures, they may concern a wide range of ailments, patients experience, for example, dizziness, nausea, drops in blood pressure or impaired concentration.

Symptoms of this type, however, are most severe in the initial stages of therapy and they do not pose a serious threat to the he alth of patients.

Certain specific disorders are much more important, which - although they are much rarer than the typical side effects of psychotropic drugs - may also appear and in the event of their occurrence it is necessary to contact a doctor urgently.

One of the risks associated with the use of psychotropic drugs mentioned above is neuroleptic malignant syndrome, occurring in approximately 1% of patients taking antipsychotics.

The problem manifests itself:

  • increasing muscle tone,
  • disturbance of consciousness, usually accompanied by psychomotor agitation,
  • a significant increase in body temperature,
  • tachycardia, arrhythmias,
  • increase in blood pressure.

The occurrence of the neuroleptic malignant syndrome forces the patient to immediately stop taking the drugs that caused the condition. Treatment in a hospital is required, which is based on stabilizing the patient's condition (control of hydration, vital signs, reducing fever) and administering dopaminergic drugs (reversing the effects of neuroleptics) and reducing muscle tension.

A problem that can also occur in the course of the use of antidepressants is the malignant serotonin syndrome. The risk of its occurrence increases especially when the patient uses too high doses of antidepressants or when he simultaneously takes other drugs that increase the amount of serotonin in the brain (an example of such a drug is the painkiller tramadol). Malignant serotonin syndrome, like the syndrome associated with treatment with neuroleptics described above, requires hospital treatment and manifests itself:

  • arousal,
  • vomiting, diarrhea,
  • increase in body temperature,
  • tachycardia,
  • increased sweating,
  • tremors.

The side effects of psychotropic drugs can also include situations that the average patient might find absurd. An example is the increased risk of taking behaviorsuicide while taking antidepressants. This is due to the fact that in the initial stages of therapy, for example with drugs from the SSRI group, the patients' drive first increases, and only then the mood improves. With the earlier existence of suicidal thoughts, this risk increases, therefore the patient should be informed of this possibility and, if necessary, immediately contact his / her doctor.

Before the implementation of any psychotropic drug, a thorough diagnosis of the patient is required, however, special attention should be paid to people with bipolar disorder. Depressive episodes may come to the fore in patients, which means that the occurrence of elevated mood may be overlooked and, therefore, after diagnosis of depressive disorders, treatment with antidepressants may be initiated. Instead of helping, this type of treatment may become a factor in exacerbating the disease, as the use of this type of medication can be a factor in triggering manic episodes.

All the situations described above occur relatively rarely and should not discourage patients from using psychotropic drugs, if, of course, there are indications for treatment.

The above description is not intended to deter, but only to warn, because the benefits of psychotropic drug therapy are often invaluable. The knowledge of the above risks is only intended to sensitize patients to what should arouse their anxiety and when they should seek medical help.

Important

Drug-alcohol interactions

The fact that alcohol consumption should be avoided while taking antibiotics is a fairly well-known fact - a similar situation applies to combining ethanol-containing beverages with psychotropic drugs. The combination of these substances is dangerous, if only because of the risk of metabolic interactions.

A significant part of psychotropic preparations is metabolized by the same enzymes that break it down with alcohol - the effect of such a situation may be both the weakening of the therapeutic agents and their intensification. Ultimately, patients may experience an increase in the severity of side effects, both of relatively low intensity (such as increased sleepiness or impaired concentration) and more serious - in extreme cases, even respiratory depression may occur. As a result of combining alcohol with psychotropic drugs, new ailments may also appear, such as arrhythmias associated with prolongation of the QT interval - such a relationshipcan be observed when ethanol is taken simultaneously with some antipsychotics or antidepressants.

A patient using psychotropic drugs does not have to be completely abstinent from alcohol. Reasonable, occasional drinking of a small amount of ethanol should not pose a threat, but it is best to ask a doctor prescribing psychotropic drugs about the possibility of drinking alcohol in specific cases.

About the authorBow. Tomasz NęckiA graduate of the medical faculty at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Category:

Psychiatry