The Use of Pharmacology in the Treatment of Mental Health Issues

Introduction

Analysing the global media, it can be seen that there are evidences of an overwhelming criticism directed toward prescription medication. A certain part of such criticism is directed toward the products of psychopharmacology. Analysing the impact of using psychopharmacology in the treatment of mental health, it can be stated that such analysis will not be ambiguous. On the one hand, there will be stories of abuse, misuse, and dangerous side effects. On the other hand, there are the apparent benefits of pharmacology, which discovery allowed successfully treating many health and behavioural problems. Finally, there is the existence of other intervention techniques such as psychotherapeutic treatments, which include “individual, group, or family and marital psychotherapy; behavior therapy techniques (such as relaxation training or exposure therapy); and hypnotherapy” (Doebbeling, 2007). Above all this, there stories such as Stan Starr’s, a 54-year-old financial consultant, who had two and a half year battle to withdraw from Klonopin, a drug from the family of Benzodiazepines, which are often prescribed to manage anxiety, panic and sleep disorders (Balestra, 2009). Tracing the history and the successes of pharmacology in treating mental health, it can e stated that mental health has many vague and ambiguous definitions and delimitations, in treating which pharmacologically some controversies might arise. Nevertheless, the effectiveness of pharmacology cannot be debated, although the best results are likely to be received when psychosocial, psychotherapeutic, and pharmacological treatments are combined.

Analysis

Background

An interesting fact is that a major advancement in the field of abnormal psychology was made with the discovery of a side effect of a certain medication. The discovery was made in the early 1950s by Henry Laborit, and the medication was Thorazine (chlorpromazine), initially used to tranquilize surgical patients, which side effect led to the wide use of drug for the treatment of Schizophrenic Disorders (Getzfeld, 2006, p. 9). The following classes of medication were also a chance discovery, a fact that was true for antidepressants (i.e. imipramine), antipsychotics (i.e. Chlorpromazine), anxiolytics (i.e. barbiturates) and mood stabilizers (Preskorn, 2006). The main contribution of the discovery of those three classes can be seen through three points, which are providing scientifically proven treatment, proving that psychiatric illnesses can be treated like any other illnesses, and providing an insight into brain mechanisms (Preskorn, 2006, p. 86). Accordingly, approximately at the same period of the discovery of the early medications their main drawbacks were discovered as well. The drawbacks were related to the discovery of the fact that early medications such as chlorpromazine and amitriptyline affected “numerous receptors over relatively narrow concentration ranges” (p.86). The first drawback was related to the adverse effect that was found related to the usage of medications. Additionally, the medication was found to be toxic in overdoses, a fact that increased the risk of suicide attempts through overdose using medications prescribed for psychiatric illnesses. Finally, those medications were not easy to be used in combination with other drugs. In that regard, all those drawbacks contributed to the development of medications which had more focused pharmacology (p.87).

Implementation

The implementation of pharmacology for mental problems has a wide range, which limits far surpass anxiety and depression treatment, although the latter constitutes a significant part of such pharmacology. In that regard, the scale of mental health problems can be acknowledged through the fact that a report by the World Health Organisation in 2009 estimated mental disorders “to account for 12% of the global burden of disease” (WHO, 2009). It should be noted that the World Health Organization clearly distinguishes between essential medications and medications which effectiveness in long term treatment and everyday mental disorder management remains unclear. The model list of essential medicine ((EML)developed by the World Health Organization contain several elements which were selected for the treatment and control of mental disorders, divided between several categories, which are psychotic disorders, depressive disorders, bipolar disorders, generalized anxiety and sleep disorders, obsessive-compulsive disorders and panic attacks, and medicines used for substance dependence programs (WHO, 2009). It should be noted that several of the medications viewed as essential merely represent a class, for which there might be other cost-effective types falling within the same category, and at the same time, there are other medications which are effective, but nevertheless are not considered essential. The impact of medications can be seen through the impact that brain chemistry has on the origin of a disorder. The biological model of diagnosing and treating mental health diseases, where researches to date were successful in identifying changes, deficits, and brain mechanisms which contribute to metal illnesses, where those illnesses are “believed to be due to biochemical disturbances in the brain… [and considered to be] neurobiological disorders” (Medeiros, 2007). The role of the brain contributes to explaining the success of pharmacology in treating certain mental illnesses.

