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-acting" substances, psychotropic drugs, have been used to treat psychiatric disorders. Public opinion switches between euphoria and condemnation - hardly any other drug is discussed as controversial and emotional.
Chlorpromazine: The first of all psychotropic drugs
Emil Kraepelin, one of the pioneers of modern psychiatry and its diagnostics, dealt at the end of the 19th century with how substances such as alcohol, tea and morphine influence simple psychic 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 psychological suffering soon turned into the opposite. Most of these substances had strong side effects, some were pending. The widespread practice of generally "sedating" patients in psychiatric 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" - is increasingly diagnosed, a substance is increasingly used methylphenidate, better known under 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 despite all the criticism: It must be distinguished whether, on the one hand, benefits, risks and side effects are in an acceptable relationship and, on the other hand, how far use and regulation are made adequately and responsibly, making full use of all other possibilities. Just because a drug is not always used wisely does not mean it does not have justification and benefits in some cases.
List of psychotropic drugs
- Neuroleptics: calming and soothing, partly antipsychotic; they are used in schizophrenia in acute seizures and for long-term treatment. High and low potency, atypical and depot neuroleptics are distinguished.
- Antidepressants: improve mood and increase drive or anxiolytic and drive-damping; Use in different Fromen of depression. There are tri-, tetra- and non-tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase (MAO) inhibitors.
- Tranquilizers: calm, anxiolytic ("anxiolytics"), sleep-inducing and partially muscle-relaxing; they can - because of addictive potential only limited in time - be prescribed for anxiety and tension states.
- Phase prophylactics: the anti-relapse drugs lithium and antiepileptic drugs (especially carbamazepine), which are used mainly in depressive disorders.
In addition to these main groups, substances that have a positive effect 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 (eg cocaine) and
- Hallucinogens (eg LSD) as well
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 temporarily used. 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 only partially achieved.
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 can occur shortly after the start of treatment, for example, as tongue maw and eye cramps or manifest themselves only after prolonged ingestion. In addition, it can also come 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, tremor, sexual desire and power disturbances, hallucinations.
- Tranquilizers: Unwanted effects include tiredness, dizziness, drowsiness, limited responsiveness, in older people also agitation and confusion. The most commonly used active ingredients - benzodiazepines (eg Valium®) - are associated with prolonged ingestion of the danger of dependency and may therefore be prescribed and taken only for a limited time. Effect and side effects are intensified with simultaneous intake of alcohol or some analgesics. If larger amounts are taken, there is a risk of possibly deadly poisoning.
- Phase Prophylactics: Lithium should be taken regularly and under close blood control as therapeutic and toxic doses are close to each other. Adverse effects include 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 should be equivalent to psycho-and sociotherapeutic measures. The medicines help to control the acute situation and create the possibility that the patient can establish a sustainable relationship with the therapist - a neurologist, psychiatrist or psychologist. Not only conversations serve the purpose of coping with the illness, but the person concerned can also learn through behavioral training how to deal with different situations in everyday life, in the social environment and in interpersonal relationships.