Psychopharmacology

The causes of psychological difficulties are varied and often very individual -to see these problems as purely biological would be overly simplistic. However, the pharmaceutical treatment of psychological problems is a growing industry and medication can sometimes help to ease symptoms in conditions like depression to help the person cope more easily on a day-to-day basis. When deciding whether or not to start a course of medication it’s important that you fully understand the nature, effects and risks of the different treatments on offer. You might like to ask your doctor:

The name of the drug and what it is used to treat
How long you’ll have to take it for
Possible side effects
If you want to stop taking it, would there be any withdrawal problems.
Interactions with other drugs.

Medication for depression

It’s important to understand that the drugs currently available treat the symptoms, but not the depression itself. A combination of medication and another form of therapy such as CBT or psychotherapy is often recommended which has been shown to reduce the rate of relapse, which remains high if medication is the only form of treatment.

Antidepressant drugs work on the basis that depression can be caused by low levels of certain chemicals (neurotransmitters) in the brain. The lists below are by no means complete, but contain the most common drugs on the market with trade brands in brackets.

There are three main types of antidepressants:

TCAs (Tricyclic Antidepressants)

It’s thought that they work by inhibiting the reuptake of neurotransmitters norepinaphrine, serotonin or dopamine. TCAs on the market at the moment include imipramine (Tofranil), amitriptyline (Elavil, Endep, Tryptanol, Trepiline), clomipramine (Anafranil) and desipramine (Norpramine, Pertofrane). TCAs have also been used to treat anxiety, ADHD and bulimia nervosa. Side effects include dry mouth, dry nose, blurred eyes and sedation, so driving can be difficult. The toxic dose of TCAs is close to the therapeutic dose, so careful dosage is especially important to prevent fatal poisoning.

SSRIs (Selective Seratonin Reuptake Inhibitors)

These are more recently developed antidepressants and work by inhibiting the reuptake of the neurotransmitter serotonin, increasing its level in the brain. Types of SSRIs include: Fluoxetine (Prozac, Seronil, Sarafem, Fluctin), paroxetine (Paxil, Seroxat) and setraline (Zoloft, Lustral). SSRIs can take up to eight weeks to have their full effect. Side effects such as nausea, drowsiness, headaches, appetite change and some sexual difficulties can occur in the first 4 weeks as the body adapts to the drug, but these effects generally subside after this period of adaptation. SSRIs have also been used in the treatment of obsessive compulsive disorder, panic disorders and eating disorders. Withdrawal effects depend on the type of SSRI in use, but can be particularly problematic with paroxetine.

MAOIs (Monoamine Oxidase Inhibitors)

These act by preventing the action of an enzyme which breaks down monoamine neurotransmitters, thus raising the levels of the neurotransmitters in the brain. MAOIs are often considered after other forms of antidepressants have failed. Dietary and drug interactions can be very dangerous when MAOIs are being taken. Tyramine, often in food that isn’t fresh (e.g. pickled, dried, cured, matured), has a dangerous interaction with MAOIs, as can several other drugs. Check with your doctor for more information. Common types of MAOIs include isocarboxazid (Marplan), moclobimide (Aurorix, Manerix), selegiline (Selegiline, Eldepryl) and iproniazid (Marsilid, Iprozid, Ipronid, Rivivol, Propilniazida). Side effects include severe high blood pressure, particularly if dietary advice is not followed, weight gain, drowsiness and nausea. Withdrawal can be difficult.

Medication for other forms of psychological difficulty

Antidepressants are often used in the treatment of other forms of psychological difficulty such as anxiety disorders and eating disorders, however there are some other more specific drugs that can also be used.

Medication for anxiety

Tranquilizers such as Benzodiazapines are sometimes used for short term relief of severe and disabling anxiety. Common types include Chlordiazepoxide (Librium), Diazepam (Valium, Valclair, Tensium), Clorazepate (Tranxene) and Alprazolam (Xanax). Dependence and withdrawal difficulties are especially problematic with this type of drug, so prescriptions are now more limited and short-term based to minimise addiction.

Anti-psychotic medication

Anti-psychotic drugs can be used both for one-off experiences of psychosis as well as part of the treatment for an ongoing illness. Psychotic experiences can occur in schizophrenia and manic episodes, but also on a short term basis in severe depression or following recreational drug use. They are though to work via a sedative effect, acting on the neurotransmitter Dopamine. Neuroleptics (literally ‘taking control of the nerves’) are the most common form of treatment for psychotic episodes and help to control symptoms such as hallucinations and anxiety. Some common examples include Chlorpromazine (Taractan) and Clozaril (Clozapine). Side effects often include neuromuscular difficulties, such as tremors, stiffness, restlessness and loss of movement. Anti-psychotic medication can also affect hormone levels, so some sexual dysfunction can occur.

More information

Talking through your options with your GP is always advisable when considering drug treatments for psychological problems. Aside from the effectiveness of the drug in treating the problem, side effects and dependency are important issues to discuss.
A Psychiatric Drug Helpline run by pharmacists can be reached on 020 7919 2999.
See our links at www.edinburghtherapy.co.uk/links.htm for details of organisations who may be able to provide assistance or information.

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