Psychiatrists take psychiatric drugs

Psychopharmacotherapy: Take patient reservations seriously

Psychotropic drugs have side effects and interactions - like all drugs. In the opinion of psychiatrists, however, avoiding them entirely is not expedient. Certain clinical pictures cannot do without them.

While drug therapies for physical illnesses are relatively well accepted, the attitude towards psychotropic drugs is much more critical and often fraught with prejudices, ”said Dr. med. Iris Hauth, President of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN), at her capital city symposium on the subject of “Psychotropic Drugs in Focus: Challenges for Care”.

In the opinion of the DGPPN, psychotropic drugs wrongly have a bad reputation, because the scientific guidelines recommend treatment with psychotropic drugs as part of the treatment plan, together with psychotherapy and psychosocial interventions, for depression, schizophrenia or bipolar disorders. Certain clinical pictures can only be treated with psychotropic drugs if they create a basis for psychotherapy or sociotherapy. “Many of those affected benefit from pharmacotherapy and can participate in social life again,” explained Hauth.

Janine Berg-Peer from the Federal Association of Mentally Ill Family Members finds the “bashing of psychotropic drugs” particularly bad: “The drugs give our mentally ill children the possibility of a reasonably tolerable life.” However, the effectiveness and dosage should be checked again and again during the course of treatment . Psychotherapy is also helpful. But it is very difficult to find a psychotherapist who has a vacancy and who then treats the severely mentally ill.

Especially at the beginning of treatment with psychotropic drugs, the side effects would often outweigh the effects, stressed DGPPN President Hauth. They should therefore only be used under strict medical supervision. Doctor-patient communication plays a decisive role in this. "We have to carefully and transparently inform our patients about the benefits of an active ingredient, but also about its side effects and interactions with other drugs," said Hauth. “And we have to take their reservations seriously”.

The prescriptions of antidepressants have increased significantly in the last few decades. According to the drug expert Prof. Dr. Gerd Glaeske, Center for Social Policy at the University of Bremen, prescribed around 200 million daily doses in 1991, compared to 1.4 million in 2013. "The noticeable increase began with the marketing and promotion of serotonin reuptake inhibitors (SSRIs), with the 'classic' tricyclic antidepressants remaining at the same level," said Glaeske. One of the classic antidepressants, opipramol, has been prescribed for many years, although its antidepressant effect has long been questioned because of the lack of controlled studies, he criticized. The drug is particularly often prescribed by general practitioners and internists, who already treat almost half of the patients diagnosed with depression. "It would be better to cooperate with general practitioners, psychiatrists and psychotherapists in order to avoid something like that," demanded Glaeske.

The drug expert reported that psychotropic drugs were prescribed particularly frequently to older people, and particularly to older women. However, especially in older people, in whom the kidneys and liver function less well than in younger years, undesirable side effects and interactions could often occur. Glaeske therefore recommends that doctors observe the so-called PRISCUS list, which lists potentially inadequate drugs for the elderly (www.priscus.net).

"Like all drugs, psychotropic drugs have side effects, but we try to find a drug profile for each patient that is acceptable to them," explained Prof. Dr. med. Andreas Meyer-Lindenberg, Central Institute for Mental Health in Mannheim. Side effects of antipsychotics used to treat schizophrenia include weight gain and sexual dysfunction. But it is precisely these drugs that are usually - always within the framework of an overall treatment concept - essential for those affected in order to be able to achieve freedom from symptoms, reintegration and participation. "It is important to have psychopharmacotherapy as early as possible when a psychosis first manifests," emphasized Meyer-Lindenberg. In long-term therapy, the dose can then be significantly lower and accordingly with fewer side effects.

Petra Bühring