Mental illness can affect anyone at any time, there are no immunity or vaccination for these issues, unlike some other physical illness and ailments in the medical field. The mental disorders we will focus on are brought on by things that are out of human control like genetics and stress, for example. In this paper, we will discuss six different mental illnesses: Schizophrenia, Bipolar Disorder, Depression, Anxiety Disorder, Borderline Personality Disorder, and Obsessive Compulsive Disorder. We will briefly examine each illness, along with the causation, the pharmaceutical methods used to help treat these illnesses and how those medications take action to work.
To begin, we will first examine schizophrenia; a chronic mental disorder affecting 1% of the population (Advokat, Comaty & Julien, 2014, p. 337). This mental illness is categorized as a neurodevelopmental disease due to the fact it is heavily correlated with brain abnormalities within the structure; which in turn impact the normal functioning of the brain and causes symptoms of psychosis like hallucinations, thought disorder and delusions. These symptoms of schizophrenia are often referred to as positive symptoms because they are frequently seen in those suffering from psychosis. Other symptoms that accompany this illness are issues like social withdrawal, loss of motivation and interest, as well as a flat effect on emotions (in respects to expression and reaction). These symptoms are known as negative symptoms because they disrupt what are viewed as normal behaviors and emotional processes. Symptoms of schizophrenia often being to manifest in the teen and young adult years, with most being diagnosed as sufferers’ move into adulthood. Currently, the cause of schizophrenia has not been discovered but researchers have linked schizophrenia to genetic factors. Although there has been no specific cause, there are treatment options available for those suffering with schizophrenia.
Schizophrenia has come a long way in the last 75 years in regards to treatment. With discoveries of how specific neurotransmitters are involved in this mental illness such as dopamine, serotonin, and glutamate; researchers have developed medications in order to help treat schizophrenia. Development of the first-generation antipsychotics in the early 1950s, and the later development of second generation antipsychotics, are primarily responsible for this progression (Advokat, Comaty & Julien, 2014, p. 350). First generation medications include but are not limited to: Haloperidol, Loxapine, Pimozide and Meloindone. These medications work and help patients with positive symptoms associated with this illness by blocking D2 receptors in dopaminergic pathways, as well as other receptors such as acetylcholine, histamine, and norepinephrine receptors (Advokat, Comaty & Julien, 2014, p. 346-347). Although first generation medications work better with reducing negative symptoms, certain side effects came along with these drugs that were severe, like Tardive Dyskinesia which causes involuntary muscle movements. Another noted side effect would be Extrapyramidal symptoms; which can include neuroleptic-induced parkinsonism, dystonia, and akathisia (Advokat, Comaty & Julien, 2014, p. 347). These severe and unpleasant side effects were the main driving factors of the development of second generation anti-psychotic medications; Including medications like Clozapine, Risperidone, Quetiapine, and Aripiprazole, to name a few. Of course, not all medications are free of side effects, but these second-generation medications have seemingly less severe side effects than those of the first generation. Common side effects experienced with second generation are weight gain and diabetes. Side effects seen in other medications like Clozapine include issues like metabolic syndrome and agranulocytosis, a deficiency of granulocytes in the blood; which in turn increases a patient’s risk for infection (Advokat, Comaty & Julien, 2014, p. 354). Another possible but infrequent side effect of these anti-psychotics include sudden cardiac death.
As for future research and developments involving schizophrenia, researchers are attempting to find ways to manage negative symptoms and cognitive issues caused by schizophrenia because most medications only control the psychosis aspect (Advokat, Comaty & Julien, 2014, p. 374). Studies are currently underway that focus on genes liked to schizophrenia. The National Institute of Mental Health published a study they co-funded, which has “pinpointed several schizophrenia-related gene variants that alter expression of other genes in illness-implicated circuitry of the human brain” (The National Institute of Mental Health). In addition to these findings, they have also, “Identified a sub-network of about 1,400 genes – including many in genomic sites linked to the illness – coding for components involved in communications between neurons that are significantly perturbed in schizophrenia” (National Institute of Mental Health). With these findings and the continuation of research regarding this topic, hopefully one day the cause of this mental illness becomes more clear, so better treatment plans and drugs can be derived to help those coping with schizophrenia.
