Benefits and Drawbacks to Using Medications in Treating Psychological Disorders - Literature review Example

and Sur Due benefits and drawbacks to using medications in treating psychological disorders A Critical Review Psychological disorders have become the bane of the human race which considers itself the most intelligent of living beings on this planet. Lower animals seldom suffer from such disorders and if at all, they usually overcome them all on their own, with minimal medical assistance. Thus a psychological disorder appears to be a function of high intelligence and an overtly active and analytical mind. Identification of a psychological disorder is also heavily biased by what the human race or particular culture or society considers ‘normal’. With the advent of very superior inroads into the ‘psyche’ of human beings with the aid of modern diagnostic techniques & equipment, and the understanding of the physiological functioning of the brain, attempts to influence any aberration in normal behavior by medical and other means have been made, both successfully and otherwise. Psychological disorders can have a biological origin where the imbalance of hormones and other biochemicals in the body can precipitate them. In other cases they could be purely the result of any emotional event or incidence which influences a person to react in an abnormal way. Such disorders are also dependant on and peculiar for different ages, sexes and cultures. Certain psychological disorders are secondary to purely infectious or immunological disorders such as diseases involving the brain [Examples: Brain tumors, Epilepsy, cerebral malaria, neurological disorders like Alzheimer’s disease, Parkinsonism and some liver diseases causing hepatic encephalopathy (pathological changes in brain)]. Such disorders definitely require medical interventions. Other disorders which are purely emotional can be treated by a trained psycho therapist, with or without the aid of drugs. The benefits and drawbacks of treating psychological disorders with drugs has always been the subject of debate where proponents of both methods of therapy (pharmacotherapy & counseling) have supported their views in the long history of psychotherapy. Plain psychotherapy without drugs has been classified by the Mayo Clinic (www.mayoclinic.com) on the basis of either ‘ changing the current behavior patterns’ of a patient or by ‘ understanding past issue’ in the patients’ history. The website lists the different approaches in psychotherapy as “Art Therapy, Behavior Therapy, Cognitive therapy, Cognitive-Behavior Therapy, Dialectical behavior Therapy, Exposure Therapy, Interpersonal Therapy, Play Therapy, Psychoanalysis, Psychodynamic Psychotherapy and Psychoeducation”. All these approaches are drug free and involve counseling, understanding the reasons for abnormal behavior and applying known techniques by experts in order to help the patient to recover from the disturbed state of mind. This type of therapy can be both short term as well long term and can be in the form of individual consultations and sittings or in a group where people suffering from the same disorder can be encouraged to cope up in a cooperative manner, where cure of one becomes an example for the other. Psychotherapy of this kind aims at exposing the deep effects of past events and emotional turmoil that a patient has experienced in the past on his sub conscious mind and bringing them to the fore and suggesting ways and means to face and overcome them with an altered perception of the idea, thereby justifying a more reasonable response and perception of the event, which is less harmful. Cognitive therapies are sometimes more bold in the approach used as they aim at reinforcing positive thoughts in a patient against his or her known fears by repetitive exposure to the precipitating causes of those fears. This type of therapy is useful in patients where the precipitating cause is purely emotional and abstract and not attributable to any physiological disorder. On the other hand there are certain mental disorders which have a very precise and known mechanism as well as pathophysiology which can only be reversed by the use of pharmacotherapeutic agents. Attention Deficit Hyperactivity Disorder (ADHD) in young children, Pre Menstrual Syndrome in women (PMS) and cognitive disorders in the elderly after undergoing general anesthesia are some of the recognized disorders attributable to some definite physiological cause. Reversal of such causes is subject to the effect of appropriate pharmacologic agents which can reverse or alleviate these conditions. Psychopharmacology is now an established branch of therapy and various mechanisms of physiological basis for the use of such drugs have been justified. According to Baldessarini Ross J., drugs with ‘significant efficacy in a broad range of severe psychiatric disorders have been developed since the 1990s’. The psychotherapeutic agents have been placed in four major categories viz. the anti-anxiety-sedative agents, antidepressants, anti-manic/mood stabilizing drugs and the anti Psychotic or Neuroleptic drugs (Baldessarini Ross J.). According to Baldessarini, the role and the evidence of the presence of biogenic amines and their receptors in the brain and what physiological role they performed was an important landmark in the development of psychotherapeutic agents. These biogenic amines which include histamine, serotonin, dopamine, norepinephrine and epinephrine have important roles as neuronal transmitters which are responsible for the various physiological processes of the central nervous system. They along with many other chemicals and specialized proteins play the role of excitatory or inhibitory neurotransmitters in the brain. Any aberration in their quantity or quality produces profound psychological disturbances which can be corrected by the administration of drugs which either stimulate or inhibit their production or action. Subsequently a lot of drugs have been developed which act by altering the levels of these biogenic amines thereby producing affects which are the beneficial in many psychological disorders. Some of the important drugs which act through such mechanisms and have proved successful in psychotherapy are Imipramine, Desipramine, Fluoxetine, Sertraline, etc. for anxiety disorders and Chlorpromazine, Thioridazine, Perphenazine, Clozapine, Haloperidol, etc. for Psychosis (Baldessarini Ross J. & Tarazi Frank I.). These drugs are now well established in therapy and used frequently in the treatment of psychiatric disorders with remarkable therapeutic effects. It has now come to be known as a necessary mode of treatment rather than an option as the disorders have been proven to be