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Human Diversity and Drug Treatment

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Human Diversity and Drug Treatment
527
Biological Treatments
in some patients (Baldessarini & Tondo, 2000; Geddes et al., 2004). Without lithium,
the typical patient with bipolar disorder has a manic episode about every fourteen
months and a depressive episode about every seventeen months; with lithium, attacks
of mania occur as rarely as every nine years (Geddes et al., 2004). The lithium dosage
must be exact and carefully controlled, however, because taking too much can cause
vomiting, nausea, tremor, fatigue, slurred speech, and, with severe overdoses, coma or
death. Combining lithium with other mood stabilizing drugs, such as carbamazepine,
has shown enhanced benefits but also more adverse side effects (Baethge et al., 2005).
In recent years, anticonvulsant drugs such as divalproex and lamotrigine (Epival/
Depakote; Lamictal) have been used as an alternative to lithium in treating mania
(e.g., Goodwin, Bowden, & Calabrese, 2004; McElroy, Zarate, & Cookson, 2004).
Compared with lithium, these drugs cause fewer side effects, are less dangerous at
higher doses, and are easier to regulate (Bowden et al., 2000; Bowden et al., 2003;
Hirschfeld et al., 1999). However, their long-term benefits in reducing mania and the
risk of suicide are not as well established, so lithium is still considered the treatment
of choice against which others are measured (Baldessarini et al., 2002; Carney &
Goodwin, 2005).
During the 1950s, a new class of drugs called tranquilizers was shown
to reduce mental and physical tension and the symptoms of anxiety. The first of these
drugs, meprobamate (Miltown or Equanil), acts somewhat like barbiturate sleeping
pills, meaning that overdoses can cause sleep and even death. Because they do not pose
this danger, the benzodiazepines—particularly chlordiazepoxide (Librium) and diazepam
(Valium)—became the worldwide drug treatment of choice for anxiety (Blackwell,
1973). Today, these and other anti-anxiety drugs, now called anxiolytics (pronounced
“ang-zee-oh-LIT-ix”), continue to be the most widely prescribed and used of all legal
drugs (Stevens & Pollack, 2005). Anxiolytics have an immediate calming effect and are
quite useful in treating the symptoms of generalized anxiety and posttraumatic stress
disorder.
One of the benzodiazepines, alprazolam (Xanax), has become especially popular
for the treatment of panic disorder and agoraphobia (Verster & Volkerts, 2004). But
benzodiazepines can have bothersome side effects, such as sleepiness, lightheadedness,
and impaired memory and thinking. Combining these drugs with alcohol can be fatal,
and continued use can lead to tolerance and physical dependence (Chouinard, 2004).
Further, suddenly discontinuing benzodiazepines after heavy or long-term use can
cause severe withdrawal symptoms, including seizures and anxiety attacks (Rickels
et al., 1993).
The anxiolytic called buspirone (BuSpar) provides an alternative anxiety treatment
that eliminates some of these problems (Lickey & Gordon, 1991; Stahl, 2002; Wagner
et al., 2003). Its effects do not occur for days or weeks after treatment begins, but buspirone can ultimately equal diazepam in reducing generalized anxiety (Gorman, 2003;
Rickels & Rynn, 2002; U.S. Surgeon General, 1999). Further, it does not seem to promote dependence, it causes less interference with thinking, and it does not interact dangerously with alcohol.
Because depression often accompanies anxiety, antidepressant drugs such as fluoxetine (Prozac), paroxetine (Paxil), clomipramine (Anafranil), fluvoxamine (Luvox), and
sertraline (Zoloft) are also used in treating anxiety-related problems such as panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder
(e.g., Gorman, 2003; Julien, 2005; Nutt, 2005b; Rickels et al., 2003). Table 13.5 lists the
effects and side effects of some of the psychoactive drugs we have described.
Anxiolytics
Human Diversity and Drug Treatment
anxiolytics
Drugs that reduce tension
and symptoms of anxiety.
Drug treatments are designed to benefit everyone in the same way, but it turns out that
the same psychoactive drug dose can have significantly different effects in each sex, and
in people from various ethnic groups (e.g., Esel et al., 2005; Seeman, 2004). For example, compared with Asians, Caucasians must take significantly higher doses of the
528
TA B L E
Chapter 13 Treatment of Psychological Disorders
13.5
A Sampling of Psychoactive Drugs Used for Treating Psychological Disorders
Psychoactive drugs have been successful in dramatically reducing the symptoms of many psychological disorders. Critics point out that drugs can
have troublesome side effects, however, and they may create dependence, especially after years of use (e.g., Breggin, 1997). They note, too, that
drugs do not “cure” mental disorders (National Institute of Mental Health, 1995), that their effects are not always strong (Kirsch et al., 2002), and
that temporary symptom relief may make some patients less likely to seek a permanent solution to their psychological problems.
For Schizophrenia: Neuroleptics (Antipsychotics)
Chemical Name
Chlorpromazine
Haloperidol
Clozapine
Trade Name
Thorazine
Haldol
Clozaril
Risperidone
Ziprasidone
Aripiprazole
Risperdal
Geodon
Abilify
Effects and Side Effects
Reduce hallucinations, delusions, incoherence, jumbled thought processes;
cause movement-disorder side effects, including tardive dyskinesia
Reduces psychotic symptoms; causes no movement disorders, but raises risk of
serious blood disease
Reduces positive and negative psychotic symptoms without risk of blood disease
Reduces positive and negative psychotic symptoms without causing weight gain
Reduces positive and negative psychotic symptoms without weight gain and with
few side effects
For Mood Disorders: Antidepressants and Mood Elevators
Tricyclics
Imipramine
Tofranil
Amitriptyline
Elavil, Amitid
Other Antidepressants
Fluoxetine
Clomipramine
Fluvoxamine
Sertraline
Escitalopram
Prozac
Anafranil
Luvox
Zoloft
Lexapro
Have antidepressant, antipanic, and anti-obsessive action
Carbolith,
Lithizine
Depakote
Lamictal
Calms mania; reduces mood swings of bipolar disorder; overdose harmful,
potentially deadly
Is effective against mania, with fewer side effects
Is effective in delaying relapse in bipolar disorder; most benefits associated with
depression
Other Drugs
Lithium carbonate
Divalproex
Lamotrigine
Act as antidepressants, but also have antipanic action; cause sleepiness and other
moderate side effects; potentially dangerous if taken with alcohol
For Anxiety Disorders: Anxiolytics
Benzodiazepines
Chlordiazepoxide
Diazepam
Alprazolam
Librium
Valium
Xanax
Clonazepam
Klonopin
Other Anti-anxiety Agents
Buspirone
BuSpar
Act as potent anxiolytics for generalized anxiety, panic, stress; extended use may
cause physical dependence and withdrawal syndrome if abruptly discontinued
Also has antidepressant effects; often used in agoraphobia (has high dependence
potential)
Often used in combination with other anxiolytics for panic disorder
Has slow-acting anti-anxiety action; no known dependence problems
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