Major depressive disorder and anxiety, as well as several other psychiatric conditions, can be often observed in people of different age and diverse life backgrounds. The prevalence of these mental impairments emphasizes the importance of the research and development of the most effective treatment methods capable of eliminating not only the symptoms but also the causes of a disorder. Despite its psychological manifestations, depression is characterized as a problem taking its roots in neurobiological processes inside the brain. Despite the diversity of theories of depression, the majority of researchers agree on the neurotransmitter-related impairments as the leading cause of depressive syndromes (Harmer, Duman, & Cowen, 2017; Kaltenboeck & Harmer, 2018; Zhang, Yao, & Hashimoto, 2016). The neuroscience has progressed to the level of starting to understand the possible causes of depressive disorders and anxiety.
Thus, there are numerous therapeutic methods aimed at restructuring the work of neurotransmitters and cells in the brain to achieve the relief of depressive symptoms. Among the most frequently used therapeutic medications used in psychotherapy, there are antidepressants, anti-psychotic, and psychotic drugs. They are aimed at either blocking or stimulating specific signals between the nerve cells in the brain, thus reducing depressive symptoms. However, despite the scope of research of the neurobiological aspects of depression, little is proven and discovered concerning the exact processes that take place when a person develops a mental disorder. Therefore, the effect of therapeutic drugs used for depression or anxiety is not sufficiently studied. Numerous psychoactive influences and side effects of the drugs causing mental or physical complications have been introduced to the field of research (Dusi, Barlati, Vita, & Brambilla, 2015; Just, 2015; Zhou et al., 2015). Given that depressive and anxiety disorders are pervasive in the modern world, the ways of their curing become more and more relevant.
It is vital to review the effects of drugs used for psychotherapeutic treatment to validate the necessity of their use as an immediate cure from mental disorders like depression or anxiety. In this research paper, the neurobiological characteristics of clinical depression and anxiety and the description of drugs used for their treatment will be presented. Also, the psychoactive effects of antidepressants, anti-psychotic, and psychotic drugs on the mental and physical functioning of a patient will be investigated.
Depression and Anxiety from the Neurobiological Perspective
Major depressive disorder and anxiety are ones of the most prevalent mental health conditions observed in the modern world. Depression is characterized by “the prolonged presence of specific somatic and cognitive abnormalities in combination with sad, empty or irritable mood” and might be a cause of disabilities, limited socialization, and even suicidal attempts (Kaltenboeck & Harmer, 2018, p. 1). According to the statistical data presented in the research by Zhang et al. (2016), the depressive disorder affects “approximately 17 percent of the population at some point in their lifetime” (p. 721). As for anxiety, it is a severe and frequently occurring psychiatric issue that affects about 21 percent of the adult population through their lifetime (Partiquin & Mathew, 2017). As defined in the article by Partiquin and Matthew (2017), generalized anxiety disorder is characterized by “worry about several events or activities,” which a person cannot control (p. 2). Both depression and anxiety are attributed to many comorbidities and complications that obstruct healthy lifestyle and become a burden and a cause of stigma.
Recent research in the field of the actual processes in the brain cells leading to such psychiatric disorders as depression and anxiety is scarce but provides some insights into the nature of the illnesses. Although depressive syndromes and anxiety are defined as different illnesses characterized by several altering symptoms, the biological basis of the processes taking place in the course of the diseases is similar. Indeed, according to Partiquin and Mathew (2017), several studies have proven the similarities in the biological nature of depression and anxiety. For example, in the cases of both anxiety and depressive disorder, the “amygdala has demonstrated increased activity … when compared to healthy controls” (Partiquin & Mathew, 2017, p. 458). Thus, it is possible to conclude the similarity in neurobiological processes preceding both analyzed states.
