Purpose/Goals Medications for the mind have a powerful effect. Important treatments center on altering the chemical balance of the brain. Often, in our fast-paced professional lives, it is difficult to remember the classifications and use of medications seen on an infrequent basis. It is important to routinely refresh our own memory, exercise cognitive processes, and review briefly the medications for the mind, psychopharmacology. Objectives On completion of this educational activity, participants will be able to; 1. Identify two major categories of psychopharmacology agents 2. Describe the effect desired from Mood Stabilizers 3. Distinguish how the mechanisms of action vary between antidepressant groups 4. Explain two uses of psychostimulant medications 5. Explain two uses of psychostimulant medications Introduction Psychopharmacology is the study and use of medications that effect thought or behavior. People ingest vast quantities of prescription psychopharmaceuticals. The benefit of prescription psychoactive agents is the lessening in symptoms of mental disorders, either acute or chronic in nature. As a general medication category, psychopharmacology agents, especially antidepressants and antipsychotics, are among the most widely prescribed pharmaceuticals of our generation. Psychostimulants find use among our children. Sedatives and hypnotics aid adults in dealing with the day-to-day stress created by our frantic lifestyles. Research gathered in 2006 revealed that one in ten adults and one in twenty children in the U. S. are taking prescription mental health medication. The prevalence of these helpful and therapeutic medications creates a need for awareness among health professionals concerning the basics related to psychoactive pharmacology, the medications for the mind (Wang, S., 2009). In Your Head Medications whose purpose is to alter the chemical balance in the brain and central nervous system (CNS) are widely used. The treatment of mental illness symptoms, mood disturbance, and even inability to focus attention all employ prescription substances that affect the mind. Medications designed to alter brain chemistry are as a general grouping referred to as psychopharmacology medications, although terms ranging from neuropsychopharmacology to just plain “psych meds” are used as general identifiers. Psychopharmacology medications fall into loose categories based on the chemistry of how they work in our body or their primary effect on the central nervous system. Some medications used in psychiatric care have effect in more than one area. Common groupings are: • Antianxiety Agents • Antidepressants • Antipsychotics • Mood Stabilizers • Psychostimulants Each of the medications that fall into these groupings possess the ability to influence or affect the chemistry within the brain. Special emphasis has been placed on the role that chemicals known as neurotransmitters play due to recent insights into the cellular structure of key brain cells and the critical function of these chemical messengers. Neurotransmitters Neurotransmitters such as dopamine and serotonin are manufactured in nerve cells known as neurons for the purpose of conveying messages from cell to cell across a tiny physical space between nerve cells known as the synaptic gap. The nerve cell structure sending the message, called the axon, exudes messenger chemicals, neurotransmitters, towards the receiving structure, a dendrite, on the next nerve cell of the message chain. The surface of the receiving dendrite is covered with specialized proteins that act as receptor sites for messenger chemicals. Receptor sites have special characteristics that respond to the unique shape of each specific neurotransmitter, much as the lock on your front door responds only to the unique shape of the key in your hand. Once a neurotransmitter is received into a corresponding receptor site the chemical messenger is either destroyed or reabsorbed and taken out of circulation. Some neurotransmitters have multiple messages they can convey, depending on factors such as which area of the nervous system where they are released into. Changes in neurotransmitter structure, alterations in the amount of neurotransmitter available to be received or in the number of available receptor sites for a particular neurotransmitter all effect the message being sent. Results of a change in neurotransmitter balance or availability may affect thoughts, emotions, behaviors, and mental processes. The total number of distinct neurotransmitters used within the central nervous system is not known. Over a hundred information-carrying molecules have already been discovered, each of which has an important, if often times mysterious, role to play. Only a few of these chemical couriers are currently