Psychopharmacology and the Effects of Discontinuance Essay Example

Psychiatric medications have been used to control mental disorders for a long time. Their use has been based on little pharmacological understanding of their mode of action in the patients. However, the medication has played a critical role in restoring normalcy in the patient’s mental state of mind. Some medication has impacted negatively on the patient’s health, especially after discontinuation. As a result, there has been an increased need for the caregivers in the psychiatric department to understand the pharmacological impact of the drugs and a wide range of side effect after withdrawal. Most patient use psychiatric medication because of the intense mental, psychological or emotional stress.

However, although mental medication normally modifies the patient’s attitude just like any other psychoactive substances, it is essential to understand that such medication does not alter the underlying cause of emotional discomfort. There is a wide range of effects related to the discontinuation of psychiatric medications which includes somatic withdrawal syndrome, a condition that is often mistaken for a relapse. Besides, rapid onset psychotic response after drug withdrawal is common, especially for both neuroleptic drugs and clozapine.

However, such outcomes are usual since much research on the medication is flawed. Moreover, there is the fact that current psychiatric conditions are iatrogenic. From the research, it evident that more analysis and investigation on psychiatric medication is essential in order to ensure adverse effects of drug discontinuation does not outweigh the benefits.

Understanding Psychopharmacology

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Clear understanding of the drug pharmacology and its mechanism of action plays a critical role in explaining not only the therapeutic impact and side effects, but also the adverse effects when the medicine is discontinued (Wenzel, 2014). Therefore, a broad review and analysis of the potential consequences connected with the discontinuation of the numerous psychotropic medications is essential. Nowadays, commonly used antidepressants have low instances of side effects when compared to previously used ones. However, some less serious and potentially harmful side effects are associated with a range of new antidepressants prevalent in the market today in an attempt to argument the efficacy (Goldberg & Ernst, 2012). Therefore, primary caregivers engaged in the modern psychiatry in the field of psychopharmacologic treatment of depression are required to be aware of the wide range of both minor and serious side effects. The paper largely focuses on psychopharmacology and the effects of discontinuing psychotropic medication.

Most individuals start taking psychiatric medications due to an extreme sense of distress. The patient is either experiencing overwhelming states of emotional or psychological distress or a combination of both conditions. However, different labels are used for such states such as depression, anxiety, paranoia, psychosis, and mania among others and the labeling changes over time (Goldberg & Ernst, 2012). In most instances, the physician informs the patients that their emotional discomfort is a result of mental disorders that have biochemical basis. Moreover,their distress is dangerous and needs to be controlled with the help of psychiatric drugs treatment. Mental medication normally effects the brain and modifies the attitude and awareness just like any other psychoactive substance (Sinacola & Peters-Strickland, 2012). However, most medications can blunt or control the symptoms of the emotional discomfort by relaxing an individual, shocking the sensitivity, or making patients sleep. They usually enable people to feel capable of living their lives more comfortably (Goldberg & Ernst, 2012).

Nonetheless, it is crucial to understand that psychiatric medication does not alter the underlying causes of the emotional distress or discomfort. It is often understood as the tool for coping mechanism that alleviates symptoms and paves the way for the transformation, but with significant risks for anyone who consumes the medication.
Just like any other altering substances, psychiatric drugs are psychoactive and adjust the mind behavior through influencing the brain chemistry. Their importance and risks usually result from shifting the brain and altering the consciousness, including the placebo and expectation. In the current medical practice, psychiatric drugs shift the levels of chemicals known as neurotransmitters (Sinacola & Peters-Strickland, 2012). Such chemicals are linked with the mental and mood functioning, and all the cells in the nervous systems, including the brain cells, utilize the neurotransmitters to communicate with one another. When the neurotransmitters’ levels change within the body system, the receptor that receives and controls the neurotransmitter, tends to be more sensitive, thus shrinks in order to adjust (Goldberg & Ernst, 2012).

For instance, selective serotonin re-uptake inhibitors (SSRIs) are known to increase the level of the neurotransmitter in the brain, thus reducing the number of brain serotonin receptors. Furthermore, antipsychotic drugs such as Haldol usually lower the amount of dopamine receptors in the mind (Sinacola & Peters-Strickland, 2012). The action of the neurotransmitters and the receptors is usually the same in any form of psychoactive medication. Alcohol affects the neurotransmitter including serotonin and dopamine, and the cocaine alters the levels of both serotonin and dopamine (Sinacola & Peters-Strickland, 2012).

