The term psychotropic drugs refers to medications that have an effect on the brain as their main action. They are therefore used to treat mental illnesses. Treatment with these drugs is also known as psychopharmacotherapy.
Here you will find further information as well as selected psychotropic drug specialists and centers.
The most important groups of psychotropic drugs are
Antidepressants were previously also known as thymoleptics. They are psychotropic drugs that have a mood-enhancing effect and, depending on the medication, increase motivation or reduce fatigue.
Antidepressants are not addictive!
They are used to treat all types of depression . For mild and moderate depression, psychotherapy alone may be sufficient. However, psychotherapies do not work as quickly.
Herbal medicines such as St. John's wort should only be used for mild depression. Drug therapy with psychotropic drugs is absolutely essential for severe depression!
It can take up to six weeks for a response to antidepressant medication. The first mood-lifting effects can usually be expected after 7 to 10 days at the earliest. In around 70 percent of patients, the depression disappears after 3 to 6 weeks of treatment.
Attempts to switch to other drugs should only be considered after 4 to 6 weeks of unsuccessful therapy at a sufficiently high dosage.
Despite intensive research, the mechanisms of action of antidepressants are not yet precisely known. All antidepressants influence the neurotransmitters serotonin and noradrenaline in particular. This leads to a change in regulatory circuits in the brain, which results in the elimination of depression.
Antidepressants help with depression or anxiety disorders, for example © Patrick Daxenbichler | AdobeStock
The first antidepressant substance was imipramine, which was discovered by chance in 1957. It is still on the market today under the name Tofranil®. Around the same time, the antidepressant properties of the monoamine oxidase inhibitor iproniazine were also discovered. This active ingredient is used in the treatment of tuberculosis. Based on these substances, further tricyclic and tetracyclic antidepressants and monoamine oxidase inhibitors were subsequently developed.
In the 1980s, selective serotonin reuptake inhibitors (SSRIs) were developed. With the same effectiveness, they are generally better tolerated than tricyclic antidepressants. Tricyclic antidepressants cause a number of side effects by binding to various other receptors.
This was later followed by further new developments such as
Antidepressants can also be divided into the following groups, depending on their more drive-enhancing or fatigue-reducing effect profile:
In addition to the desired antidepressant effects, antidepressants also have side effects of varying severity. They occur particularly in the first two weeks of treatment and then often disappear.
As there is often no improvement in mood during this time, patience is required! Do not stop taking the medication, even if you do not yet feel any positive effects.
The side effects of the individual medications can be derived directly from the influence on messenger substances and their binding sites:
Due to the side effects, check-ups are required at regular intervals during antidepressant therapy. These include
Your doctor will provide you with detailed information about the therapy and check-ups.
Mood stabilizers are used to stabilize depressive and/or manic mood swings in the context of affective and schizoaffective disorders. They are also known as phase prophylactics and are intended to prevent relapses.
With the exception of lamotrigine, mood stabilizers are also used for the acute treatment of certain forms of bipolar disorder.
The following mood stabilizers are currently in clinical use:
Lithium (e.g. Quilonum® or Hypnorex®)
Lithium is a salt that has been used successfully for decades. It is dosed in such a way that the blood level is usually between 0.6 and 0.8 mmol/l. Regular blood level checks are necessary because
The main side effects include
Various drugs taken at the same time can lead to an increase in blood levels and even intoxication. Patients should therefore inform any doctor that they are taking lithium!
The acute effect of lithium in the treatment of mania often sets in within a few days. The relapse-preventing effect often only becomes apparent after months.
Valproic acid (e.g. Ergenyl® or Orfiril®)
Valproic acid was originally used to treat epilepsy, but is also effective in bipolar disorders. It is dosed in such a way that blood levels of 50 to 125 µg/ml are achieved.
Overall, valproic acid is well tolerated. The most important side effects are
Carbamazepine (e.g. Tegretal® or Timonil®)
Carbamazepine is also used to treat epilepsy. It is used if lithium does not work or the patient cannot tolerate it. This medication is also adjusted according to blood levels (6 to 12µg/ml).
The most important (usually temporary) side effects are
Lamotrigine (e.g. Elmendos®)
Lamotrigine must be dosed very slowly to avoid dangerous skin and mucous membrane reactions. The patient receives 25 mg per day for the first two weeks, then 50 mg for a further two weeks. This is followed by an increase of 50 to 100 mg every two weeks.
The dose may need to be adjusted if the patient is taking certain other medications.
Neuroleptics have a dampening effect on
These psychotropic drugs are therefore also known as antipsychotics. Strong neuroleptics are mainly used in the treatment of schizophrenia and other psychotic disorders. They lead to a good improvement in psychosis in 75 percent of cases.
Weak, fatigue-reducing neuroleptics are also used for
sleep disorders.
The mechanism of action of neuroleptics is not yet completely clear. They block binding sites (receptors) of brain messengers such as dopamine. This brings with it a whole series of subsequent reactions, which then lead to the antipsychotic effect.
