Editing Psychiatric medication

{{Short description|Medication used to treat mental disorders}}
{{See also|List of psychotropic medications|List of psychiatric medications by condition treated}}

A '''psychiatric''' or '''psychotropic medication''' is a [[psychoactive drug]] taken to exert an effect on the chemical makeup of the [[brain]] and nervous system. Thus, these medications are used to treat [[Mental disorder|mental illnesses]]. These medications are typically made of [[Chemical synthesis|synthetic]] [[chemical compound]]s and are usually prescribed in [[psychiatry|psychiatric]] settings, potentially [[Involuntary treatment|involuntarily]] during [[Involuntary commitment|commitment]]. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care.<ref>{{cite book|last1=Rose|first1=Nikolas|title=Historical changes in mental health practice|publisher=Oxford University Press|isbn=9780199565498|doi=10.1093/med/9780199565498.003.0012|chapter=Chapter 2 Historical changes in mental health practice|year=2010}}</ref><ref>{{cite book|last1=Grob|first1=Gerald N.|title=Mental health policy in modern America|publisher=Oxford University Press|isbn=9780199565498|doi=10.1093/med/9780199565498.003.0014|chapter=Chapter 3 Mental health policy in modern America|year=2010}}</ref><ref>{{cite book|last1=Becker|first1=Thomas|last2=Koesters|first2=Markus|title=Psychiatric outpatient clinics|publisher=Oxford University Press|isbn=9780199565498|doi=10.1093/med/9780199565498.003.0086|chapter=Chapter 16 Psychiatric outpatient clinics|year=2010}}</ref><ref>{{cite book|last1=Shaywitz|first1=Jonathan|last2=Marder|first2=Stephen|title=Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting|publisher=Oxford University Press|isbn=9780199565498|doi=10.1093/med/9780199565498.003.0109|chapter=Chapter 22 Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting|year=2010}}</ref> The [[relapse|recidivism]] or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the [[relapse]]s are under research.<ref>{{cite journal | doi = 10.1186/1471-244X-14-161 | pmid=24888262 | pmc=4059735 | volume=14 | pages=161 | title=The frequency of rehospitalization and associated factors in Colombian psychiatric patients: a cohort study | journal=BMC Psychiatry| year=2014 | last1=Jaramillo-Gonzalez | first1=Luis Eduardo | last2=Sanchez-Pedraza | first2=Ricardo | last3=Herazo | first3=Maria Isabel | doi-access=free }}</ref><ref>{{cite journal | pmc= 2802091 | pmid=20017226 | volume=50 | issue=6 | title=Revolving-door patients in a public psychiatric hospital in Israel: cross sectional study |vauthors=Oyffe I, Kurs R, Gelkopf M, Melamed Y, Bleich A | journal=Croat Med J | pages=575–82| year=2009 | doi=10.3325/cmj.2009.50.575 }}</ref><ref>{{cite journal | pmc= 3792950 | pmid=24116059 | doi=10.1371/journal.pone.0075612 | volume=8 | issue=10 | title=The revolving door phenomenon revisited: time to readmission in 17'145 [corrected] patients with 37'697 hospitalisations at a German psychiatric hospital |vauthors=Frick U, Frick H, Langguth B, Landgrebe M, Hübner-Liebermann B, Hajak G | journal=PLOS ONE | page=e75612| year=2013 | doi-access=free }}</ref><ref>[http://psychrights.org/research/Digest/Chronicity/contraindicated.pdf "Are There Schizophrenics for Whom Drugs May be Unnecessary or Contraindicated?". Authors Rappaport M, Hopkins HK, Hall, Belleza and Silverman. International Pharmacopsychiatry (Neuropsychobiology) 13:100–111 (1978)]</ref>

A 2022 [[umbrella review]] of over 100 [[meta-analysis|meta-analyses]] found that both psychotherapies and pharmacotherapies for adult mental disorders generally yield small effect sizes, suggesting current treatment research may have reached a ceiling and needs a paradigm shift.<ref>{{cite journal |last1=Leichsenring |first1=Falk |last2=Steinert |first2=Christiane |last3=Rabung |first3=Sven |last4=Ioannidis |first4=John P. A. |author-link4=John Ioannidis |date=February 2022 |title=The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses |journal=[[World Psychiatry]] |volume=21 |issue=1 |pages=133–145 |pmid=35015359 |pmc=8751557 |doi=10.1002/wps.20941 |doi-access=free}}</ref>

