Pharmacology for Psychological Disorders

Pharmacology for Psychological Disorders

There have been several studies conducted to explore the effect of drugs on the central nervous system. The primary aim of these studies have been to establish penetration of blood-brain barrier, explore the target engagement and the mechanism involved. Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of mental disability. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are the first line of treatment for Generalized Anxiety Disorders (GAD). The recommended duration of treatment may vary anywhere from 3 months to 1 year or longer depending on the client’s compliance, the conditions and other influencing factors. These medications are well tolerated and the side effects and adverse effects are short lived or managed with the use of adjunctive treatment. The tricyclic antidepressants were the first classes of medications used for anxiety disorders that act as reuptake inhibitors of transporters of serotonin and norepinephrine. However despite its efficacy to SSRIs they are less prescribed due to side effects including sedation, weight gain, dry mouth, arrhythmias, and risk of mortality with overdose(Bakker, Balkom, & Spinhoven, 2002). Mixed antidepressants such as Mirtazapine has a broad pharmacological effect and Bupropion is approved for the treatment of MDD as it acts as a dopamine norepinephrine reuptake inhibitor. Although there is increasing stigma around the use of Benzodiazepines they have been a longstanding treatment for anxiety and are still widely prescribed class of psychiatric medications (Agarwal, & Landon, 2019). The most studied antihistamine is Hydroxyzine. It is the only antihistamine that has been approved by FDA for use in anxiety. Certain Beta adrenergic antagonist although not approved for any psychiatric indications has been widely prescribed for social anxiety disorder and performance anxiety. The only antipsychotic which is FDSA approved for anxiety treatment is a first generation antipsychotic, trifluoperazine.

References

Agarwal, S. D., & Landon, B. E. (2019). Patterns in Outpatient Benzodiazepine Prescribing in the United States. JAMA Network Open, 2(1), e187399. https://doi.org/10.1001/jamanetworkopen.2018.7399

Bakker, A., van Balkom, A. J. L. M., & Spinhoven, P. (2002). SSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis. Acta Psychiatrica Scandinavica, 106(3), 163–167. https://doi.org/10.1034/j.1600-0447.2002.02255.x

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584