Neuroleptics are not addictive!
A distinction is made between strong and weak neuroleptics. The group of strong neuroleptics is divided into classic and atypical neuroleptics.
Strong neuroleptics
The classic neuroleptics have been on the market for decades and are safe to use. They have good antipsychotic efficacy. They can be administered both as tablets and via the muscles. However, they often have motor side effects.
The atypical neuroleptics include
They have little or no motor side effects and are therefore referred to as "atypical". They are usually better tolerated than the classic neuroleptics. This is why they are increasingly being used today for the initial treatment of acute schizophrenia.
There are essentially no differences in efficacy between the individual substances. The choice of medication is therefore based on criteria such as efficacy in previous treatment or side effect profile.
Only the atypical neuroleptic clozapine (Leponex®) has been shown to have superior efficacy in schizophrenia that does not respond to other neuroleptics.
Neuroleptics should be administered in sufficient doses for at least 4 to 6 weeks. If there is no effect, only then is it possible to switch to another preparation.
Weak neuroleptics
Weak neuroleptics are used to treat restlessness and sleep disorders. They are often combined with strong neuroleptics to treat schizophrenia.
Examples of such substances are Eunerpan®, Dipiperon® and Atosil®.
The most important side effects of classic neuroleptics affect motor function. These include
However, atypical neuroleptics also have side effects. However, motor side effects are much lower or do not occur at all. The most important side effects include
Regular medical check-ups are therefore necessary. In rare cases, Leponex® can lead to a sharp drop in white blood cell counts. A blood count must therefore be carried out in the first 18 weeks.
The weak neuroleptics are generally very well tolerated.
Anxiolytics are psychotropic drugs that relieve anxiety and tension. Hypnotics (sleeping pills), on the other hand, are all psychotropic drugs that induce sleep. In the past, these psychotropic drugs were also referred to as sedatives or tranquilizers.
Benzodiazepines are the most important group of anxiolytics and hypnotics. They are problematic to use mainly because of their high potential for abuse and dependence.
The most important groups of drugs are
These include, for example
Their effect is
They also have a muscle relaxant effect. Musaril® can therefore also be used to treat severe muscle tension and spasticity.
Due to their effectiveness against seizures, they are also used as antiepileptic drugs in neurology.
In psychiatry and psychotherapy, benzodiazepines are used for the acute treatment of
used.
Due to the high risk of developing dependency, these medications may only be used for a short period of time. The standard duration of treatment is a maximum of 6 weeks.
However, they are still prescribed quite uncritically, even if other therapies show good efficacy. Other side effects include concentration disorders and slower reaction times, which is why the ability to drive is impaired!
These drugs used purely as sleeping pills include
Overall, these medications are less likely to lead to the development of dependence. They are generally very well tolerated, but should only ever be taken temporarily.
ß-blockers are mainly used for anxiety that is associated
There is no risk of dependence developing. Antidepressants (especially selective serotonin reuptake inhibitors) are also used to treat anxiety disorders. In the treatment of mild sleep disorders , behavioral changes and herbal preparations (hops and valerian preparations) are often sufficient.
Commercially available hypnotics also include certain antihistamines such as
Their sleep-inducing effect is relatively low compared to the actual hypnotics. They are therefore only suitable for mild sleep disorders.
Chloral hydrate (Chloraldurat®) can also be used as a sleep-inducing agent. The sleep-promoting effect starts at a dose of 0.5 to 2 g and lasts for about 5 hours. After regular intake, the effect is soon lost. Patients with gastrointestinal, liver or heart disease should not take chloral hydrate. Dependency may develop.
Anti-dementia drugs are various types of psychotropic drugs that lead to an improvement in
in the context of organic mental disorders, especially dementia.
A distinction is made between three groups of substances:
The acetylcholinesterase inhibitors include
which are used to treat mild and moderate Alzheimer 's dementia. The main side effects at the beginning are usually only
occur. Occasionally there may be a slowing of the heartbeat with a risk of falling. This risk exists in particular with the simultaneous administration of beta-blockers. Acetylcholinesterase inhibitors should only be used with particular caution in the case of
should be used.
Memantine (e.g. Ebixa®) is one of the glutamate modulators. It is used for moderate and severe Alzheimer's dementia and other dementias. It is relatively well tolerated. Rare, but possible, are
Nootropics include various substances such as
which have hardly any side effects. The efficacy of these substances in the treatment of dementia has not been reliably demonstrated.
Among the psychotropic drugs used to treat alcohol dependence, a distinction is made between
In about 50 percent of cases of alcohol withdrawal, drug treatment with Distraneurin® is necessary. This medication may only be used during detoxification treatment in a specialist clinic.
Campral® is available on the market as a relapse-preventing medication that must be taken daily. It reduces the craving for alcohol. It should always be administered in conjunction with psychotherapeutic treatment.