Despite the risk of psychiatric drugs, the benefits of the medications are widely promoted. The most important aspect of the drugs tends to be mixed with misleading claims. There are different ways psychiatric drugs can be useful. For instance, sleep deprivation is a single cause or contributor to emotional crisis and the psychiatric medication is used to control the condition (Sinacola & Peters-Strickland, 2012). It is established that psychiatric drugs protect individuals from emotional crisis that is so severe that threatens their mental stability and even their lives. It is reported that symptoms feel manageable on medications and the episodes of depression or mania are eased. Besides, interrupting crisis and getting adequate sleep enable the patient to reduce stress, an aspect that decreases life chaos (Élie et al., 2010). It is, usually, the groundwork for a greater stability and addresses a situation that could have been difficult to control.

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Irrespective of the medical principle of informed consent, physicians usually tend to leave crucial information about the psychiatric drugs they prescribe to the patients. Higher doses and extended use of such drugs changes tend to be deeper and long lasting (Élie et al., 2010). The drugs are often very difficult to stop using because of their adverse effects associated with withdrawal. Though the brain has the potential to heal and repair itself, such process takes a long period for it to recover fully from the withdrawal (Goldberg & Ernst, 2012). Besides, it is essential to understand that neuroleptic drugs, though claimed to be anti-psychotic, rarely target psychosis or specific symptoms of mental disorder. Instead, they only diminish the brain functioning in general for any patient using the above medication. Most patients using the drugs report that their psychotic symptoms continue to persist though their emotional reaction tends to lessen.

Health and Mental Risk Associated with the Psychiatric Drugs

Deciding whether to come off psychiatric drugs implies evaluating both the risks and benefits involved, including essential information about the effects. However, drug effects can vary significantly among individuals. Psychiatric drugs are harmful and can injure the patient’s body (Élie et al., 2010). Neuroleptic drugs can cause life-threatening problems known as neuroleptic malignant syndrome as well as Parkinson disease. Besides, regular blood checkup is crucial for drugs such as lithium and clozapine in order to assess any potential physical harm. Besides, many psychiatric drugs have been found to lead to sudden heart attack, kidney failure, and other serious blood disorders among other effects (Élie et al., 2010). Other toxic effects include interfering with the normal menstrual cycle flow, pregnancy, and serotonin syndrome.

Furthermore, psychiatric drugs have the potential to injure the brain cells. For instance, tardive dyskinesia is a common problem that leads to disfigurement of the persons facial fits. It is very widespread among the patients taking high and enduring anti-psychotic drugs (Élie et al., 2010). Antipsychotic medication has been found to cause brain shrinkage while anti-depressant leads to memory problems and increases vulnerability to depression. Other effects include mental and cognitive impairment and brain injury. The drug effect poses the risk of lowering the quality of life, including decreased sexuality, depression, and increased sense of restlessness. Lithium medications interact with water and salt within the patient’s body, leading to potency fluctuation (Wenzel, 2014). Although regular blood tests are used to keep the lithium dosage in check, individuals using the medication are usually at a higher risk of exposure to it. Other psychiatric drugs such as Ritalin and Adderall have been reported to cause stunted growth among the children. They also present an unknown risk to the normal brain growth. Besides, just like amphetamines, Ritalin and Adderall are also addictive and cause psychosis and heart problems (Wenzel, 2014).

Mental health risks are the least understood aspects of psychiatric medications. Such medications make psychotic symptoms worse and raise the likelihood of having a crisis. The drugs have the potential to change receptors. For instance, such neurotransmitter as dopamine makes a patient supersensitive to psychosis (Élie et al., 2010). As a result, it raises sensitivity of the emotions and the experiences. It has been reported that psychiatric drug prompts suicidal feelings as one of the psychotic symptoms. However, physicians tend to respond by prescribing more drugs to the diagnosis. Furthermore, many people experience increasing change in personality, including feeling drugged, emotional blunting, reduced physics, and impaired creativity (Wenzel, 2014). Patients taking psychiatric medication, particularly anti-psychotics, have been found to develop long term problems as mental patients.