It is claimed that depressive syndromes depend on neurobiological alterations in such structural brain areas as “prefrontal cortex …and medial temporal cortex” which are responsible for cognitive and emotional functioning (Dusi et al., 2015, p. 458). In general, depression is a severe and complex illness that has a system of neurobiological abnormalities as its basis. Depression occurs in a situation when the neurotransmitters in the brain do not function properly due to the defects concerning such monoamines as serotonin, noradrenaline, and dopamine (Kaltenboeck & Harmer, 2018). Thus, when neurotransmitters fail to function appropriately and establish links between the nerve cells in the brain, a person experiences such symptoms as worry, sadness, bad mood, fatigue, and other manifestations of anxiety or depression. The researched neurobiological basis for such frequently occurring mental disorders allowed for targeting the identified problems in neurotransmitters’ functioning and developing particular medication capable of stimulating necessary monoamines to eliminate adverse symptoms.
Medication for Depression and Anxiety Treatment
Due to the prevalence of anxiety and depression, as mentioned above, the need for treatment of these illnesses is acute. Apart from psychotherapeutic interventions aimed at relieving the symptoms by applying specific techniques, there are many medications which target the biological aspect of the problem. The development of the sphere of drugs for depression provides more insights into the effectiveness of the drugs but still lacks complete scientific and evidence-based justification.
Antidepressants
Depression and anxiety are frequently occurring psychiatric states which cause debilitating effect and often obstruct an individual’s healthy life and functioning in society. Moreover, such problems are usually of intimate character, and people suffering from these illnesses do not tend to ask for help from a therapist, especially at early stages of problem development. In such a case, taking a pill seems to be the easiest and most effective way to resolve the issue and find a practical solution.
As the review made by the scholars at the Centers for Disease Control and Prevention shows, the number of people taking antidepressants has significantly increased throughout more than a decade. The use of antidepressants by the American individuals aged 12 years and older increased “from 7.7% in 1999–2002 to 12.7% in 2011–2014” (Pratt, Brody, & Gu, 2017, p. 5). Moreover, besides the increased level of antidepressant use by Americans, 25 percent of those who have used medication for depression within the previous month indicated that they had been using it for the last ten years (Pratt et al., 2017). Such prevalent use of this type of medication by the population justifies the investigation of the effect it makes on the brain and the symptoms of mental disorders.
In essence, antidepressants inhibit the returning of the neurotransmitters to the cells, which produced them, thus eliminating depressive symptoms. The most frequently used antidepressant is a Selective Serotonin Reuptake Inhibitor (SSRI) performs the changes in the molecular structure of the brain and ensures proper neurotransmission (Dusi et al., 2015). This type of antidepressant was introduced approximately 60 years ago, and many new developments in the field have been made in the area since then (Harmer et al., 2017). Nevertheless, SSRI remains one of the main pharmacological substances used for both depression and anxiety.
The advancement in the field of antidepressant medication was encouraged by the varying effectiveness of the drugs and the different time of their effect. There exist other types of antidepressants which primarily target other neurotransmitters. For example, reboxetine is a selective noradrenaline reuptake inhibitor, and bupropion is an inhibitor of noradrenaline and dopamine reuptake, “which gives it a more activating profile than SSRIs” (Harmer et al., 2017, p. 410). More new drugs do not only block the reuptake of neurotransmitters but also affecting other 5-hydroxytryptamine (5-HT) receptors improving the antidepressant influence of the medication. For example, venlafaxine and duloxetine have a twofold impact affecting serotonin-norepinephrine reuptake inhibitors (Harmer et al., 2017). The development and in-depth investigation of how antidepressants work to provide more and more perspectives on the possible ways to treat psychiatric conditions.
Anti-psychotic Drugs
Despite the scope of antidepressant medications available for patients suffering from depression, only half of the suffering population experiences remission upon antidepressants use. Those, whose symptoms remained unchanged upon initial treatment are diagnosed with treatment-resistant depression and have to be prescribed anti-psychotic drugs (Zhou et al., 2015). Among such medications, three ones have been approved for medical use in the USA: aripiprazole, quetiapine, and olanzapine (Zhou et al., 2015). These agents work at a more precise level by blocking specific dopamine receptors. Anti-psychotic drugs selectively affect 5-HT2 receptors and D2 (dopamine) receptors and influence various areas of the brain, thus providing multiple therapeutic effects depending on dosage (Zhou et al., 2015). Similarly to antidepressants, anti-psychotic drugs also lack precise clinical justification of results and are at the stage of investigation for further application.
