Medication is frequently and effectively used to treat a number of psychological problems. In fact, Prozac, a drug used to treat depression, today is one of the best selling of all prescribed medications. Two major reasons for the widespread use of drug therapies today are the development of several very effective psychoactive medications and the fact that drug therapies can cost less than psychotherapy. Critics suggest, however, that another reason is our society’s “pill mentality,” or belief that we can take a medicine to fix any problem.
Antipsychotic Drugs Before the mid-1950s, drugs were not widely used to treat psy- chological disorders, because the only available sedatives induced sleep as well as calm. Then the major tranquilizers reserpine and the phenothiazines were introduced. In addition to alleviating anxiety and aggression, both drugs reduce psychotic symptoms, such as hal- lucinations and delusions; for that reason, they are called antipsychotic drugs. Antipsy- chotic drugs are prescribed primarily for very severe psychological disorders, particularly schizophrenia. They are very effective for treating schizophrenia’s “positive symptoms,” like hallucinations, but less effective for the “negative symptoms,” like social withdrawal. The most widely prescribed antipsychotic drugs are known as neuroleptics, which work by blocking the brain’s receptors for dopamine, a major neurotransmitter (Leuner & Müller, 2006; Oltmanns & Emery, 2006). The success of antipsychotic drugs in treating schizophre- nia supports the notion that schizophrenia is linked in some way to an excess of this neuro- transmitter in the brain.
Antipsychotic medications sometimes have dramatic effects. People with schizophre- nia who take them can go from being perpetually frightened, angry, confused, and plagued by auditory and visual hallucinations to being totally free of such symptoms. These drugs do not cure schizophrenia; they only alleviate the symptoms while the person is taking the drug (Oltmanns & Emery, 2006; P. Thomas et al., 2009). Moreover, antipsychotic drugs can have a number of undesirable side effects (H.-Y. Lane et al., 2006., Roh, Ahn, & Nam, 2006). Blurred vision, weight gain, and constipation are among the common complaints, as are temporary neurological impairments such as muscular rigidity or tremors. A very serious potential side effect is tardive dyskinesia, a permanent disturbance of motor control, partic- ularly of the face (uncontrollable smacking of the lips, for instance), which can be only par- tially alleviated with other drugs (Chong, Tay, Subramaniam, Pek, & Machin, 2009; Eberhard, Lindström, & Levander, 2006). In addition, some of the antipsychotic medica- tions that are effective with adults are not as well tolerated by children who experience an increased risk for many of the side effects described above (Kumra et al., 2008). Another problem is that antipsychotics are of little value in treating the problems of social adjust- ment that people with schizophrenia face outside an institutional setting. Because many discharged people fail to take their medications, relapse is common. However, the relapse rate can be reduced if drug therapy is effectively combined with psychotherapy.
Mind–Body Combining Drugs and Psychotherapy For some disorders a combination of drugs and psychotherapy works better than either approach used independently. This underscores the fact that the relationship between mind and body is highly complex. The causes of depression have not yet been fully determined, but they will probably be found to include a mixture of genetic predisposi- tion, chemical changes in the brain, and life situation (see Chapter 12, “Psychological Disorders”). ■
Antidepressant Drugs A second group of drugs, known as antidepressants, is used to combat depression like that experienced by Brooke Shields. Until the end of the 1980s, there were only two main types of antidepressant drugs: monoamine oxidase inhibitors (MAO inhibitors) and tricyclics. Both drugs work by increasing the concentration of the neuro- transmitters serotonin and norepinephrine in the brain (McKim, 2007; A. V. Terry, Bucca- fusco, & Wilson, 2008). Both are effective for most people with serious depression, but both produce a number of serious and troublesome side effects.
In 1988, Prozac (fluoxetine) came onto the market. This drug works by reducing the uptake of serotonin in the nervous system, thus increasing the amount of serotonin active in the brain at any given moment. (See Figure 13–2.) For this reason, Prozac is part of a group of psychoactive drugs known as selective serotonin reuptake inhibitors (SSRIs). (See Chapter 2, “The Biological Basis of Behavior.”) Today, a number of second-generation SSRIs are available to treat depression, including Paxil (paroxetine), Zoloft (sertraline), and Effexor (venlafaxine HCl). For many people, correcting the imbalance in these chemicals in the brain reduces their symptoms of depression and also relieves the associated symptoms of anxiety. More- over, because these drugs have fewer side effects than do MAO inhibitors or tricyclics (Nemeroff & Schatzberg, 2002), they have been heralded in the popular media as “wonder drugs” for the treatment of depression.