Shifting focus, the next mental illness we will discuss affects over 5.4 million Americans, and is known as Bipolar Disorder (National Alliance on Mental Health). Bipolar disorder affects the brain causing uncontrollable shifts in mood and emotional highs, also referred to as mania, as well as emotional lows or depression. This can be a vicious cycle, happening only once every few months or once every few days, all depending upon the individual. These mood shifts also affect the energy and behavior of the individual suffering. Mania symptoms of bipolar include: excessive irritability, increased energy, decreased sleep, inability to concentrate, and impulsivity. Some depressive symptoms associated with bipolar are: prolonged sadness, social withdrawal, and loss of energy (Depression and Bipolar Support Alliance). Similar to schizophrenia, bipolar has no direct cause at this point, but it is linked to genetics and abnormal brain functioning.
Presently, there are a few different classes of medications that treat bipolar disorder such as antipsychotics and mood stabilizers. While we have an understanding of the mechanism of action for antipsychotics, the same cannot be concluded for mood stabilizers. We are a step closer to understanding how these work though, In the text Julien’s Drug Primer of Action, authored by Robert Julien, Clair Advokat, and Joseph Comaty, it is discussed how, “Mood stabilizers may reverse some of the impairments in brain structure and levels of brain-derived neurotrophic factor and these reversals could be relevant to the therapeutic benefit of mood stabilizers in bipolar disorder” (Advokat, Comaty & Julien, 2014, p. 472). The most commonly prescribed mood stabilizer for bipolar is lithium, because lithium is effective in treating 60 to 80 percent of acute manic and hypomanic episodes. As with all medications lithium has its drawbacks of side effects and toxicity, as well as the fact it doesn’t effectively control rapid-cycle mania; resulting in its use going down over the years (Advokat, Comaty & Julien, 2014, p. 475). Side effects of lithium include problems like tremors, skin reactions such as rashes or acne, as well as ataxia.
Besides lithium, a few other mood stabilizers that fall under the anticonvulsant category, are used to treat bipolar disorder. These medications include: Carbamazepine, Oxcarbazepine, Gabapentin, Valproic acid, and Topiramate (Advokat, Comaty & Julien, 2014). Also, antipsychotic drugs have been used to treat bipolar disorder by blocking the D2 receptors as done with schizophrenia, with the most commonly used antipsychotic medications for bipolar disorder being risperidone and olanzapine. Looking towards the future in this area, current research is being pursued in order to understand bipolar disorder a bit better. A recent study run by Fernando S. Goes at John Hopkins Medical, shows linkage between genes that cause schizophrenia and autism, with genes that are linked to causing bipolar disorder (Brain and Behavior Research Foundation). Besides research on causation, there is on-going research regarding things like combination therapy for treatment.
Next, we will discuss another prominent wide spread mental health issue that affects over 30 million Americans, Major Depressive Disorder also commonly known as Depression; a serious issue which is responsible for 70% of psychiatric hospital stays and 40% of suicides (Advokat, Comaty & Julien, 2014, p. 386). Depression causes alterations to emotions and mood, so it is classified as an affective disorder. Symptoms of depression are prolonged sadness, irritability, feelings of hopelessness, loss of interest and suicidal thoughts. The cause of depression has been long debated, but Harvard researchers feel that it is important to note that, “depression doesn’t spring from simply having too much or too little of certain brain chemicals; depression has many possible causes,” which can include faulty mood regulation by the brain, genetic vulnerability and stressful or traumatic life events (Harvard Health Publication). Stress is said to be a major contributing factor to depression. Depression, like many other mental illnesses doesn’t discriminate by race, age, or gender. In fact, 10 percent of men and up to 25 percent of women experience depression in their lifetime (Advokat, Comaty & Julien, 2014, p. 386).
Similar to other illnesses and ailments, depression can be treated with medication or psychotherapy, even a combination of both. When it comes to treating depression with pharmaceuticals, currently most who suffer from this are prescribed oral anti-depressants that are either monoamine oxidase inhibitors such as Selegiline or selective serotonin reuptake inhibitors like Prozac, Zoloft, Celexa, and Paxil (Advokat, Comaty & Julien, 2014, p. 397-402). Before these new age medications, depression was treated using what are known as tricyclic anti-depressants. These include drugs like Imipramine, Desipramine, and Doxepin to name a few. Tricyclic anti-depressants work in two ways, one by blocking the presynaptic reuptake transporter for serotonin and norepinephrine; and secondly, by blocking postsynaptic receptors for histamine and acetylcholine (Advokat, Comaty & Julien, 2014, p.395). Prescribers shifted from Tricyclic anti-depressants to serotonin reuptake inhibitors due to lesser toxicity and elevated patient comfort. Although SSRI’s and MAOI’s are more frequently prescribed, that doesn’t stop the risk for side effects for either of these medications. Side effects of both can include insomnia, nausea, and headache (Mayo Clinic). And another side effect that is frequently experienced with SSRI’s includes sexual dysfunction (Advokat, Comaty & Julien, 2014, p. 407).