amiable to pharmaceutical manipulation, generally by boosting or suppressing their functional availability. However, what can be accessed allows new treatment mechanisms and new tools to ease undesired symptoms found in the mental or emotional realm (Purves, D., et al., 2007). Select Neurotransmitter Function Acetylcholine was the first neurotransmitter recognized, in 1921, for the role it plays, and resulted in a Nobel Prize. Acetylcholine It stimulates muscles, aids in sensory function, facilitates REM sleep, attention, (ACh) motivation, learning, and memory. Too much ACh can lead to muscle spasms, tremors, and movement disorders. Insufficient ACh leads to a state of torpor or paralysis. Dopamine is strongly associated with brain reward mechanisms, arousal, and general physical motivation. If a feeling of anticipation is present proceeding an action, activity Dopamine or consuming a substance, dopamine is likely involved. Too much dopamine has been associated with Schizophrenia, while too little accompanies Parkinson’s disease and social anxiety disorders. Endorphins are a group of very similar neurochemicals. Every runner has heard of Endorphins endorphins. They function similarly to opioid narcotics. Their presence reduces pain (enkephalins) perception and effects pleasure, they tend to reduce stress, and enhance calm feelings. GABA GABA slows the excitation that leads to anxiety. Its presence has been linked to sleep (gamma and eating disorders. Too little GABA is associated with anxiety disorders and even aminobutyric epilepsy. acid) Glutamate is the most common neurotransmitter in the CNS, and is very important to Glutamate memory function as well as how pain is perceived. Excess glutamate is associated with the destruction of brain cells, such as in ALS/ Lou Gehrig’s disease. Norepinephrine also won its discoverer a Nobel Prize. Norepinephrine This is the “high alert” transmitter, increasing heart rate and blood pressure to deal with (noradrenalin) stress or danger. It prompts both physical and mental arousal, and can elevate the mood. It is also important for forming lasting memories. The link between serotonin and mood has been widely discussed. Not enough serotonin accompanies depression, excessive carbohydrate cravings, sleep troubles, anger Serotonin control issues, migraines, irritable bowel syndrome, fibromyalgia, obsessive- compulsive disorder, and an increase in suicide related thoughts and acts. (Boeree, CG., 2009) (Morris, C., et al., 2004) The goal of psychopharmacology is to help regain proper balance in the chemistry of the brain, and restore optimal functioning. The use of medications for the mind is therefore, in most instances, directed towards the control of symptoms. Psychiatric medications are not like antibiotics. Medications alone seldom result in a permanent “cure” of mental or emotional troubles. This means in effect that most psychiatric type medications will need to be taken or be available over an extended period of time while other treatments or therapy seek a resolution to the problem causing the symptoms. Antianxiety Agents Antianxiety agents are the most commonly prescribed psychoactive drug in the United States. In the adult population, roughly 12.5 percent use a prescribed anxiety medication during the course of a year, while 2 percent of the population will utilize antianxiety medication on any given day (Sola, C., et al., 2010). Medications that effect brain chemistry in such a manner that they lessen or alleviate anxiety are antianxiety agents. These chemicals may be referred to by terms such as; anxiolytics, sedatives, sedative-hypnotics, or minor tranquilizers. Prescription sleep aids are so closely related to antianxiety medications that they are firmly in the realm of psychopharmacological study and use. Barbiturates and benzodiazepines, along with a loose assortment of other prescription chemicals traditionally form the antianxiety group. In recent years, barbiturates have fallen from use in areas other than induction of anesthesia leaving the benzodiazepines as the mainstay anxiolytic (DuPont, R., et al, 2009). Sedatives vs. Hypnotics Sedative - a sedative lowers excitement and calms the Hypnotic - a hypnotic produces drowsiness and awake patient promotes sleep Sedatives and Hypnotics are by tradition categorized into a single class because of their common ability to induce a state resembling relaxation, sedation and sleep. (DuPont, R., et al, 2009) Anxiety medication can be very useful in treating the symptoms that accompany anxiety disorders and often find use in combination with other forms of treatment, such as cognitive-behavioral therapy. The use of anxiolytics help to ease symptoms so that therapy focused on underlying causation may move forward. It is important