Psychotic Drugs
Psychotic or psychotropic medications constitute an array of drugs affecting cognitive, emotional, or behavioral functioning and having a direct impact on the brain. According to the data presented by the American Association of Post-Acute Care Nursing (AAPACN), psychotropic drugs are a new type of medication that includes “anti-psychotics, anti-depressants, anti-anxiety, and hypnotics” (Davis, 2017, para. 4). In general, such drugs usually have both beneficial and adverse effects. However, if a person suffers from a severe form of mental disease and seeks relief of symptoms alongside psychotherapy, psychotropic drugs become a beneficial variant of problem resolution. Due to the fact that this type of drugs causes crucial changes in brain functioning, they have numerous side effects which have to be taken into account when prescribing such treatment. The risks associated with psychoactive drug use impose time and dosage limitations that have to be conducted by a specialist (Davis, 2017). To understand what psychotropic effect such medications for mental illnesses have on the brain, one should review its influence on the physiological, physical, and mental functioning of the human body.
Psychoactive Effect of the Drugs for Depression and Anxiety on the Brain
As it has been previously mentioned, depression is a complex and multifaceted mental illness that is not completely studied and the biological nature of which is not fully understood. The functioning of a depressed individual’s brain is affected by the drug stimulating neurobiological changes in the cells and thus minimizing the symptoms of the illness. However, since these medications affect the most important organ of a human body that is responsible for all the systems of organism, there are multiple side effects and risks that accompany medical treatment.
Physiological Changes in the Brain
Depression is often explained as a complication in human responses to some life events and stressors, which imped positive reactions to certain stimuli and reinforce negative ones. As mentioned by Harmer et al. (2017), the “style of focusing on and remembering … information that is negative, while disregarding positive information” encourages “negative thoughts, feelings, and beliefs seen in depression” (p. 414). Thus, the administration of antidepressant medications is expected to improve the processing of positive responses to social information in order to minimize symptoms of depression.
Since psychoactive drugs primarily target the work of brain nerve cells and the connections between them, the use of such medications results in significant changes in the physiological processes in the brain. Interestingly, the differences in the timeline of neurobiological and therapeutic effects imply the complexity of changes taking place in the brain in response to the influence of agents of antidepressants or anti-psychotics. According to Harmer et al. (2017), the neurochemical effect of monoamine function stimulation might be observed soon after several hours of drug consumption, whereas the therapeutic effect is achieved within several weeks.
Overall, different types of psychoactive drugs used for depression or anxiety consist of agents capable of targeting specific neurotransmitters and either stimulating or blocking their work in the brain cells. More specifically, antidepressants work as selective monoamine reuptake inhibitors, causing the shifts in signal transmission in specific brain areas (Harmer et al., 2017). These brain areas are responsible for particular functions in the organism; thus the physiological changes in the brain under the influence of psychoactive drugs have their side effects on patients’ physical and mental performance.
Physical Functioning
The consumption of psychoactive drugs aimed at curing major depressive disorder or anxiety has its influence on the physical performance of a patient. Indeed, many studies were dedicated to the investigation of the long-term outcomes of psychoactive medications use (Cartwright, Gibson, Read, Cowan, & Dehar, 2016; Just, 2015; Zhou et al., 2015). Some of them have reported an array of physical side effects that impose a discussion of the comparison of benefits and adverse effects of psychotropic medical substances intake. Among the most frequently observed physical effects of psychoactive drugs on the human body there are such mild manifestations as increased sweating, dry mouth, headaches, nausea, and muscle pain (Cartwright et al., 2016). Also, there were some health impairments and potential disease development identified concerning psychoactive drug consumption. They include “osteoporosis and fracture, bleeding disorders, hyponatremia, and diabetes mellitus” (Cartwright et al., 2016, p. 1402). However, the most common and the most challenging adverse effects of such drugs are sexual dysfunction and weight loss.
