PSYCHOACTIVE MEDICATIONS


WHAT IS A PSYCHOACTIVE MEDICATION?

Psychoactive medications are drugs that, when prescribed and used carefully, can reduce or eliminate the suffering caused by psychological conditions such as anxiety, insomnia, depression, psychosis, bipolar affective disorder, etc.

Psychoactive medications are prescribed by physicians. After examining a patient, the doctor diagnoses his or her mental health condition and, if treatment appears necessary, prescribes the most appropriate treatment for it.

Many people use psychoactive medications, with or without prescriptions, to cope with the problems of their daily lives. Examples include older people taking medications to deal with loneliness, people who are overworked or overstressed, and people who have gone through a stressful experience.

Sleep disturbances are one of the most common reasons that people see their doctors, and one of the most common conditions for which psychoactive medications are prescribed. Sleep disturbances may be occasional or temporary, but they can become chronic. They may be due to physical causes, psychological causes, or mental illness. Sometimes, however, the person is simply trying to sleep in conditions that make sleeping difficult.

EFFECTS AND DANGERS OF PSYCHOACTIVE MEDICATIONS

The effects of psychoactive medications vary with their chemical composition, the doses in which they are taken, and the sensitivity of the person taking them.

Taking other psychoactive substances in combination with medications can be dangerous, especially since little is known about certain interactions. For example, alcohol can potentiate or cancel the effects of each of the substances taken.

The effects of psychoactive medications vary depending upon the category to which they belong. The main categories of psychoactive medications are as follows:

  1. anxiolytics and sedatives
  2. hypnotics or sleeping pills
  3. antidepressants
  4. antipsychotics
  5. mood stabilizers

1. Anxiolytics and sedatives

Anxiolytics and sedatives are central nervous system depressants. They reduce anxiety and its symptoms (muscle tension, agitation, etc.) while calming and tranquilizing the user. However, not all patients who are experiencing anxiety necessarily need to be treated with these medications.

The anxiolytics and sedatives that are prescribed most often, especially for long-term treatment, belong to the benzodiazepine family. The benzodiazepines preferably used as anxiolytics are alprazolam (Xanax®), bromazepam (Lectopam®), chlordiazepoxide (Apo-Chlordiazepoxide ®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), and oxazepam (Serax®).

These medications can cause short-term memory loss, diminished alertness, diminished reflexes, and sleepiness. These effects make it dangerous to drive a vehicle or to operate machines or equipment that require especially close attention. These substances are also known for the risks of physical and psychological dependence that they entail. They are often taken in massive doses or together with other substances and lead to a form of drug addiction that is hard to overcome.

The other medications that may be used as anxiolytics or sedatives are the barbiturates, buspirone (BuSpar®), chloral hydrate (Chloral Hydrate-Odan®), and zopiclone (Imovane®).

Elles sont aussi fréquemment utilisées de façon abusive, à doses massives ou en association avec d’autres produits.

2. Hypnotics or sleeping pills


These are central nervous system depressants. which are used to induce or maintain sleep. They can therefore make people less alert when awake. The hypnotics that are prescribed most often, especially for long-term treatment, belong to the benzodiazepine family.

The benzodiazepines mostly used as hypnotics (sleeping pills) are flurazepam (Dalmane®), nitrazepam (Mogadon®), temazepam (Restoril®), and triazolam (Halcion®). These benzodiazepines have the same properties as the others mentioned before. They are often abused, when people take them in massive doses or together with other substances.

In appropriate doses, the other benzodiazepines previously described as anxiolytics and sedatives can also be used as sleeping pills. Non-benzodiazepine hypnotics include barbiturates, chloral hydrate (Chloral Hydrate-Odan®), zaleplon (Starnoc®), and zopiclone (Imovane®).

3. Antidepressants


Antidepressants are another class of psychoactive medications. Some antidepressants act directly or indirectly on neurotransmitters, in particular serotonin and norepinephrine. Antidepressants are prescribed to treat depression, characterized by a marked lack of interest or pleasure in life, sleep disturbances, agitation or apathy, unexplained sensations of fatigue or loss of energy, excessive feelings of guilt or worthlessness, and a reduced ability to think and concentrate.

