Psychopharmacology: Current Trends


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This self-study program qualifies for These examples help you begin to understand how important the route of administration can be for psychoactive drugs. Metabolism involves the breakdown of psychoactive drugs, and this occurs primarily in the liver. The liver produces enzymes proteins that speed up a chemical reaction , and these enzymes help catalyze a chemical reaction that breaks down psychoactive drugs.

What Is Psychopharmacology?

There is not a unique enzyme for each drug; rather, certain enzymes can break down a wide variety of drugs. Tolerance to the effects of many drugs can occur with repeated exposure; that is, the drug produces less of an effect over time, so more of the drug is needed to get the same effect. This is particularly true for sedative drugs like alcohol or opiate-based painkillers. Metabolic tolerance is one kind of tolerance and it takes place in the liver.

Some drugs like alcohol cause enzyme induction — an increase in the enzymes produced by the liver. For example, chronic drinking results in alcohol being broken down more quickly, so the alcoholic needs to drink more to get the same effect — of course, until so much alcohol is consumed that it damages the liver alcohol can cause fatty liver or cirrhosis. Certain types of food in the stomach can alter the rate of drug absorption, and other foods can also alter the rate of drug metabolism. The most well known is grapefruit juice. Grapefruit juice suppresses cytochrome P enzymes in the liver, and these liver enzymes normally break down a large variety of drugs including some of the psychotropic drugs.

If the enzymes are suppressed, drug levels can build up to potentially toxic levels. In this case, the effects can persist for extended periods of time after the consumption of grapefruit juice. Some psychotropic drugs that are likely to interact with grapefruit juice include carbamazepine Tegretol , prescribed for bipolar disorder; diazepam Valium , used to treat anxiety, alcohol withdrawal, and muscle spasms; and fluvoxamine Luvox , used to treat obsessive compulsive disorder and depression.

A link at the end of this module gives the latest list of drugs reported to have this unusual interaction. Mental illnesses contribute to more disability in western countries than all other illnesses including cancer and heart disease. Depression alone is predicted to be the second largest contributor to disease burden by World Health Organization, Pharmacotherapy with psychological therapy may be the most beneficial treatment approach for many psychiatric conditions, but there are still many unanswered questions.

For example, why does one antidepressant help one individual yet have no effect for another? Many people do not respond to the first antidepressant prescribed and may have to try different drugs before finding something that works for them.

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Other people just do not improve with antidepressants Ioannidis, As we better understand why individuals differ, the easier and more rapidly we will be able to help people in distress. One area that has received interest recently has to do with an individualized treatment approach. We now know that there are genetic differences in some of the cytochrome P enzymes and their ability to break down drugs.

The general population falls into the following 4 categories: 1 ultra-extensive metabolizers break down certain drugs like some of the current antidepressants very, very quickly, 2 extensive metabolizers are also able to break down drugs fairly quickly, 3 intermediate metabolizers break down drugs more slowly than either of the two above groups, and finally 4 poor metabolizers break down drugs much more slowly than all of the other groups. Now consider someone receiving a prescription for an antidepressant — what would the consequences be if they were either an ultra-extensive metabolizer or a poor metabolizer?

The ultra-extensive metabolizer would be given antidepressants and told it will probably take 4 to 6 weeks to begin working this is true , but they metabolize the medication so quickly that it will never be effective for them. In contrast, the poor metabolizer given the same daily dose of the same antidepressant may build up such high levels in their blood because they are not breaking the drug down , that they will have a wide range of side effects and feel really badly — also not a positive outcome. What if — instead — prior to prescribing an antidepressant, the doctor could take a blood sample and determine which type of metabolizer a patient actually was?

They could then make a much more informed decision about the best dose to prescribe. There are new genetic tests now available to better individualize treatment in just this way.


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A blood sample can determine at least for some drugs which category an individual fits into, but we need data to determine if this actually is effective for treating depression or other mental illnesses Zhou, Currently, this genetic test is expensive and not many health insurance plans cover this screen, but this may be an important component in the future of psychopharmacology.

A recent Centers for Disease Control CDC report has suggested that as many as 1 in 5 children between the ages of 5 and 17 may have some type of mental disorder e. Why has there been such an increase in these numbers? There is no single answer to this important question.

Some believe that greater public awareness has contributed to increased teacher and parent referrals. Others argue that the increase stems from changes in criterion currently used for diagnosing. Still others suggest environmental factors, either prenatally or postnatally, have contributed to this upsurge. We do not have an answer, but the question does bring up an additional controversy related to how we should treat this population of children and adolescents.

Many psychotropic drugs used for treating psychiatric disorders have been tested in adults, but few have been tested for safety or efficacy with children or adolescents.

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The most well-established psychotropics prescribed for children and adolescents are the psychostimulant drugs used for treating attention deficit hyperactivity disorder ADHD , and there are clinical data on how effective these drugs are. However, we know far less about the safety and efficacy in young populations of the drugs typically prescribed for treating anxiety, depression, or other psychiatric disorders.

The young brain continues to mature until probably well after age 20, so some scientists are concerned that drugs that alter neuronal activity in the developing brain could have significant consequences.

Psychopharmacology Current Trends

There is an obvious need for clinical trials in children and adolescents to test the safety and effectiveness of many of these drugs, which also brings up a variety of ethical questions about who decides what children and adolescents will participate in these clinical trials, who can give consent, who receives reimbursements, etc.

Another population that has not typically been included in clinical trials to determine the safety or effectiveness of psychotropic drugs is the elderly. Currently, there is very little high-quality evidence to guide prescribing for older people — clinical trials often exclude people with multiple comorbidities other diseases, conditions, etc.

This is a serious issue because the elderly consume a disproportionate number of the prescription meds prescribed. The term polypharmacy refers to the use of multiple drugs, which is very common in elderly populations in the United States.

Recreational Stimulants (Memorable Psychopharmacology 10)

As shown in Table 3 from Schwartz and Abernethy, , it is quite clear why the typical clinical trial that looks at the safety and effectiveness of psychotropic drugs can be problematic if we try to interpret these results for an elderly population. Metabolism of drugs is often slowed considerably for elderly populations, so less drug can produce the same effect or all too often, too much drug can result in a variety of side effects.

One of the greatest risk factors for elderly populations is falling and breaking bones , which can happen if the elderly person gets dizzy from too much of a drug. Although we are gaining an awareness about some of the issues facing pharmacotherapy in older populations, this is a very complex area with many medical and ethical questions. This module provided an introduction of some of the important areas in the field of psychopharmacology.

It should be apparent that this module just touched on a number of topics included in this field.

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