Different Interventions Combined

The main argument that should be stated in defence of using pharmacology in treatment is the fact that they are not intended to be used as the ultimate cure –they are not panaceas, and not supposed be (Getzfeld, 2006). According to the Diathesis-Stress Model, the occurrence of a mental disorder is attributed to a physical aspect as well as a life situation (or environmental stressor) (Medeiros, 2007). The Diathesis-Stress Model explains the method through which the genes and the environment interact, where “individuals inherit tendencies to express certain traits or behaviours, which may be then activated under conditions of stress” (Barlow & Durand, 2008, p. 36). Thus, considering the fact that there are two aspects involved in a mental illness, a physical and environmental, it is logical to assume that there should be treatments corresponding to each aspect. Psychopharmacology, in that matter, is a method corresponding only to the physical aspect, and thus, “there must be other form of treatment available to target the “non-physical” contributors to these disorders” (Medeiros, 2007).

Non-pharmacological therapy includes such methods as electroconvulsive therapy and psychotherapy. The field that had the most advancement in recent years is psychotherapy, which in turn can be divided into several practices, such as “supportive psychotherapy, psychoanalysis, psychodynamic psychotherapy, cognitive therapy, behavior therapy, or interpersonal therapy” (Doebbeling, 2007). Psychotherapy is suitable for many conditions and even can be beneficial even with people who do not have mental conditions. As it might be understood form the explanation of the Diathesis-Stress Model, psychotherapy addresses the environment al causes of an illness. A study in Pratt (2011) aimed at identifying treatments that were evidence-based and empirically supported for working with children and adolescents with mental and behavioural disorders. Researching several scholarly databases such as the Cochrane Database of Systematic Reviews, the Evidenced-Based Mental Health Treatment for Children and Adolescents group, Evidenced-based Therapy site, and others, the study found out that in reviews of pharmacological versus psychological treatments for specific disorders there were no significant differences between the two methods, where both found to be helpful (Pratt, 2011).

In that regard, according to the condition psychotherapy alone or in conjunction can be used to eliminate negative outcomes of mental and behavioural disorders (Pratt, 2011). Moreover, a study of the treatment of bipolar disorders addressed the efficiency of psychosocial interventions. Evidences found that despite the effectiveness of medications in the treatment of acute episodes, many patients could not achieve functional recovery from such episodes. The study, on the other hand, found that the treatment for bipolar disorder, in which psychopharmacological interventions were used as adjuncts to psychosocial interventions, was found to be effective (Crowe et al., 2010, p. 896).

Drawbacks

The drawbacks related to the use of pharmacology ion treating mental health are numerous. Some of them are based on weak arguments, while some of them have sound foundation, but nevertheless, they do not contradict the success of pharmacology as well as the fact that such drawbacks can be managed. One drawback can be attributed to the comorbidity of drug abuse and mental illnesses (NIDA, 2007). Although according to the National Institute on Drug Abuse it is not implied that both disorders are causing each other, there are certain scenarios in which pharmacology have a role. The explanation of the role of pharmacology is at the same time the same factor that defends, which is drug abuse and misuse. According to US statistics, “an estimated 48 million people (aged 12 and older), according to the National Institute on Drug Abuse, have used prescription drugs for nonmedical reasons in their lifetime” (WebMD, 2011). Central Nervous System (CNS) depressants are among the most commonly abused drugs, where the use of a drug leads eventually to larger doses being needed for patients. In that regard, it can be stated that the key term in such drawback is “abuse” and misuse” which is mostly refers to the patients themselves, although doctors also have a certain role. Such role can be seen through another drawback, which is the increased reliance on psychopharmacology, as opposed to combining it with types of interventions. It is argued that one of the reason prescription drug abuse is on the rise is the fact that “writing more prescriptions for patients than ever before” (WebMD, 2011). In that regard, the misuse of substance is a known problem which creates a major health problem throughout the world (Wilbourn & Prosser, 2003, p. 179). In that regard, the symptoms of misuse of medications can be parallel in many cases with the symptoms of misusing other illegal drugs.