Currently there is ongoing research surrounding many different areas of depression, but one especially interesting is the development of ketamine, a drug originally classified as a psychedelic anesthetic that was popularly abused during the 1990s. When this drug is taken for abusive purposes it produces positive and negative symptoms of schizophrenia, but using it doesn’t led to schizophrenia (Advokat, Comaty & Julien, 2014, p. 257). It has been suspected ketamine it’s self could have some anti-depressant properties, but more recently, it was discovered that a by-product of ketamine after it is metabolized could potentially hold the key to the anti-depressant action. With funding from the National Institute of Mental Health, scientist have discovered a metabolite from the breakdown of ketamine that, “[Has] singularly reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine” (National Institute of Mental Health). The metabolite derived from the breakdown of ketamine activates AMPA receptors, resulting in the anti-depressant effects. Researcher Todd Gould from the University of Maryland School of Medicine, explains what this finding could mean saying, “Now that we know that ketamine’s antidepressant actions in mice are due to a metabolite, not ketamine itself, the next steps are to confirm that it works similarly in humans, and determine if it can lead to improved therapeutics for patients” (National Institute of Mental Health). These kinds of breakthroughs have the potential to change the pharmacology of anti-depressants as we know it.
Moving Forward, the next mental illness we will focus our attention on is Anxiety disorder, one of the leading mental disorders in the United States. Anxiety disorders affects 18% of the United States population, which is over 40 million people (National Alliance on Mental Illness). Types of anxiety disorders include: generalized anxiety disorder, separation anxiety, phobia anxiety, social anxiety, and panic disorder; but the type of anxiety we are going to focus on is generalized anxiety which alone affects millions of adults every year. This disorder is defined as excessive worrisome thoughts that may be sometimes unrealistic, but remain consistent for more than 6 months. Anxiety is often diagnosed by its psychological and physiological symptoms. Psychological symptoms people who suffer can experience are things like irritability, feeling tense, restlessness, feelings of apprehension and so on (National Alliance on Mental Illness). Physiological symptoms can take form as well, impacting one’s physical wellbeing. For example, those who suffer from generalized anxiety may feel physically sick to their stomach, shortness of breath, tachycardia, headache, sweating, and insomnia (National Alliance on Mental Illness). General anxiety disorder doesn’t have any chemical causes, but is similar to depression and other disorders previously mentioned because stress usually causes it. Genetics can also play a role in developing general anxiety and other anxiety disorders.
Furthermore, generalized anxiety can be treated with medications as almost any other mental illness can be. Treating generalized anxiety disorder can be done with medications that fall under the category of anti-depressants or anti-anxiety medications that fall under the category of benzodiazepines. Benzodiazepines have a different mechanism of action than anti-depressants, In Julien’s Drug Primer of Action, it’s explained that, “Benzodiazepines facilitate the binding of GABA to its receptor. They do not directly stimulate the GABA receptor; rather, they bind to a site adjacent to the GABA receptor, producing a three-dimensional conformational change in the receptor structure that, in turn, increases the affinity of GABA for the receptor” (Advokat, Comaty & Julien, 2014, p. 436). Benzodiazepines that are frequently prescribed to treat anxiety include medications like Valium, Klonopin, Ativan and Xanax. Although effective in treatment, these drugs are meant for short term use due to the fact they can be abused and users become dependent upon them. These drugs can also cause a range of side effects such as ataxia, drowsiness, motor difficulty and disorientation (Advokat, Comaty & Julien, 2014, p. 448). Common anti-depressants prescribed to treat anxiety are Zoloft, Paxil, Lexapro, Prozac and Celexa. The side effects from anti-depressants are more physiological, including issues like insomnia, nausea and headache as discussed earlier.
Research regarding anxiety has attempted to uncovered a better understanding of anxiety and the internal framework of it, in order to improve treatments. Two researchers for the National Institute of Mental Health, Daniel Pine and Joseph LeDoux, believe we have been too quick to attribute all the feelings of anxiety to the amygdala, the fear circuit in the brain but, “Mounting evidence [suggests] that such subjective feeling states are mediated via different circuitry than defensive behaviors,” causing them to examine fear and anxiety as two separate systems (National Institute of Mental Health). With this new view of fear and anxiety being broken down into two systems, these researchers think they may be able to adapt or tailor current medications to better to treat anxiety. LeDoux and Pine feel this achievement is possible with their new dual system understanding, by using brain biomarkers to pinpoint specific circuit dysfunctions, then using that information to improve pharmaceuticals and aid in psychotherapy techniques (National Institute of Mental Health). This could potentially lead to further advancements in the future, such as to reduce the general side effect of anxiety as well that other psycho-medications can cause, in addition to treating general anxiety disorder itself.