the result of abnormal physiologic activity in the brain. However, therapy with drugs is not the panacea for psychiatric disorders as they are blamed to exert concomitant adverse effects which can be detrimental to the ultimate health status of the patient. As the pathological altered state in the physiological elements in the brain is not a single activity but the result of a multiplicity of factors, they cannot be pinpointed accurately and precisely for a single action. Rebound anxiety, depression and psychosis attacks have occurred once these drugs are withdrawn. The role of sex is also important in psychiatric disorders as men and women are subject to their own peculiar problems. Women especially are more prone to depression during the puberty stage, menstruation, after childbirth and are prone to ADHD in an exclusive manner, different from males (www.ncpamd.com). ADHD is another disorder which has been the subject of much debate about whether it needs therapy with drugs or not. It is a psychiatric disorder which occurs in early childhood and may carry on in adulthood if left untreated. It manifests in children as a difficulty in focusing on the task at hand, high degree of irritability and inability to sit still for a long time. This condition is more common in boys than girls. Kids suffering from ADHD are under achievers and fail to accomplish simple learning tasks which are otherwise easy for their age group in normal children. Multimodal treatment with agents such as methylphenidate, amphetamine and atomoxetine (Graham, Seth & Coghill, 2007) has been used successfully to treat ADHD. The authors have stressed more on the psycho social approach in treatment which include parent training to handle such children as well as classroom behavioural interventions. Such non pharmacological interventions were comparable in effect as well as efficacy in treating children with ADHD when compared with the pharmacological approach which had the disadvantage of adverse effects and drug dependence. The pharmacologic approach is more successful when the disorder is recognized at an early stage and therapy is initiated with low doses of methylphenidate until recovery. (Graham, Seth & Coghill, 2007). There is much controversy at present whether wrong or over medication with anti ADHD drugs might lead to drug abuse later in life. Numerous studies have been conducted to explore this theory. According to Wilens T. E. et al, 2003, untreated ADHD subjects were about twice as likely as ADHD subjects treated with stimulant medications to develop substance abuse. On the contrary in a long duration study conducted over a period of thirteen years by Barkley R. A. et al, 2003, it was found that the frequency of cocaine use was higher in the treated group as compared to the untreated one. However this was dependent upon the intensity of medication as the children who were severely affected were subject to intensive medication and they were the ones who indulged in substance abuse later in life. Similar studies conducted all over the world have pointed towards more likelihood of substance abuse in the untreated children and have advocated the proper and judicious use of medication for ADHD at the right stage in children suffering from the disorder. There is a general agreement within the experts that for optimum therapeutic response medications for ADHD should be used in conjunction with behavioral interventions. They are of the view that further research is needed to develop new pharmacotherapy for ADAH associated substance use disorders and establish clinical guidelines on how to use these medications most effectively. An article on the website www.bio-medicine.org debates the use of medications in psychoanalysis. ‘The potential benefits of using medications in psychoanalysis have assumed great importance as the average American patients seeks a quick fix for the multifarious psychological disorders’. It has been expressed by experts that there should be a cautious approach while using medications. The experts agree that combining medication with psychoanalysis should only be practiced after an informed consent from the patient as it has economic as well ethical implications. The danger of side as well as adverse effects is always associated when quick fixes are attempted with the aid of drugs. In conclusion it would be reasonable to say that minimal use of drugs should be made in psychological disorders which are subject to treatment by plain old psychotherapy; counselling and the age old tried and tested methods of expert psychotherapists. Counselling can sometimes work wonders in cases where proper guidance and direction can propel the patient in the right direction. Some of the disorders like alcohol, tobacco and drug abuse are self inflicted and can be positively influenced by the right person like a close relative or friend who can guide the abuser to desist from such self destructive habits. Religion, Culture and social organizations can have a lasting and profound effect by conducting psychotherapeutic sessions for such persons. On the other hand, disorders which are purely biologic in origin and involve a specific pathogenesis causing mental disease can be treated by the appropriate medications under expert medical guidance. Many of the psychological disorders attributable to altered physiology in the brain have been identified and the causes ascertained. Such cases are subject to treatment by the modern psychopharmacological agents where much insight has been gained into their actions and therapeutic uses by the concerned scientific fraternity. Baldessarini Ross J. & Tarazi Frank I., Drugs and the Treatment of Psychiatric Disorders, Chapter 19, Pgs 447 - 514, Goodman & Gilmans The Pharmacological Basis of Therapeutics, Tenth Edition Barkley RA, Fischer M, Smallish L, Fletcher K. Does stimulant treatment of ADHD contribute to drug use/abuse? A 13-year prospective study. Pediatrics. 2003; 111:97- 109. Graham J, Seth S, Coghill D,2007,Elseveir Ltd. Whats new in ADHD,Medicine 35:3 Medications for Anxiety:Drug Benefits, Risks and Side Effects, Available online at:http://www.helpguide.org/mental/anxiety_medication_drugs_treatment.htm Psychotherapy: June 2008, An overview of the types of therapy available online at: http://www.mayoclinic.com/health/psychotherapy/MH00009 Uses of medications in psychoanalysis, Online Article available at:http://www.bio- medicine.org/medicine-news-1/Uses-of-medications-in-psychoanalysis-9315-1/ Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention- deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics. 2003;111:179-185. Womens Mental Health, Online Article available at:http://www.ncpamd.com/Womens_Mental_Health.htm Read More