== History ==
Several significant psychiatric drugs were developed in the mid-20th century. In 1948, [[Lithium (medication)|lithium]] was first used as a psychiatric medicine. One of the most important discoveries was [[chlorpromazine]], an [[antipsychotic]] that was first given to a patient in 1952. In the same decade, [[Julius Axelrod]] carried out research into the interaction of neurotransmitters, which provided a foundation for the development of further drugs.<ref>{{cite web|title=The Julius Axelrod Papers|url=http://profiles.nlm.nih.gov/HH/|publisher=National Library of Medicine|access-date=6 May 2013}}</ref>  The popularity of these drugs have increased significantly since then, with millions prescribed annually.<ref>{{cite web|last1=Martin|first1=Emily|title=Resources on the History of Psychiatry|url=https://www.nlm.nih.gov/hmd/pdf/historypsychiatry.pdf|publisher=National Library of Medicine|access-date=6 May 2013|last2=Rhodes|first2=Lorna A.}}</ref>

The introduction of these drugs brought profound changes to the treatment of mental illness. It meant that more patients could be treated without the need for confinement in a [[psychiatric hospital]]. It was one of the key reasons why many countries moved towards [[deinstitutionalization]], closing many of these hospitals so that patients could be treated at home, in general hospitals and smaller facilities.<ref name=Stroman>{{cite book|last=Stroman|first=Duane|year=2003|title=The Disability Rights Movement: From Deinstitutionalization to Self-determination|publisher=University Press of America}}</ref><ref name=Eisenberg>{{cite journal|last1=Eisenberg|first1=Leon|author-link=Leon Eisenberg|last2=Guttmacher|first2=Laurence|title=Were we all asleep at the switch? A personal reminiscence of psychiatry from 1940 to 2010|journal=[[Acta Psychiatrica Scandinavica]]|date=August 2010|volume=122|issue=2|pages=89–102|doi=10.1111/j.1600-0447.2010.01544.x|pmid=20618173|doi-access=free}}</ref> Use of physical restraints such as [[straitjacket]]s also declined.

As of 2013, the 10 most prescribed psychiatric drugs by number of prescriptions were [[alprazolam]], [[sertraline]], [[citalopram]], [[fluoxetine]], [[lorazepam]], [[trazodone]], [[escitalopram]], [[duloxetine]], [[bupropion|bupropion XL]], and [[venlafaxine|venlafaxine XR]].<ref>[http://psychcentral.com/lib/top-25-psychiatric-medication-prescriptions-for-2013/ Top 25 Psychiatric Medication Prescriptions for 2013] Author John M. Grohol, Psy.D..Psych Central.</ref>

== Administration ==
Psychiatric medications are [[prescription medication]]s, requiring a prescription from a [[physician]], such as a [[psychiatrist]], or a psychiatric [[nurse practitioner]], PMHNP, before they can be obtained. Some [[U.S. states]] and [[U.S. Territories|territories]], following the creation of the [[prescriptive authority for psychologists movement]], have granted prescriptive privileges to [[clinical psychologists]] who have undergone additional specialised education and training in [[medical psychology]].<ref name=Bridget>{{cite web
 | last = Murray
 | first = Bridget
 | title = A Brief History of RxP
 | publisher = APA Monitor
 | date = October 2003
 | url = http://www.apa.org/monitor/oct03/rxp.html
 | access-date = 11 April 2007 }}
</ref> In addition to the familiar dosage in pill form, psychiatric medications are evolving into more novel methods of drug delivery. New technologies include [[transdermal]], [[transmucosal]], [[inhalation]], [[suppository]] or [[depot injection]] supplements.<ref>{{cite web|last=DeVane|first=C. Lindsay|title=New Methods for the Administration of Psychiatric Medicine|url=http://www.medscape.org/viewarticle/550958|website=Medscape|access-date=6 May 2013}}</ref><ref>{{Cite journal|last1=Brissos|first1=Sofia|last2=Veguilla|first2=Miguel Ruiz|last3=Taylor|first3=David|last4=Balanzá-Martinez|first4=Vicent|date=2014|title=The role of long-acting injectable antipsychotics in schizophrenia: a critical appraisal|journal=Therapeutic Advances in Psychopharmacology|volume=4|issue=5|pages=198–219|doi=10.1177/2045125314540297|issn=2045-1253|pmc=4212490|pmid=25360245}}</ref>

