Psychopharmacology
How do psychiatric medicines work?
Psychiatric medications target messenger chemicals called neurotransmitters and their receptor sites in and on neurons (brain cells). Neurotransmitters carry messages from cell to cell crossing the synaptic gap between the axon (transmitting terminal) of one neuron to the dendrites (receiving terminals) of the next neuron. The chemical structure of each neurotransmitter is designed to fit its neuroreceptor the way a key fits a lock. A change in a neurotransmitter’s chemical structure or an imbalance in the amount present may affect emotions, moods, thoughts, behaviors, and mental states. Psychiatric medications help restore proper balance. Once proper balance is restored it often takes time for cells to re-adjust the number of receptor sites available which is why, for example, an antidepressant may take two or more weeks to have an effect.
Important neurotransmitters that medications target include the monoamines serotonin, dopamine, epinephrine, norepinephrine, and acetylcholine as well as gamma-aminobutyric acid (GABA), glutamic acid, and endorphins. The monoamines are called regulatory neurotransmitters because they exist in small amounts and control specific areas of neurons. The vast majority of neurons use primarily GABA( +) and Glutamate(+) to propagate an electrical impulse. The regulatory neurotransmitters alter the balance of + and – in specific ways to effect a thought or feeling.
Read more: *psychopharmacology (chemicals involved in mental illness)
Everything that any human being experiences is mediated by neurotransmitters in the brain. When you watch a football game and feel a roller coaster of emotions neurotransmitters are mediating that experience. When you look at a woman and feel libido this experience is mediated by neurotransmitters. When you experience a loss and feel sad this is mediated by neurotransmitters. When you feel anxious for an upcoming test this is mediated by neurotransmitters.
When I insult you and you get mad I have caused a marked change in your brain chemistry with a non-pharmacologic intervention. When I listen to music and feel good I am experiencing a non-pharmacologic intervention.
The brain works very hard to maintain homeostasis. That means that it wants all these chemicals to be balanced and performing properly. When there is an imbalance the brain tries to counter with a chemical response. For example, when you experience pain and there is a spike in epinephrine that increases heart rate and blood pressure your brain increases its production of endorphins to bring things back to homeostasis.
When you interact with other people your brain directs this interaction by causing you to feel happy, sad or anxious depending on what is happening in the relationship.
If you experience a chronically stressful environment your brain’s attempt to compensate might be stretched to its limit. Receptor sites might increase or decrease resulting in a pathological alteration in emotions. This condition may be corrected by doing things that chronically correct the imbalance like taking meds or changing your environment or doing psychotherapy. Other things that can work include hypnosis or meditation or use of complementary medicine.
The big point I am making in this book is that all non-pharmacologic interventions do essentially the same thing. Whether you are doing hypnosis, psychotherapy, massage therapy, talking to a doctor, exercising, meditating, doing yoga or taking medications you are altering brain chemicals to try and restore homeostasis. You are doing this when you do alternative medicine and there is even a science to the way people promote alternative interventions that maximizes this effect.
You can go to a psychotherapist if you have a major depression and learn techniques to restore your brain’s chemical balance and we now know that this can work as well as medication for mild to moderate depressions. I believe that you can also go to an herbal specialist and get products that are physiologically inert but the manner in which you are presented with them can have a positive placebo effect and improve your mild to moderate depression just as if you had gone to a psychotherapist.
You can also experience the opposite which is a nocebo effect if your doctor talks to you in a manner that reduces your expectation of an improvement.
We also know that the best outcomes happen when you do both psychotherapy and medications together. I think this would also apply to alternative interventions. If you are someone who believes in homeopathy and can get a placebo effect from it you should do that and also take Prozac. That will improve your depression better than either alone.
There are many ways to do a non-pharmacologic intervention and what will work for any individual can vary widely. One person might respond best to psychotherapy and another to acupuncture and another still to an exercise routine with vitamin supplements. I think it would be great if you could go to your primary care physician and he can make an assessment of what would work best for you and then make a recommendation.
Here is some information on the specific neurotransmitters most frequently thought to have an effect on mental health and how to alter them.
Neurotransmitters
Dopamine: This neurotransmitter is produced in small amounts in the brainstem and projected to specific locations in the cerebral cortex (surface of the brain where thinking occurs). Too much dopamine can cause psychosis and to little can cause your muscles to become rigid as in Parkinson’s disease. Dopamine is also the neurotransmitter that is increased by most stimulating drugs of abuse such as cocaine. Dopamine plays important roles in executive functions, motor control, motivation, arousal, reinforcement, and reward, as well as lower-level functions including lactation, sexual gratification, and nausea.
Serotonin: This neurotransmitter is also produced in the brainstem in small amounts but is projected more widely to the cerebral cortex than dopamine is. It regulates mood, appetite, and sleep. It also has some cognitive functions, including memory and learning. Antidepressant medications block it’s re-uptake and the psychedelic drugs psilocin/psilocybin, DMT, mescaline, and LSD stimulate its release.
Norepinephrine: This neurotransmitter is also produced in small amounts in the brain stem and projected to the cerebral cortex. It increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety. It is responsible for the fight or flight reflex. Antidepressant drugs increase it in the brain.
Endorphins: These chemicals are endogenous opioid neuropeptides that are produced by the central nervous system and the pituitary gland. They are morphine-like substances originating from within the body. The principal function of endorphins is to inhibit the transmission of pain signals; they may also produce a feeling of euphoria. Endorphins are known for producing feelings of pleasure. Endorphins work like the brain’s reward center and the body’s painkillers at the same time. When experiencing either food, sex, or pain, the body’s hypothalamus triggers Endorphins.
Video (1:55): Pain Perception and the Human Brain
GABA and glutamate: Cortical excitability reflects a balance between excitation and inhibition. Glutamate is the main excitatory and GABA the main inhibitory neurotransmitter in the mammalian cortex.
Video (3:34): GABA Neurotransmitters and Glutamate
Functional brain imaging
Pain and endorphins have been the most studied with functional brain imaging in regards to the placebo effect but depression and antidepressants have also received study. Here is an article that reviews these findings: Neurobiological Mechanisms of the Placebo Effect (Fabrizio Benedett, et al. The Journal of Neuroscience, 9 November 2005, 25(45): 10390-10402). Here is an image from Placebo and Opioid Analgesia– Imaging a Shared Neuronal Network (Predrag Petrovic, et al. Science 1 March 2002: Vol. 295 no. 5560 pp. 1737-1740) that demonstrates how placebo and opioids appear to function in a similar way in the brain.
(A. Increased activity was observed in the right (cross) and left insula (left panel, horizontal section), in the thalamus (left panel), and in the caudal ACC (right panel, sagittal section) during the main effect of pain [(POP + PPL + P)-(WOP + WPL + W)]. B. The activation was most pronounced in the rACC during the main effect of opioids [(POP + WOP)-(P + W)]. Increased activity is apparent in the lower pons. C. Increased activity in the same area of the rACC was also seen in the placebo effect during pain (PPL-P). The activations are presented on an SPM99-template. The activation threshold is at P= 0.005.)
In conclusion, when you are treating symptoms that the brain is capable of treating by itself without taking medications such as pain or depression you can employ non-pharmacologic interventions which can include a variety of alternative treatments. The effectiveness of these therapies can vary widely from individual to individual because expectation and conditioning are a part of the effect. The placebo effect is best for mild to moderate symptoms and using non-pharmacologic treatments together with pharmacologic treatments usually results in the best outcome. This is especially true for more severe symptoms. Furthermore, underlying disease pathology such as an anatomical defect or a virus or bacteria can not be treated by placebo.
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