A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research. Psychiatric medications are prescription-only and come in forms such as pills, patches, injections, or inhalation. They carry risks like neurotoxicity, withdrawal, and complications from untested drug combinations. Their use is controversial, with critics citing overmedicalization, placebo effects, and potential long-term brain changes. Untreated mental illness also poses cognitive risks. A 2022 umbrella review of over 100 meta-analyses found that both psychotherapies and pharmacotherapies for adult mental disorders generally yield small effect sizes, suggesting current treatment research may have reached a ceiling and needs a paradigm shift.
History Several significant psychiatric drugs were developed in the mid-20th century. In 1948, lithium was first used as a psychiatric medicine. One of the most important discoveries was chlorpromazine, an antipsychotic that was first given to a patient in 1952. In the same decade, Julius Axelrod carried out research into the interaction of neurotransmitters, which provided a foundation for the development of further drugs. The popularity of these drugs have increased significantly since then, with millions prescribed annually. The introduction of these drugs brought profound changes to the treatment of mental illness. It meant that more patients could be treated without the need for confinement in a psychiatric hospital. It was one of the key reasons why many countries moved towards deinstitutionalization, closing many of these hospitals so that patients could be treated at home, in general hospitals and smaller facilities. Use of physical restraints such as straitjackets also declined.
Administration Psychiatric medications are prescription medications, requiring a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner, PMHNP, before they can be obtained. Some U.S. states and territories, following the creation of the prescriptive authority for psychologists movement, have granted prescriptive privileges to clinical psychologists who have undergone additional specialised education and training in medical psychology. In addition to the familiar dosage in pill form, psychiatric medications are evolving into more novel methods of drug delivery. New technologies include transdermal, transmucosal, inhalation, suppository or depot injection supplements.
Research
Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of pharmacology and psychopharmacology do not typically focus on psychedelic or recreational drugs, and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactive drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions within the brain. Physicians who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology. A 2022 umbrella review of over 100 meta-analyses found that both psychotherapies and pharmacotherapies for adult mental disorders generally yield small effect sizes, suggesting current treatment research may have reached a ceiling and needs a paradigm shift.
Adverse and withdrawal effects Psychiatric disorders, including depression, psychosis, and bipolar disorder, are common and gaining more acceptance in the United States. The most commonly used classes of medications for these disorders are antidepressants, antipsychotics, and lithium. Unfortunately, these medications are associated with significant neurotoxicities. Psychiatric medications carry risk for neurotoxic adverse effects. The occurrence of neurotoxic effects can potentially reduce drug compliance. Some adverse effects can be treated symptomatically by using adjunct medications such as anticholinergics (antimuscarinics). Some rebound or withdrawal adverse effects, such as the possibility of a sudden or severe emergence or re-emergence of psychosis in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly.
Medicine combinations with clinically untried risks While clinical trials of psychiatric medications, like other medications, typically test medicines separately, there is a practice in psychiatry (more so than in somatic medicine) to use polypharmacy in combinations of medicines that have never been tested together in clinical trials (though all medicines involved have passed clinical trials separately). Polypharmacy that includes a benzodiazepine is associated with increased mortality in patients with schizophrenia.
Types
There are five main groups of psychiatric medications.
Antidepressants, which treat disparate disorders such as clinical depression, dysthymia, anxiety disorders, eating disorders and borderline personality disorder. Antipsychotics, which treat psychotic disorders such as schizophrenia and psychotic symptoms occurring in the context of other disorders such as mood disorders. They are also used for the treatment of bipolar disorder. Anxiolytics, which treat anxiety disorders, and include hypnotics and sedatives Mood stabilizers, which treat bipolar disorder and schizoaffective disorder. Stimulants, which treat disorders such as attention deficit hyperactivity disorder and narcolepsy.
Antidepressants
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