== Research ==
{{Main|Psychopharmacology}}
Psychopharmacology studies a wide range of substances with various types of psychoactive properties. The professional and commercial fields of [[pharmacology]] and psychopharmacology do not typically focus on [[psychedelic drug|psychedelic]] or [[Recreational drug use|recreational drugs]], and so the majority of studies are conducted on psychiatric medication. While studies are conducted on all psychoactive drugs by both fields, psychopharmacology focuses on psychoactive and chemical interactions within the brain. Physicians who research psychiatric medications are [[psychopharmacologist]]s, specialists in the field of psychopharmacology.

A 2022 [[umbrella review]] of over 100 [[meta-analysis|meta-analyses]] found that both psychotherapies and pharmacotherapies for adult mental disorders generally yield small effect sizes, suggesting current treatment research may have reached a ceiling and needs a paradigm shift.<ref>{{cite journal |last1=Leichsenring |first1=Falk |last2=Steinert |first2=Christiane |last3=Rabung |first3=Sven |last4=Ioannidis |first4=John P. A. |author-link4=John Ioannidis |date=February 2022 |title=The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses |journal=[[World Psychiatry]] |volume=21 |issue=1 |pages=133–145 |pmid=35015359 |pmc=8751557 |doi=10.1002/wps.20941 |doi-access=free}}</ref>

== Adverse and withdrawal effects ==

Psychiatric disorders, including depression, psychosis, and bipolar disorder, are common and gaining more acceptance in the United States. The most commonly used classes of medications for these disorders are antidepressants, antipsychotics, and lithium. Unfortunately, these medications are associated with significant neurotoxicities.

Psychiatric medications carry risk for neurotoxic [[adverse effect]]s. The occurrence of neurotoxic effects can potentially reduce [[Compliance (medicine)|drug compliance]]. Some adverse effects can be [[symptomatic treatment|treated symptomatically]]  by using adjunct medications such as [[anticholinergic]]s (antimuscarinics). Some [[rebound effect|rebound]] or [[Drug withdrawal|withdrawal]] adverse effects, such as the possibility of a sudden or severe emergence or re-emergence of [[psychosis]] in antipsychotic withdrawal, may appear when the drugs are discontinued, or discontinued too rapidly.<ref name="Moncrieff">{{cite journal|last=Moncrieff|first=Joanna|date=23 March 2006|title=Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse|journal=Acta Psychiatrica Scandinavica|volume=114|issue=1|pages=3–13|issn=1600-0447|url=http://www3.interscience.wiley.com/journal/118626311/abstract|archive-url=https://archive.today/20130105081330/http://www3.interscience.wiley.com/journal/118626311/abstract|url-status=dead|archive-date=5 January 2013|access-date=3 May 2009|doi=10.1111/j.1600-0447.2006.00787.x|pmid=16774655|s2cid=6267180}}</ref>

===Medicine combinations with clinically untried risks===
While [[clinical trial]]s of psychiatric medications, like other medications, typically test medicines separately, there is a practice in psychiatry (more so than in somatic medicine) to use [[polypharmacy]] in combinations of medicines that have never been tested together in clinical trials (though all medicines involved have passed clinical trials separately). It is argued that this presents a risk of adverse effects, especially [[brain damage]], in real-life mixed medication psychiatry that are not visible in the clinical trials of one medicine at a time (similar to mixed drug abuse causing significantly more damage than the additive effects of brain damages caused by using only one illegal drug). Outside clinical trials, there is evidence for an increase in mortality when psychiatric patients are transferred to polypharmacy with an increased number of medications being mixed.<ref>Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume I: Multiple Medication Use Strategies"</ref><ref>Michael S Ritsner (2013) "Polypharmacy in Psychiatry Practice, Volume II: Use of Polypharmacy in the "Real World""</ref><ref>Otto Benkert, Wolfgang Maier, Karl Rickels (2012) "Methodology of the Evaluation of Psychotropic Drugs"</ref>

