Psychotropic Drugs: Salvation or Doom?

Substances that influence the central nervous system and thus alter perception, mood and behavior have been known since ancient times and were used primarily for cultic and religious purposes. For the past 50 years or so, such “acting on the soul” substances, psychotropic drugs, have been used to treat psychiatric disorders. Public opinion alternates between euphoria and condemnation – hardly any other drug is discussed so controversially and emotionally.

Chlorpromazine: the first of all psychiatric drugs

Emil Kraepelin, one of the pioneers of modern psychiatry and its diagnostics, was concerned at the end of the 19th century with how substances such as alcohol, tea and morphine affect simple mental processes. This was the first step towards the therapy of psychiatric disorders by means of drugs. In 1950, the substance chlorpromazine was artificially produced and its unexpected effect on schizophrenia was discovered. The first psychotropic drug was born – and was quickly followed in the 1950s by others that could be used for 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 into the opposite. Most of these substances had strong side effects, and some made people dependent. The widespread practice, especially in the 1960s, of generally “sedating” patients in psychiatric institutions with such substances also did not help to build public confidence. Negative opinions have never died down since then, but psychotropic drugs are still part of the standard therapy in psychiatry. In recent years, they have once again been increasingly caught in the crossfire of criticism – the frequency of prescriptions has increased massively not only in the USA, but also in Germany. Since ADHD – the “fidget syndrome” – has been increasingly diagnosed, one substance has come into greater use Methylphenidate, better known by its trade name Ritalin. It is estimated to be prescribed 40 times more often than it was 5 years ago. Opipramol, an antidepressant, was prescribed almost 2 million times in Germany in 2003, and a total of about 50 million boxes of psychotropic drugs crossed the pharmacy counter. However, despite all the criticism, a distinction must be made between whether the benefits, risks and side effects are in an acceptable ratio and the extent to which use and prescription are adequate and responsible, taking all other options into account. Just because a drug is not always used judiciously does not mean that it does not have justification and benefit in certain cases.

List of psychotropic drugs

  • Neuroleptics: have a sedative and depressant effect, and some are antipsychotic; they are used in schizophrenia in acute attacks and for long-term treatment. A distinction is made between high-potency and low-potency, atypical and depot neuroleptics.
  • Antidepressants: have a mood-lifting and drive-increasing or anxiety-relieving and drive-dampening effect; used in various forms of depression. Tri-, tetra- and non-tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI) and monoamine oxidase (MAO) inhibitors are distinguished.
  • Tranquilizers: have a calming, anxiety-relieving (“anxiolytics“), sleep-promoting and partially muscle-relaxing effect; they can be prescribed – because of addictive potential only for a limited time – in states of anxiety and tension.
  • Phase prophylactics: the – mainly used for depressive disorders – relapse-preventing drugs lithium and antiepileptics (especially carbamazepine).

In addition to these main groups, substances that positively affect 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 analgesics,
  • Psychostimulants (e.g., cocaine), and
  • Hallucinogens (e.g., LSD) and
  • Nootropics

In addition to being classified according to their clinical effects, psychotropic drugs can also be distinguished according to their site of action in the brain and the nature of their biochemical mechanism of action.

Effect and side effects

Although their effects are only partially understood in detail, the psychotropic drugs available today have a firm place in the treatment of severe mental illness. Indications include, in particular, schizophrenia, depression, and mania, as well as acute anxiety and tension states. They are also used temporarily in drug withdrawal. The spectrum of possible side effects is wide and also varies within the supergroups. Attempts have been and are being made to develop newer generation tablets with fewer side effects, but this has only been partially successful to date. The following is a selection of possible side effects:

  • Neuroleptics: so-called “extrapyramidal motor symptoms,” i.e., movement disorders (“dyskinesias”) originating in the central nervous system. These may occur shortly after the start of treatment, e.g., as tongue slurring and gaze spasms, or may manifest only after prolonged use. In addition, there may also be a strong urge to move and Parkinson’s syndrome, in addition to similar complaints as with antidepressants.
  • Antidepressants: dryness of mucous membranes, constipation, weight gain, low blood pressure, cardiac arrhythmias, tremors, impaired desire and potency, hallucinations.
  • Tranquilizers: adverse effects include fatigue, dizziness, lightheadedness, impaired responsiveness, and in the elderly, agitation and confusion. The most commonly used active ingredients – benzodiazepines (e.g. Valium) – carry the risk of dependence if taken for prolonged periods and may therefore only be prescribed and taken for limited periods. The effect and side effects are increased if alcohol or some painkillers are taken at the same time. If larger amounts are taken, there is a risk of possibly fatal poisoning.
  • Phase prophylactics: Lithium must be taken regularly and under close blood monitoring because therapeutic and toxic doses are close together. Adverse effects include nausea, dry mouth, muscle weakness and tremors, weight gain, goiter.

Assistance, but not a cure

Always applies: psychotropic drugs do not eliminate the disease, but they can help to alleviate distressing symptoms or even make them disappear. They can improve the patient’s quality of life and, at best, enable him or her to lead a normal daily life. They are only aidscrutches that make walking easier. It is important that the person affected receives competent care. Great expertise is needed to make the decision for or against drug treatment. From the list of possible medications, the one that best suits the individual situation must be selected. Psychotropic drugs are not medications that should be prescribed “just like that,” and the patient must be closely monitored throughout the course. In addition: medication in tablet form should not be chosen as the only form of therapy, but should be given equal weight alongside psychotherapeutic and sociotherapeutic measures. The medication helps to get the acute situation under control and creates the possibility for the patient to establish a sustainable relationship with the therapist – a neurologist, psychiatrist or psychologist. Not only do conversations help the patient cope with the illness, but behavioral training can also help the patient learn how to deal with various situations in everyday life, in the social environment, and in interpersonal relationships.