Psychotropic drugs - rescue or doom?

Substances that affect the central nervous system and thus change perception, mood and behavior have been known since ancient times and were used primarily for cultic and religious purposes. For about 50 years, such "soul-effecting" substances, psychotropic, used for the treatment of psychiatric disorders. Public opinion switches between euphoria and condemnation - hardly any other drug is discussed so controversially and emotionally.

Chlorpromazine: the first of all psychotropic drugs

Emil Kraepelin, one of the pioneers of modern psychiatry and its diagnostics, at the end of the nineteenth century was concerned with how substances, e.g. Alcohol, tea and morphine affect simple mental processes. A first step towards the treatment of psychiatric disorders by medication was done.

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

Substances with side effects

The initial euphoria of finally being able to do something about mental suffering quickly turned to the opposite. Most of these substances had strong side effects, some were pending. The widespread practice of generally "sedating" patients in mental hospitals with such substances, especially in the 1960s, did not contribute to public confidence. The negative opinions have never fallen silent since then, but psychotropic drugs are standard therapy in psychiatry.

In recent years, they have again been caught in the crossfire of criticism - the prescription frequency has massively increased not only in the US, but also in Germany. Since the ADHD - the "Zappelphilipp syndrome" - increasingly diagnosed, a substance is 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 2003 in Germany, and in total about 50 million boxes of psychotropic drugs were sold over the counter of pharmacies.

But with all criticism: It must be distinguished whether, on the one hand, benefits, risks and side effects are in an acceptable ratio and, on the other hand, how far use and regulation are made adequately and responsibly, taking full advantage of all other possibilities. Just because a drug is not always used wisely does not mean that it does not have justification and benefits in certain cases.

List of psychotropic drugs

  • neuroleptics: have a calming and soothing effect, eg. antipsychotic; they are used in schizophrenia in acute onset and for long-term treatment. There are high and low potency, atypical and depot neuroleptics a distinction.
  • antidepressants: have a mood-enhancing and drive-enhancing or anxiolytic and drive-damping effect; Use in different Fromen of depression. There are tri-, tetra- and non-tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase (MAO) inhibitors.
  • Tranquilizer: have a calming, anxiolytic ("anxiolytic"), sleep-inducing and partially muscle-relaxing effect; they can - because of addictive potential only limited in time - be prescribed for anxiety and tension states.
  • mood stabilizers: the anti-relapse drugs lithium and antiepileptic drugs (especially carbamazepine), which are used mainly for depressive disorders.

In addition to these main groups, substances that have a positive influence on higher brain functions such as concentration, memory and attention are also counted as psychotropic drugs in the 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
  • nootropics

In addition to the classification according to their clinical effect psychotropic drugs can also be distinguished according to the location of their point of attack in the brain and the nature of the biochemical mechanism of action.

Effect and side effects

Although their effects have only been partially clarified, today's psychotropic drugs have a firm place in the treatment of severe mental illnesses. Indications include schizophrenia, depression and mania as well as acute states of anxiety and tension. Even with the drug withdrawal, they are used temporarily. The spectrum of possible side effects is large and also different within the upper groups. It has been and is trying to develop tablets of newer generations with fewer side effects, which has been achieved only partially.

Below is a selection of possible side effects:

  • neuroleptics: so-called "extrapyramidal-motor symptoms", ie movement disorders originating from the central nervous system ("dyskinesia"). These may occur shortly after the start of treatment, e.g. occur as tongue maw and eye cramps or manifest themselves after prolonged ingestion. In addition, it can also lead to strong urge to move and Parkinsonsyndrom, in addition to similar symptoms as the antidepressants.
  • antidepressants: Dryness of the mucous membranes, constipation, weight gain, low blood pressure, cardiac arrhythmia, trembling, sexual desire and power disturbances, hallucinations.
  • Tranquilizer: Adverse effects include tiredness, dizziness, drowsiness, limited ability to react, in older people also states of excitement and confusion. The most commonly used drugs - benzodiazepines (such as Valium®) - are associated with prolonged ingestion of the risk of dependence and may therefore be prescribed and taken only for a limited time. Effect and side effects are increased with the simultaneous intake of alcohol or some analgesics. If larger amounts are taken, there is a risk of possibly deadly poisoning.
  • mood stabilizers: Lithium should be taken regularly and under close blood control, as therapeutic and toxic doses are close to each other. Undesirable effects are e.g. Nausea, dry mouth, muscle weakness and trembling, weight gain, goiter.

Assistance, but no cure

It is always true that psychotropic drugs do not eliminate the disease, but they can help to alleviate or even eliminate agonizing symptoms. They can improve the quality of life of the patient and at best enable him to have a normal everyday life. They are only aids - crutches that make walking easier.

Important is the competent care of the person concerned. In order to make the decision for or against a drug treatment, great expertise is needed. From the list of possible drugs, it is necessary to select the one that best suits the individual situation. Psychotropic drugs are not medications that should be prescribed "just like this" and the patient must be closely monitored during the course of the procedure.

In addition, medications in tablet form should not be chosen as the only form of therapy, but be equivalent to psycho-and sociotherapeutic measures. The medications help to control the acute situation and create the possibility that the patient can build a sustainable relationship with the therapist - a neurologist, psychiatrist or psychologist. Not only conversations serve the purpose of coping 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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