==Types==
{{See also|List of psychiatric medications|List of psychiatric medications by condition treated}}
There are five main groups of psychiatric medications.
*[[Antidepressant]]s, which treat disparate disorders such as [[clinical depression]], [[dysthymia]], [[anxiety disorders]], [[eating disorder]]s and [[borderline personality disorder]].<ref>
{{cite journal
 | last = Schatzberg
 | first = A.F.
 | year = 2000
 | title = New indications for antidepressants
 | journal = Journal of Clinical Psychiatry
 | volume = 61
 | issue = 11
 | pages = 9–17
 | pmid = 10926050}}</ref>
*[[Antipsychotic]]s, which treat [[psychotic disorder]]s such as [[schizophrenia]] and [[psychotic]] symptoms occurring in the context of other disorders such as [[mood disorder]]s. They are also used for the treatment of bipolar disorder.
*[[Anxiolytic]]s, which treat [[anxiety disorder]]s, and include [[hypnotic]]s and [[sedative]]s
*[[Mood stabilizer]]s, which treat [[bipolar disorder]] and [[schizoaffective disorder]].
*[[Stimulant]]s, which treat disorders such as [[attention deficit hyperactivity disorder]] and [[narcolepsy]].

===Antidepressants===
{{Main|Antidepressant}}
Antidepressants are drugs used to treat [[clinical depression]], and they are also often used for anxiety and other disorders. Most antidepressants will hinder the breakdown of [[serotonin]], [[norepinephrine]], and/or [[dopamine]]. A commonly used class of antidepressants are called [[selective serotonin reuptake inhibitor]]s (SSRIs), which act on serotonin transporters in the brain to increase levels of serotonin in the [[synaptic cleft]].<ref name="Stahl"/> Another is the [[serotonin-norepinephrine reuptake inhibitors]] (SNRIs), which increase both serotonin and norepinephrine. Antidepressants will often take 3–5 weeks to have a noticeable effect as the regulation of receptors in the brain adapts. There are multiple classes of antidepressants which have different mechanisms of action. Another type of antidepressant is a [[monoamine oxidase inhibitor]] (MAOI), which is thought to block the action of [[monoamine oxidase]], an enzyme that breaks down serotonin and [[norepinephrine]]. MAOIs are not used as first-line treatment due to the risk of [[hypertensive crisis]] related to the consumption of foods containing the amino acid [[tyramine]].<ref name="Stahl"/>

Common antidepressants:
*[[Fluoxetine]] (Prozac), SSRI
*[[Paroxetine]] (Paxil, Seroxat), SSRI
*[[Citalopram]] (Celexa), SSRI
*[[Escitalopram]] (Lexapro), SSRI
*[[Sertraline]] (Zoloft), SSRI
*[[Duloxetine]] (Cymbalta), SNRI
*[[Venlafaxine]] (Effexor), SNRI
*[[Bupropion]] (Wellbutrin), [[Norepinephrine-dopamine reuptake inhibitor|NDRI]]<ref>{{cite journal| author =Stephen M. Stahl, M.D.| title =A Review of the Neuropharmacology of Bupropion, a Dual Norepinephrine and Dopamine Reuptake Inhibitor
| publisher =Journal of Clinical Psychiatry; 6(04) 159-166 2004 PHYSICIANS POSTGRADUATE PRESS, INC| year = 2004 | url = http://www.psychiatrist.com/pcc/pccpdf/v06n04/v06n0403.pdf | access-date =2006-09-02 |display-authors=etal}}</ref>
*[[Mirtazapine]] (Remeron), [[NaSSA]]
*[[Isocarboxazid]] (Marplan), MAOI
*[[Phenelzine]] (Nardil), MAOI
*[[Tranylcypromine]] (Parnate), MAOI
*[[Amitriptyline]] (Elavil), TCA

