Psychiatric medication

Psychiatric medications, also called psychotropic drugs, are psychoactive substances that alter brain and nervous system chemistry to treat mental illness. Most are synthetic compounds and are prescribed in psychiatric settings, sometimes against a patient's will during involuntary commitment. Since the mid-1900s, they have become a primary treatment for many mental disorders, reducing the need for long hospital stays and cutting mental health care costs. However, rehospitalization rates for people with mental illness remain high in many countries, and researchers are still investigating why relapses occur.

These drugs require a prescription and come as pills, patches, injections, or inhalable forms. They carry risks including neurotoxicity, withdrawal symptoms, and complications from combining medications that have not been tested together. Their use is controversial: critics point to overmedicalization, placebo effects, and possible long-term changes to the brain. On the other hand, leaving mental illness untreated also poses cognitive risks. A 2022 umbrella review of over 100 meta-analyses found that both talk therapies and drug therapies for adult mental disorders generally produce only small effects, suggesting current treatment research may have hit a limit and needs a new approach.

**History**

Key psychiatric drugs emerged in the mid-20th century. Lithium was first used as a psychiatric medicine in 1948. Chlorpromazine, an antipsychotic, was given to a patient for the first time in 1952. Around the same period, Julius Axelrod studied neurotransmitter interactions, laying groundwork for future drug development. Since then, the popularity of these medications has soared, with millions of prescriptions written each year.

These drugs transformed mental health treatment. Many patients could be treated without being confined to psychiatric hospitals, which was a major driver of deinstitutionalization—closing large hospitals so patients could be treated at home, in general hospitals, or smaller facilities. The use of physical restraints like straitjackets also declined.

**Administration**

Psychiatric medications require a prescription from a physician, such as a psychiatrist, or a psychiatric nurse practitioner (PMHNP). In some U.S. states and territories, clinical psychologists who complete extra specialized training in medical psychology can also prescribe, following the prescriptive authority for psychologists movement. Besides standard pills, newer delivery methods include transdermal patches, transmucosal routes, inhalers, suppositories, and depot injections.

**Research**

Psychopharmacology studies a wide range of psychoactive substances. The professional and commercial fields of pharmacology and psychopharmacology generally do not focus on psychedelic or recreational drugs; most studies center on psychiatric medications. Psychopharmacologists are physicians who research these drugs. The 2022 umbrella review mentioned above found that both psychotherapies and pharmacotherapies for adult mental disorders typically yield small effect sizes, indicating that current research may have reached a ceiling and needs a paradigm shift.

**Adverse and Withdrawal Effects**

Depression, psychosis, and bipolar disorder are common and increasingly accepted in the United States. The most frequently prescribed drug classes for these conditions are antidepressants, antipsychotics, and lithium. Unfortunately, these medications are linked to significant neurotoxicities. Neurotoxic side effects can reduce how consistently patients take their drugs. Some side effects can be managed symptomatically with additional medications, such as anticholinergics (antimuscarinics). Withdrawal or rebound effects—like the sudden or severe return of psychosis after stopping an antipsychotic—can occur when the drugs are discontinued or tapered too quickly.

**Medicine Combinations with Clinically Untried Risks**

Clinical trials for psychiatric medications usually test each drug separately. But in psychiatry, more so than in general medicine, doctors often prescribe combinations of drugs that have never been tested together in trials (though each drug individually passed its own trials). Polypharmacy that includes a benzodiazepine is linked to higher mortality in patients with schizophrenia.

**Types**

There are five main groups of psychiatric medications:

- **Antidepressants**, used for conditions like clinical depression, dysthymia, anxiety disorders, eating disorders, and borderline personality disorder. - **Antipsychotics**, used for psychotic disorders such as schizophrenia and for psychotic symptoms in other disorders, including mood disorders; also for bipolar disorder. - **Anxiolytics**, which treat anxiety disorders and include hypnotics and sedatives. - **Mood stabilizers**, used for bipolar disorder and schizoaffective disorder. - **Stimulants**, used for disorders involving attention and hyperactivity.