Psychoactive Effects of Psychiatric Medication

A characteristic and well-recognized property of chemical substances used for recreational purposes is their ability to produce altered states of consciousness and concomitant changes in behavior by virtue of their action on the central nervous system. Drugs prescribed to treat psychiatric disorders, including drugs commonly classified as antidepressants, antipsychotics, anxiolytics, stimulants, and drugs such as lithium and anticonvulsants used to treat bipolar disorder, also modify normal mental processes and behavior, but there has been a widespread tendency to conflate these actions with a presumed effect on underlying disease processes. In this paper, we use the term “psychoactive effects” to refer to the way some substances produce altered cognitive and emotional states, which differ from the normal un-drugged state, and we distinguish these effects from the putative disease-specific effects of prescribed drugs. The distinction matters because, although significant, the consequences of the psychoactive effects of psychiatric medications are not well-recognized.

Just like the various substances that are used recreationally, each type of psychiatric medication induces a distinctive altered mental and physical state, whose characteristics depend largely on the nature of the drug ingested. Numerous studies with human volunteers and countless studies with animals document the range of ways that different psychiatric drugs impact on normal cognition, emotion, and behavior. Although the term “psychoactive” refers particularly to the mental alterations produced by drugs, most of these alterations appear intimately connected to physical or bodily effects, with many “mental” effects having concomitant physical manifestations, together producing a “global” drug effect. Sedation, for example, is both a mental and physical experience, and arousal, like that produced by stimulant drugs, has mental and physical aspects. It is likely that no psychoactive drug produces only mental effects.

Some psychiatric medications produce pleasurable psychoactive effects, or euphoria, and have consequently become drugs that some people use recreationally and sometimes excessively (leading to their designation as possessing “abuse potential”). This has been the fate of stimulants like amphetamine, introduced as a treatment for depressive neurosis in the 1940s .Apart from their use in attention-deficit hyperactivity disorder, they are now most commonly associated with recreation and performance enhancement. Benzodiazepines and the related “Z-drugs” continue to be widely prescribed in general practice and psychiatry, but have become popular black market drugs, frequently used alongside opiates by those with serious addiction problems. Anecdotal evidence suggests that some other psychiatric medications, including quetiapine and amitriptyline, have a modest “street” value for their sedative effects.

When novel drugs were introduced into psychiatry in the 1950s, in contrast to nowadays, clinicians and researchers expressed considerable interest in their characteristic mind- and behavior-altering effects. They described the striking state of mental restriction provoked by the early neuroleptics, for example, which they contrasted with the more familiar type of sedation produced by barbiturates:

People use licit substances like caffeine, alcohol, and nicotine to achieve a range of effects, including enhancing performance and sociability, producing relaxation, and managing stress or everyday emotional discomfort. People also sometimes use licit and illicit substances to combat more severe symptoms of anxiety and depression, to suppress painful memories of trauma, and to help manage or “escape” from psychologically or physically challenging situations, like living on the street or dealing with chronic stressors. Anecdotally, people are reported to have used illicit substances like opiates to self-medicate psychotic symptoms

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Regards,
Nancy Ella
Dual Diagnosis: Open Access
Email: dualdiagnosis@emedsci.com
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