Psychopharmacology, Human Behavioral

Therapeutic Drugs

The most widespread therapeutic drugs include those used to treat anxiety disorders, depression, psychotic illnesses, and attention deficit/hyperactivity disorder (AD/HD). Agents used in treating these disorders can interact with psychosocial treatments. A psychotropic medication provides symptomatic relief that may increase the effectiveness of psychosocial treatment. For example, a patient suffering from an acute psychiatric illness may be withdrawn, apathetic, and unable to interact with the counselor. Medications ameliorate these symptoms so that the patient can then develop the skills and abilities necessary for a functional recovery. On the other hand, under some circumstances psychotherapeutic agents may hinder the delivery and application of psychosocial treatment, as in the case of drugs with severe sedative and amnesia-causing actions. Therefore, counselors consider the side effects of common psychotherapeutic drugs, and the possibility that these effects may present further psychological problems that must be addressed.

Anxiolytic (antianxiety) agents are among the most frequently prescribed psychiatric medications. Benzodiazepines, such as diazepam (Valium) and alpra-zolam (Xanax), are widely used for the treatment of generalized anxiety and panic disorders. At low doses, these drugs produce calming effects and mild sedation. Therefore, they are prescribed to treat both daytime anxiety and insomnia. At high doses, these drugs prolong sleep and, in the presence of other central nervous system (CNS) depressants, they can cause life-threatening respiratory depression (slowed breathing). The main side effects of these drugs are drowsiness, confusion, and impaired coordination. Benzodiazepines also have strong memory-impairing effects.

Although these drugs are effective for a variety of anxiety-related problems, there is some concern regarding their long-term use and potential for dependence. Some patients report that physical and psychological withdrawal symptoms make it difficult to stop taking benzodiazepines. Patients may also experience short-term rebound anxiety after stopping their medication. The risk of dependence on benzodiazepines is greater in individuals with severe mental illness or co-occurring substance-use disorders. Nevertheless, the long-term risk-benefit ratio of benzodiazepines in other patient populations remains controversial. Newer nonbenzodiazepine anxiolytic agents, such as sertra-line (Zoloft), appear to have a better risk-benefit ratio.

Antidepressants are also widely prescribed, and may be used with psychosocial treatment. Currently, the first line of treatment for major depression are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), sertraline (Zoloft), and esci-talopram (Lexapro). These drugs may also be used to treat anxiety disorders such as panic disorders and obsessive-compulsive disorder.

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