===Antipsychotics===
{{Main|Antipsychotics}}
Antipsychotics are drugs used to treat various symptoms of psychosis, such as those caused by psychotic disorders or [[schizophrenia]]. [[Atypical antipsychotic]]s are also used as [[mood stabilizers]] in the treatment of [[bipolar disorder]], and they can augment the action of antidepressants in [[major depressive disorder]].<ref name="Stahl">{{cite book|author= Stahl, S. M. | title=Stahl's Essential Psychopharmacology: Neuroscientific basis and practical applications|url= https://archive.org/details/stahlsessentialp00stah |url-access= registration | publisher=Cambridge University Press | year=2008}}</ref>
Antipsychotics are sometimes referred to as neuroleptic drugs and some antipsychotics are branded "major tranquilizers".

There are two categories of antipsychotics: [[typical antipsychotic]]s and [[atypical antipsychotic]]s. Most antipsychotics are available only by prescription.

Common antipsychotics:
{|
|- style="border-spacing: 2px; border: 0px solid white; vertical-align: top;"
|Typical antipsychotics
|Atypical antipsychotics
|- style="vertical-align: top;"
|
*[[Chlorpromazine]] (Thorazine)
*[[Haloperidol]] (Haldol)
*[[Perphenazine]] (Trilafon)
*[[Thioridazine]] (Melleril)
*[[Thiothixene]] (Navane)
*[[Flupenthixol]] (Fluanxol)
*[[Trifluoperazine]] (Stelazine)
*[[Levomepromazine]] (Nozinan)
|
*[[Aripiprazole]] (Abilify)
*[[Clozapine]] (Clozaril)
*[[Lurasidone]] (Latuda)
*[[Olanzapine]] (Zyprexa)
*[[Paliperidone]] (Invega)
*[[Quetiapine]] (Seroquel)
*[[Risperidone]] (Risperdal)
*[[Zotepine]] (Nipolept)
*[[Ziprasidone]] (Geodon)
|}

===Anxiolytics and hypnotics===
{{See also|List of benzodiazepines|benzodiazepines}}

[[Benzodiazepine]]s are effective as hypnotics, anxiolytics, anticonvulsants, myorelaxants and amnesics.<ref name="Ashton 25–40">{{cite journal|last=Ashton|first=Heather|s2cid=46966796|title=Guidelines for the rational use of benzodiazepines. When and what to use|journal=Drugs|date=July 1994|volume=48|issue=1|pages=25–40|doi=10.2165/00003495-199448010-00004|pmid=7525193}}</ref>  Having less proclivity for overdose and toxicity, they have widely supplanted [[barbiturate]]s, although barbiturates (such as [[pentobarbital]]) are still used for [[euthanasia]].<ref>{{Cite web |last=Martin |first=Hannah |date=2020-08-14 |title=Euthanasia referendum: What drugs are used in assisted dying, and how do they work? |url=https://www.stuff.co.nz/national/health/euthanasia-debate/300073069/euthanasia-referendum-what-drugs-are-used-in-assisted-dying-and-how-do-they-work |access-date=2024-04-14 |website=www.stuff.co.nz}}</ref><ref>{{Cite journal |last1=Pepper |first1=Brianne Marlene |last2=Chan |first2=Hedia |last3=Ward |first3=Michael P. |last4=Quain |first4=Anne |date=2023-04-27 |title=Euthanasia of Dogs by Australian Veterinarians: A Survey of Current Practices |journal=Veterinary Sciences |volume=10 |issue=5 |pages=317 |doi=10.3390/vetsci10050317 |doi-access=free |issn=2306-7381 |pmid=37235400|pmc=10224218 }}</ref>

Developed in the 1950s onward, benzodiazepines were originally thought to be non-addictive at therapeutic doses, but are now known to cause [[Drug withdrawal|withdrawal]] symptoms similar to barbiturates and [[alcohol withdrawal syndrome|alcohol]].<ref>{{cite journal |vauthors=MacKinnon GL, Parker WA |title=Benzodiazepine withdrawal syndrome: a literature review and evaluation |journal=Am J Drug Alcohol Abuse |volume=9 |issue=1 |pages=19–33 |year=1982 |pmid=6133446 |doi= 10.3109/00952998209002608}}</ref> Benzodiazepines are generally recommended for short-term use.<ref name="Ashton 25–40"/>

[[Z-drug]]s are a group of drugs with effects generally similar to benzodiazepines, which are used in the treatment of insomnia.