The aforementioned drawbacks are associated with the misuse form the patients size as well as the prevalence of its prescription by doctors, while there are drawbacks associated with the medications themselves, their characteristics and the clinical practice in using them. It stated that the reliance on a more focused pharmacology led to that the medications are easier to use with other types of medications. The latter lead to the one of the most problems with current medications: “each one of these medications is of limited utility in treating most patients with common psychiatric illnesses” (Preskorn, 2006, p. 88). The occurrence of the aforementioned drawback is largely related to the disconnection that exists between clinical trials and clinical practice. In that regard, despite the fact that the medication prescribed for mental illnesses go through an extensive testing period, it is argued that the conditions in which the medications are tested, i.e. clinical trials, have little resemblance to clinical practice, where in the former, the patients have a single medical condition, which is the focus of the trial, with only one medication being given for treatment (Preskorn, 2006, p. 88). In clinical practice, many patients have more than one condition and thus, it can be argued that there is an apparent need for medications to be tested in conditions closer to reality.

Discussion

It can be seen that the variety of the variables causing a disorder, it is illogical to criticise the case when only one of such variable is being targeted. The latter is especially true when the means used to target such variable are misused and abused. The assessment of the way the pharmacology is used in the treatment of mental disorders cannot be based on the fact of patients abusing medications and/or using them without prescription. Nevertheless, other problem might be outlined in such case which is the increased reliance on medications. Even with equal effectiveness, and with psychotherapy having almost no adverse side effects, considering that it can be used with patients who do not have mental problems, it can be seen that the reliance on psychotherapy should be prioritised. Such priority will increase when the pharmacological treatment can be avoided. The main point is that in many cases the pharmacological treatment cannot be avoided, and proven its effectiveness. It is a matter of assessing each case individually, which places a great responsibility on doctors, psychoanalysts, psychologists, or any other professional with the authority to prescribe medication. There are several guidelines that should be known, the most basic of which is taking in consideration the potential risks and the benefits for each individual patient. Thus, health care providers should not consider only medication as the easiest route for treatment, and neither should they deliver such message to their patients. Accordingly, a detailed clinical assessment should be completed prior the issuing a prescription. In response to the case detailed at the beginning of the essay, it can be stated that increasing the awareness of the patients regarding the potential impact of anxiety medications can be seen as a suitable solution. The notoriety that such class of medication gained recently will; contribute to increasing the responsibility on health care providers when issuing a prescription. In any case, the blame cannot be put on pharmacology in general.

Conclusion

The essay provided an analysis on the use of pharmacology in the treatment of mental problems. The essay argued that pharmacology is effective in treating many mental problems, which is most effectiveness when combined with other forms of interventions such as psychotherapy. The paper analysed the implementation of pharmacology and its common drawbacks. It can be concluded, the most of the criticism directed toward pharmacology is resulted from abuse and misuse, in which part of the responsibility is attributed to health care providers. Thus, following guidelines in the treatment of mental illnesses is a good option to avoid such criticism.

References

Balestra, K. (2009). Anti-Anxiety Drugs Raise New Fears. The Washington Post. Web.

Barlow, D. H., & Durand, V. M. (2008). Abnormal Psychology: An Integrative Approach: Cengage Learning.

Crowe, M., Whitehead, L., Wilson, L., Carlyle, D., O’Brien, A., Inder, M., & Joyce, P. (2010). Disorder-specific psychosocial interventions for bipolar disorder—A systematic review of the evidence for mental health nursing practice. International Journal of Nursing Studies, 47, 896-908. doi: 10.1016/j.ijnurstu.2010.

Doebbeling, C. C. (2007). Treatment of Mental Illness. The Merck Manuals. Web.

Getzfeld, A. R. (2006). Essentials of abnormal psychology. Hoboken, N.J.: John Wiley.

Medeiros, J. (2007). Treating Mental Health Disorders: Psych Meds Versus Psychotherapy. HealthMad. Web.

NIDA. (2007). Comorbid Drug Abuse and Mental Illness. National Institute on Drug Abuse. Web.

Pratt, H. D. (2011). Point-Counter-Point: Psychotherapy in the Age of Pharmacology. Pediatric Clinics of North America, 58(1), 1-9. doi: DOI: 10.1016/j.pcl.2010.10.012.

Preskorn, S. H. (2006). Pharmacogenomics, informatics, and individual drug therapy in psychiatry: past, present and future. Journal of Psychopharmacology, 20(4), 85-94. doi: 10.1177/1359786806066070.

WebMD. (2011). . WebMD, LLC.

WHO. (2009). . World Health Organization.

Wilbourn, M., & Prosser, S. (2003). The pathology and pharmacology of mental illness. Cheltenham: Nelson Thornes.

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