Sexual function impairment is recognized to be one of the leading adverse outcomes of antidepressant medication intake. Alongside with weight gain which was found in more than 65 percent of patients taking antidepressants, there appeared almost 72 percent of population suffering from sexual dysfunction as a result of psychopharmacological treatment (Cartwright et al., 2016). In general, this type of health problem is widespread in people suffering from mental disorders such as depression or anxiety. The statistical data presented in the study by Just (2015) shows that sexual impairments were detected in “30%–80% in women and 45%–80% in men” having mental illnesses (p. 1655). The essential idea to note here is that anti-psychotic treatment of depressive disorders only worsens the situation and is observed as the main complication of such treatment. Indeed, approximately 30 percent of women and 54 percent of men treated with anti-psychotics suffer some sexual dysfunction ranging from problems achieving an erection to “reduced orgasm intensity” (Just, 2015, p. 1655).
The roots of the identified problem might be found in the neurochemical process in the central nervous system. The dopaminergic structures in the hypothalamus are in charge of sexual function. When treated with agents provoking changes in monoamines and their transmission, changes in the work of hypothalamus might be observed, leading to specific impairments (Just, 2015). Different types of psychoactive drugs, including a sedative and stimulating medications deal with neurotransmitters related to sexual performance and thus obstruct its healthy development.
Mental Functioning
It has been noted that antidepressants and anti-psychotics affect the brain in a way that allows for transforming negative responses to social information and stressors to positive ones. It is commonly expected that the changes to neurochemical processes in the brain will affect the emotional and behavioral aspects of the life of a patient. However, multiple studies have discovered adverse outcomes of psychoactive medications on mental functioning, especially when being treated on a long-term basis (Cartwright et al., 2916, Just, 2015).
One of the common effects of psychoactive drugs is observed in the changes in the emotional sphere. Patients who have been using psychopharmacological medications for a long time report emotional numbness and feelings of addiction to the drugs (Cartwright et al., 2016). Indeed, the positive effect of depression or anxiety symptoms reduction encourages patients to continue intake of drugs, causing a belief that one cannot perform properly without them. Also, the influence of anti-psychotics and antidepressants is characterized by “sedative-type effects, emotional blunting, and emotional instability” (Cartwright et al., 2016, p. 1402). Thus, the behavior of a person under treatment changes in both positive and adverse ways.
Such impairments are closely associated with mental functioning changes of a patient. The use of sedative drugs and SSRIs have shown decreased attentiveness, fatigue, loss of interest in social interaction, diminished alertness, and insomnia. On the other hand, drugs having a stimulating effect might cause mania syndrome characterized by increased activity level and excitement. Also, despite overall positive effects of antidepressant medications on the coping mechanisms with negative stimuli in patients, there were many of those who reported suicidal intentions as a result of antidepressant consumption (Cartwright et al., 2016). Such tendencies might be explained by the inability to cope with depression or anxiety without medication. Since psychoactive drugs impact some crucially essential areas of the brain, such mental functions as memory, learning abilities, or motivation might also be affected. Thus, the development of the field of neuropharmacology has introduced a significant shift in understanding how the human brain works. However, at the same time, there is no complete answer to how to treat psychiatric disorders without damaging the life-important systems of the organism and maintaining the quality of patients’ lives.
Conclusion
The recent advancement in psychoactive drugs use for the treatment of major depressive disorder, anxiety, and other mental illnesses has presented a variety of controversial theories and discussions. The controversy is based on the twofold nature of the effect psychotropic medications have on the human body. The results of treatment in various groups of patients show different levels of improvement and different responses to the effects of psychoactive drugs. Such diversity in reactions to medications only justifies the complexity of mental illnesses and their insufficient investigation.
In conclusion, there exist numerous psychoactive drugs used for mental illnesses treatment, including antidepressants and anti-psychotics, which have psychoactive effects on the human brain. These medications were developed on the basis of the latest discoveries in the field of neurobiological processes taking place in the brain of a suffering individual. Thus, the drugs improve the functions of neurotransmitters, such as serotonin, dopamine, noradrenaline, and others, and receptors in the brain nerve cells to ensure positive responses to stimuli. Alongside with the symptom reduction, there are significant adverse effects on mental, physical, and emotional functioning caused by psychoactive substances. The use of psychotropic drugs can be only justified if the benefits outnumber the adverse effects.
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