On the basis of the mechanisms by which they act, antidepressants are grouped into eight categories. Their representatives include:

  • imipramine (Tofranil®)
  • venlafaxine (Effexor® XR)
  • citalopram (Celexa®), escitalopram (Cipralex®), fluoxetine (Prozac®), fluvoxamine (Luvox®), paroxetine (Paxil®), and sertraline (Zoloft®)
  • mirtazapine (Remeron®, Remeron RD®)
  • bupropion (Wellbutrin® SR, Wellbutrin® XL, Zyban®)
  • phenelzine (Nardil®) and tranylcypromine (Parnate®)
  • moclobemide (Manerix®)
  • selegiline (Gen-Selegiline®)

Antidepressants can have undesirable side effects, including reduced alertness, sleepiness, and excitation.

These medications should be used only for cases of depression diagnosed by a physician and are not generally prescribed for temporary problems.

Antidepressants do not create a significant physical dependence. However, if treatment needs to be stopped, the dosage should be reduced gradually to avoid symptoms such as dizziness, nausea, and sudden recurrence of the depressive symptoms themselves. Ideally, this process should be done under medical supervision.

4. Antipsychotics

Antipsychotics are a class of psychoactive medications that are used mainly to treat psychoses (mental illnesses that affect behaviour), such as schizophrenia.

Treatment for these illnesses is typically longterm, and the patient’s psychological and social care is just as important as any medication prescribed.

As with any other medication, it is not recommended to stop using a prescribed antipsychotic without consulting a physician.

Antipsychotics do not create dependence.

Antipsychotics are grouped into nine categories of chemicals whose main representatives are as follows:

  • chlorpromazine (Largactil®)
  • haloperidol (Haloperidol®)
  • flupenthixol (Fluanxol®)
  • pimozide (Orap®)
  • loxapine (Loxapine®)
  • clozapine (Clozaril®)
  • olanzapine ( Zyprexa®)
  • quetiapine (Seroquel®)
  • risperidone (Risperdal®)

5. Mood stabilizers

Mood stabilizers are medications that are used to treat bipolar affective disorder, formerly known as manic-depressive psychosis. These medications facilitate the regulation of mood in people who are experiencing the alternating manic and depressive phases of this disease.

The prototype of this class of medications is lithium (Carbolith®, Duralith®, Lithane®).

Lithium is of limited effectiveness in some patients and displays significant toxicity. Two good alternatives to lithium are valproic acid (Depakene®, Epiject I.V. ®) and carbomazepine (Tegretol®).

Lastly, quetiapine (Seroquel®) and risperidone (Risperdal®) are used specifically to treat manic episodes of bipolar disorder and olanzapine (Zyprexe®) to treat manic or mixed episodes in bipolar affective disorder.
Right and wrong ways of using psychoactive medications that are meant for therapeutic purposes and should never be taken lightly

When prescribed and used carefully, psychoactive medications can reduce or eliminate psychological suffering

The effects of psychoactive medications vary with their chemical composition, the doses in which they are taken, and the sensitivity of the person taking them

These medications can cause short-term memory loss, diminished alertness, diminished reflexes, and sleepiness

Hypnotics are often abused, when people take them in massive doses or together with other substances

Antidepressants should be used only for cases of depression diagnosed by a physician

As with any other medication, it is not recommended to stop using a prescribed antipsychotic without consulting a physician

Mood stabilizers are medications that are used to treat bipolar affective disorder

A FEW TIPS

  • Psychoactive medications should not be taken again without a new prescription from the doctor, and are not appropriate for others to use: a prescription is specific to the patient to whom the drug has been prescribed.
  • A medical consultation does not necessarily end with a prescription for medications such as anxiolytics, sedatives or hypnotics.
  • An anxiety state is not automatically treated with anxiolytics, sedatives or hypnotics. The doctor knows whether this state is an illness or a temporary problem and will recommend appropriate solutions accordingly.
  • Patients must faithfully follow a doctor’s prescription and avoid using alcohol or other drugs while being treated with psychoactive medications.
  • Taking alcohol or other central nervous system depressants while being treated with benzodiazepines entails certain risks, because this combination can potentiate the depressant effects, thus causing mental and physical deterioration.