Common benzodiazepines and z-drugs include:
{|
|- style="border-spacing: 10px; border: 0px solid white; vertical-align: top;"
|Benzodiazepines
|Z-drug hypnotics
|- style="vertical-align: top;"
|
*[[Alprazolam]] (Xanax), anxiolytic
*[[Chlordiazepoxide]] (Librium), anxiolytic
*[[Clonazepam]] (Klonopin), anxiolytic
*[[Diazepam]] (Valium), anxiolytic
*[[Lorazepam]] (Ativan), anxiolytic
*[[Nitrazepam]] (Mogadon), hypnotic
*[[Temazepam]] (Restoril), hypnotic
*[[Midazolam]] (Versed), hypnotic
|
*[[Eszopiclone]] (Lunesta)
*[[Zaleplon]] (Sonata)
*[[Zolpidem]] (Ambien, Stilnox)
*[[Zopiclone]] (Imovan)

|}

===Mood stabilizers===
{{Main|Mood stabilizers}}
In 1949, the Australian [[John Cade]] discovered that [[lithium pharmacology|lithium salt]]s could control [[mania]], reducing the frequency and severity of manic episodes. This introduced the now popular drug [[lithium carbonate]] to the mainstream public, as well as being the first mood stabilizer to be approved by the U.S. [[Food & Drug Administration]]. 
Besides lithium, several [[anticonvulsants]] and [[atypical antipsychotic]]s have mood stabilizing activity. The mechanism of action of mood stabilizers is not well understood.

Common non-antipsychotic mood stabilizers include:
*[[Lithium (medication)|Lithium]] (Lithobid, Eskalith), the oldest mood stabilizer
*Anticonvulsants
**[[Carbamazepine]] (Tegretol) and the related compound [[oxcarbazepine]] (Trileptal)
**[[Valproic acid]], and salts (Depakene, Depakote)
**[[Lamotrigine]] (Lamictal)

===Stimulants===
{{Main|Stimulant}}
A stimulant is a drug that stimulates the central nervous system, increasing arousal, attention and endurance. Stimulants are used in psychiatry to treat [[Attention deficit hyperactivity disorder|attention deficit-hyperactivity disorder]]. Because the medications can be addictive, patients with a history of drug abuse are typically monitored closely or treated with a non-stimulant.

Common stimulants:
*[[Methylphenidate]] (Ritalin, Concerta), a [[norepinephrine-dopamine reuptake inhibitor]]
*[[Dexmethylphenidate]] (Focalin), the active dextro-enantiomer of methylphenidate
*[[Serdexmethylphenidate/dexmethylphenidate]] (Azstarys)
*[[Adderall|Mixed amphetamine salts]] (Adderall), a 3:1 mix of dextro/levo-enantiomers of [[amphetamine]]
*[[Dextroamphetamine]] (Dexedrine), the dextro-enantiomer of amphetamine 
*[[Lisdexamfetamine]] (Vyvanse), a [[prodrug]] containing the dextro-enantiomer of amphetamine
*[[Methamphetamine]] (Desoxyn), a potent but infrequently prescribed amphetamine

== Controversies ==
{{Main|Controversies about psychiatry|Political abuse of psychiatry}}
Professionals, such as [[David Rosenhan]], [[Peter Breggin]], [[Paula Caplan]], [[Thomas Szasz]], [[Giorgio Antonucci]] and [[Stuart A. Kirk]], sustain that psychiatry engages "in the systematic medicalization of normality".<ref name="Kirk 2013 p. 185">{{cite book|last=Kirk|first=Stuart|title=Mad science : psychiatric coercion, diagnosis, and drugs|publisher=Transaction Publishers|year=2013|isbn=978-1-4128-4976-0|location=New Brunswick, N.J|page=185|oclc=808769553}}</ref> More recently these concerns have come from insiders who have worked for and promoted the APA (e.g., [[Robert Spitzer (psychiatrist)|Robert Spitzer]], [[Allen Frances]]).<ref name="Kirk2013">{{cite book|last=Kirk|first=Stuart A.|title=Mad Science: Psychiatric Coercion, Diagnosis, and Drugs|publisher=Transaction Publishers|year=2013}}</ref>{{rp|185}}