Side Effect of Psychopharmacology Discontinuance

The discontinuation or reduction of psychiatric drugs leads to adverse medical problems. The somatic discontinuation syndrome also commonly known as a withdrawal reaction is the most prevalent. The syndrome usually refers to the psychological expression of the biological effects caused by the discontinuation of a regularly administered medication (Marin & Escóbar, 2013). Such syndromes have previous been conceptualized as resulting from biological adaptations to the continued psychotic drug use, which became suddenly unopposed when the drug is withdrawn, especially abruptly. It is now established that the withdrawal syndrome occurs with a wide array of medications, and not only the anti-depressants and neuroleptics. However, the response to the lithium medication has been recognized as the most frequent (Landry & Skalli, 2010). In some instances, the discontinuation reaction has been reported to persist for an extended period of times (Marin & Escóbar, 2013). Besides, the most cases of withdrawal symptoms usually included behavioral and psychological ones such as restlessness, anxiety, and impaired sleep which are often interpreted as the signs of relapse.

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Rapid Onset Psychosis

Rapid onset psychosis is one of the common effects of psychopharmacology discontinuation. It entails occurrence of the psychotic incidents shortly after withdrawal from long term usage of psychiatric drugs, particularly neuroleptic. However, the occurrence of such cases is higher in clozapine, where a number of cases have demonstrated this effect in the patients with both treatment resistance and responsive psychosis (Marin & Escóbar, 2013). The rapid onset psychosis appears usually few days after the withdrawal, and the symptoms tend to be consistent including visual hallucinations, paranoid delusions, and hostility. Nonetheless, most of the cases have been documented in the people without previous psychiatric histories. In addition, there are few cases of new onset psychotic symptoms documented in the patients that were previously diagnosed with manic depression problem (Landry & Skalli, 2010).

Nonetheless, evidence points out the possibility that psychotic reaction tends to be distinctive from the underlying disorder and usually represents an iatrogenic syndrome. The prevalence of the people without previous known psychiatric history strengthens the evidence to this effect and the new start of specific signs documented in many other cases (Marin & Escóbar, 2013). The comparative constancy of the symptoms also indicates the possibility that they are all related to the symptoms of stimulant psychosis attributed to over-activity of the dopamine. However, the rapidity of the onset indicates that the phenomenon is a physical manifestation of the withdrawal process. Furthermore, in the case of clozapine, it is explicit that the occurrence of the effects coincided with the somatic withdrawal syndrome (Landry & Skalli, 2010). Although it is challenging to understand how frequent the somatic syndrome is, it has been described commonly after the clozapine withdrawal, an aspect attributable to the clozapine short half-life. However, as for the psychiatric drugs with a longer half-life, a withdrawal psychosis is often misinterpreted for a naturally occurring reversion, since its onset tends to be less rapid (Marin & Escóbar, 2013).

Psychological Reaction and Misattribution

Theoretically, reduction or discontinuation of psychiatric drugs has the potential to prompt psychological reactions that are similar to the opposite of the placebo effect commonly known as the nocebo effect (Landry & Skalli, 2010). The term describes a situation where expectation of illness induces real illness. A number of investigations have shown that individuals can become ill and psychologically stressed through suggestion. Nocebo effect is the idea that the outcome of the withdrawal may become influenced by the negative anticipation of the psychiatric patients or others involved with their care. It is usually influenced by either reduction of the drug supply in the body or the somatic withdrawal because of the drug amount reduced (Sinacola & Peters-Strickland, 2012). Theoretically, it can be distinguished from the psychological symptoms displayed directly by the biological effects of the drug discontinuation though in practice it might be problematic. Nonetheless, a psychological reaction might be less consistent in its symptom profile and the onset rather than the withdrawal symptom (Landry & Skalli, 2010). Therefore, anxiety tends to be the most prominent symptom of misattribution. An individual involved with the patients’ care experiences substantial anxiety about changes in medication, specifically, in the reduction in long-term drug treatment. As a result, such feeling may be transferred to the patient and tend to exacerbate the psychological reaction in the patients (Sinacola & Peters-Strickland, 2012).

Besides, there is a related scenario that normal long-term fluctuations in the patient’s condition are misattributed to the impact of the drug withdrawal by the patient or others who are concerned about the outcome of the reduction. It is a very common incident and occurs when clinical offices are opposed to the decision to decrease discontinuation of the medication (Stahl, 2014). In such situation, all the negative events that happen after change in the psychiatric drug schedule are related to it irrespective of the previous occurrences. Psychological reaction is a very critical concept just like physiological withdrawal syndrome; it is usually mistaken for relapse. Moreover, they contribute to the re-occurrence of the psychotic illness (Stahl, 2014).