PSYCHOACTIVE MEDICATIONS AND DEPENDENCE

Though some psychoactive medications do not cause any physical dependence, all of them can create a psychological dependence in some individuals. Benzodiazepines, in particular, can cause both physical and psychological dependence.

When people take more of a psychoactive medication than their doctor prescribed, this may mean they are abusing their prescription drugs which is called prescription drug abuse. It can take various forms:

Classic prescription drug abuse

This concerns all types of medications, the combination of different medications not being rare.

The user’s life is focused on taking the drug. An alternating pattern going from periods of controllled use to periods of excessive use is observed. When trying to understand the reason for this pattern, it is often difficult to distinguish between trying to forget, sleep, relieving anxiety, finding a state of well-being or the need to escape to another psychological state.

Insidious prescription drug abuse

Medications are generally taken following a doctor’s prescription and, in light of persisting symptoms or the occurrence of new symptoms, the patient use more and more medication. The person is always searching for a substance that will provide a cure, and the doctor, while more or less understanding the need for such requests, prescribes new drugs or increases the dose.

The situation is exacerbated when the patient makes his or her own mixture, combining different prescriptions from one or more doctors, for the purpose of self-medication.

In this case, the patient, hooked on the prescriptions, regularly takes large quantities of all kinds of medications. It thus becomes difficult to clearly distinguish the role of the illness from the physical and psychological dependency, the fear of seeing the symptoms reappear and the desire to feel the effect of the medication.
It is often difficult to distinguish between trying to forget, sleep, relieving anxiety, finding a state of well-being or the need to escape to another psychological state

The situation is exacerbated when the patient makes his or her own mixture, combining different prescriptions from one or more doctors, for the purpose of selfmedication

HISTORY

MOST PSYCHOACTIVE MEDICATIONS HAVE BEEN DERIVED FROM PLANTS

The pharmacopoeia (a collection of medications) of the Mesopotamians already consisted of nearly 250 different species of plants to treat various conditions. With the Renaissance, came various medicinal tropical plants. But it was not until the early 19th century that chemistry became advanced enough for scientists to begin isolating the active ingredients from plants and plant materials.

The use of drugs derived from animals is less common but dates back just as far. Poisons and venoms obtained from various species of animals were used.

Substances of mineral origin have also been used for medicinal purposes since the dawn of history. The ancient Egyptians used calcium carbonate to treat acidity in the digestive tract, and the Romans used iron oxide to staunch bleeding. Nowadays, some minerals are used to treat dietary deficiencies of elements such as iron, copper, manganese, iodine, calcium, magnesium, etc., while the element lithium is used to treat bipolar affective disorder.

PSYCHOACTIVE MEDICATIONS
       SOME RECENT STATISTICS FOR CANADA

  • Provincial surveys 13, 18, 20, 21, 22 on the use of drugs among students revealed usage ratios for non-medical tranquilizers or benzodiazepines of 2% in Ontario, 4% in Prince Edward Island and 5% in Nova Scotia and New Brunswick. In British Columbia, 9% of students reported having taken prescription drugs without a doctor’s prescription.
  • Although they are not necessarily being treated for this problem, patients admitted in alcohol and drug treatment and rehabilitation centres sometimes report having taken non-medical prescription drugs such as benzodiazepines: 13% in Alberta (2002-2003) and 18% in Manitoba (2003- 2004)23.

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WHAT DOES THE LAW SAY?

  • Most sedatives and hypnotics, antidepressants, antipsychotics, and mood stabilizers are not listed in the schedules of the Canadian Controlled Drugs and Substances Act. These medications require a prescription, and are part of Schedule F of the Food and Drug Regulations.
  • Benzodiazepines are listed in Schedule IV of the Controlled Drugs and Substances Act.
  • Unless authorized, trafficking, possession for the purpose of trafficking, production, importing and exporting of benzodiazepines, and possession for the purpose of exporting are illegal.