Scholars such as [[David Cooper (psychiatrist)|Cooper]], [[Michel Foucault|Foucalt]], [[Erving Goffman|Goffman]], [[Gilles Deleuze|Deleuze]] and [[Thomas Szasz|Szasz]] believe that pharmacological "treatment" is only a [[placebo]] effect,<ref>{{Cite book |last=Szasz, Thomas Stephen |title=Ceremonial chemistry : the ritual persecution of drugs, addicts, and pushers |date=2003 |publisher=Syracuse Univ. Press |isbn=0-8156-0768-7 |oclc=834790127}}</ref> and that administration of drugs is just a [[religion]] in disguise and ritualistic chemistry.<ref>{{Cite journal|last=Szasz|first=Thomas S.|date=October 1974|title=The Myth of Psychotherapy|journal=American Journal of Psychotherapy|volume=28|issue=4|pages=517–526|doi=10.1176/appi.psychotherapy.1974.28.4.517|pmid=4429160|issn=0002-9564}}</ref> Other scholars{{Who|date=April 2024}} have argued against psychiatric medication in that significant aspects of mental illness are related to the psyche or environmental factors, but medication works exclusively on a pharmacological basis.

Antipsychotics have been associated with decreases in brain volume over time, which may indicate a neurotoxic effect. However, untreated psychosis has also been associated with decreases in brain volume and treatments have been shown improve cognitive functioning.<ref>{{cite web | url=https://drvolkerbusch.de/kampf-den-vorurteilen-podcast-gehirn-gehoert-folge-15/ | title=Kampf den Vorurteilen - Wie uns Stereotype und Klischees in die Irre führen können | date=21 July 2021 }}</ref><ref>{{Cite journal|title=How do psychiatric drugs work?|first1=Joanna|last1=Moncrieff|first2=David|last2=Cohen|date=May 29, 2009|journal=The BMJ|volume=338|pages=b1963|doi=10.1136/bmj.b1963|pmid=19482870|pmc=3230235}}</ref><ref>{{Cite journal|last1=Ho|first1=Beng-Choon|last2=Andreasen|first2=Nancy C.|last3=Ziebell|first3=Steven|last4=Pierson|first4=Ronald|last5=Magnotta|first5=Vincent|date=February 2011|title=Long-term Antipsychotic Treatment and Brain Volumes|journal=Archives of General Psychiatry|volume=68|issue=2|pages=128–137|doi=10.1001/archgenpsychiatry.2010.199|issn=0003-990X|pmc=3476840|pmid=21300943}}</ref><ref>{{Cite journal|title=Antipsychotics and the Shrinking Brain|url=https://www.psychiatrictimes.com/view/antipsychotics-and-shrinking-brain|access-date=2020-07-25|journal=Psychiatric Times|series=Psychiatric Times Vol 28 No 4 |date=4 May 2011 |volume=28 |issue=4 }}</ref>

==See also==
*[[List of long term side effects of antipsychotics]]
*[[Medication]]
*[[Medicine]]
*[[Psychopharmacology]]

==References==
{{Reflist}}

== External links ==
*[https://web.archive.org/web/20060721082804/http://www.childadvocate.net/childpresentations/child_medication.htm Children and Psychiatric Medication – a multimodal presentation]
*[http://www.psychiatricdrugs.net/ Psychiatric Drugs: Antidepressant, Antipsychotic, Antianxiety, Antimanic Agent, Stimulant Prescription Drugs]

{{Major drug groups}}
{{Chemical classes of psychoactive drugs}}
{{Authority control}}

{{DEFAULTSORT:Psychiatric Medication}}
[[Category:Psychoactive drugs]]
[[Category:Neuropharmacology]]