Re-Occurrence of an Underlying Condition

This complication results from the relapse or the exacerbation of the underlying medical illness due to discontinuation of the psychiatric drugs. The association between the decreased medication and relapse is usually complex (Stahl, 2014). However, a relapse occurs after the prescribed medications discontinuation largely because of the removal of the beneficial prophylactic impacts of the medication (Wenzel, 2014). Furthermore, the withdrawal process in itself also induces a degeneration that would not otherwise have ensued during the time of the natural course of the disorder.

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Despite the earlier skepticism, there is a consensus that discontinuing of lithium medication raises the risk of relapse of the manic depression above the levels related to the natural course of the mental illness. The increased risk of relapse is usually common within the first few days of discontinuations and usually ends thereafter. However, high rate of relapse occurs after a rapid withdrawal compared to a gradual withdrawal (Stahl, 2014). Besides, the rate of recurrence after withdrawal from lithium medication usually exceeds the rates of episodes before lithium medication initiation (Wenzel, 2014).

Pharmacodynamics Adaptation

Long-term use of psychiatric drugs, especially those that suppress specific neurotransmitters, is believed to cause the compensatory rises in the number of sensitivity of the relevant receptors. When such receptors are no longer suppressed by the drugs, there is usually an over activity of the neurotransmitters systems (Élie et al., 2010). It results in characteristic discontinuation syndromes that lead to rapid onset psychosis and eventually pharmacodynamics stress, which increases the vulnerability to a relapse. Furthermore, research on the super sensitivity psychosis has indicated that humans exhibit shifts in dopamine receptors, especially after a long period of neuroleptic drug use. Nonetheless, the connection between dopamine and psychosis receptor over-sensitivity has not been examined empirically while presumed manifestations of dopamine super-sensitivity such as prolactin sensitivity have not been demonstrated consistently (Élie et al., 2010).

Elevated risk of relapse consequent on the discontinuation of the medication is largely attributed to the same model of pharmacodynamics adaptations. Abrupt withdrawal of neuroleptics and lithium is usually associated with elevated risks. On the other hand, gradual withdrawal would be consistent with such explanation because of the lower opportunity for adaptations and return to normal (Landry & Skalli, 2010). Since the adaptation is usually present only for weeks in human after a single dose, it explains why the risk of relapse persists months after the initial withdrawal. Furthermore, psychological reaction to the discontinuation of the psychiatric medication causes symptom and increases the vulnerability to relapse. Research case studies indicate such effects in humans with psychosis. However, psychological reaction is also very prevalent among individual suffering from depression (Landry & Skalli, 2010). Besides, psychological effects combine with pharmacodynamics mechanisms in different ways. For instance, elimination sedating and intoxicating effects of the medication raise the anxiety directly or indirectly by reminding people that their medication is being discontinued. Therefore, the psychological reactions of the staffs, patients, and the caregivers are critical determinants of the success or failure of discontinuation (Landry & Skalli, 2010).

In conclusion, it is evident that though psychopharmacology plays a critical role in psychiatry; withdrawal often leads to a variety of effects either minor or serious. Although antidepressants and other medication alleviate the potential impairing syndrome of depression and other mental illnesses, it is essential to acknowledge the significance of their side effects in order to maintain compliance (Wenzel, 2014) However, since the adverse effects outlined above may be mistaken for a re-emergence of the underlying illness, it will be essential to re-evaluate the evidence on the value of maintenance of the psychiatric medications.

The placebo groups are often subject to above adverse effects. However, since such facts are often overlooked, they are attributable to the underlying illness and are taken as evidence of superiority of the continued use of such medications (Goldberg & Ernst, 2012).

When relapse is basically evaluated simply as clinical deterioration, somatic discontinuation symptoms, as well as anxiety induced process are mistaken for it. There is the critical need for improvement in the awareness of the side effects of the psychiatric medications used in the treatment of most disabling mental illnesses (Stahl, 2014). As a result, it will play a critical role in eliminating misinterpretation evident between side effects and relapse of the condition and ensure that the benefits of discontinuation outweigh the side effects.

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