Continuing to examine mental disorders, we will next discuss a less common but very serious mental illness known as Borderline Personality Disorder, which effects 2% of the population. This disorder is usually characterized by episodes of impulsiveness, anxiety, anger (including self-harm behavior), depression and hostility (Advokat, Comaty & Julien, 2014, p. 372). Besides these characteristics that define the disorder, other symptoms include paranoia, fear of abandonment, suicidal behaviors, unstable relationships through shifts of idealization to devaluation, and dissociative symptoms such as feeling outside of one’s body (National Institute of Mental Health). Right now, there is no clear-cut cause of borderline personality disorder, but it is seen to be more of a combination of factors in most cases. Factors include genetics, brain abnormalities in areas that control emotional functioning and decision making processes, as well as environmental factors or previous traumas (National Alliance on Mental Illness). It is important to also acknowledge that people with borderline personality often other have co-occurring mental illnesses especially mood and anxiety disorders.
When it comes to options for treating borderline personality disorder, mood stabilizers are sometimes utilized but more frequently utilized are antipsychotic medications. Mood stabilizers that can be used to reduce symptoms of impulsiveness or anger include drugs like lithium. Second generation antipsychotic medications that have shown positive effects in treating this disorder include medicines like Risperidone, Olanzapine, and Clozapine (Advokat, Comaty & Julien, 2014, p. 372). Side effects of these medicines include diabetes and weight gain, as previously mentioned. Along with medications to help stabilize symptoms, an important part of treatment for this disorder is psychotherapy, due to the high rates of self-harm and because medication alone is not enough to handle the overwhelming symptoms that come along with borderline personality disorder. Psychotherapy can help people who suffer learn to cope with emotions and control impulsive habits. Research pertaining to borderline personality disorder is limited, but currently efforts are being made in different clinic trials that examine pharmacological treatment methods as well as new ways to detect or prevent borderline personality disorder; these trials are co-conducted and co-funded by the National Institute of Mental Health.
The last mental illness we are going to examine is Obsessive Compulsive Disorder, a chronic disorder that is characterized by repetitive and intrusive thoughts known as obsessions, as well as irrational and uncontrollable urges to complete specific actions in a specific manner, which can be referred to as compulsions. Obsessions trigger distress, and the compulsions that follow are a way of self-soothing or decreasing the distress brought on by the obsession, which creates a repetitive cycle (National Alliance on Mental Health). Obsession compulsion disorder can be different for each person that suffers in, in regards to severity and the obsessions. For example, some people obsess about germs, which could lead to compulsive cleaning, handwashing, or other ritualistic behavior. Another example of this illness would be obsessing about things being in a systematic order or doing things a specific number of times because that number is “good”. Therefore, compulsive behavior happening such as reorganizing or repeated checking of things (like if the car is locked). The exact cause of obsessive compulsive disorder is unknown but research has linked it back to genetics and different portions of the brain that may not be responding normally to the neurotransmitter serotonin (National Alliance on Mental Health).
Treating obsessive compulsive disorder is often done using antidepressants, that are selective serotonin reuptake inhibitors such as Zoloft, Paxil, and Prozac; but at higher dosages than what people with depression are prescribed (Mayo Clinic). It is important to note that these medications do not always work immediately, sometimes taking up to 12 weeks to become fully effective. Psychotherapy is another treatment option, which can teach sufferer’s healthy ways to cope with the anxiety caused by obsessions. Both treatment options can work separately, but in severe cases, it’s best to combine both a medication and psychotherapy into a treatment plan. Recently, researchers at Yale School of Medicine did a genetic study involving children with obsessive compulsive disorder and their parents who did not have this disorder, finding 20 gene mutations in children with OCD that had not been inherited from either parent. These mutations were then, “Mapped out by how the proteins encoded by those genes interact with other proteins in cells,” and it was found that many of the changes were likely to impact the development and function of the central nervous system (the brain and spinal cord) as well as the immune system (Brain & Behavior Research Foundation). The findings in this research could lead to a more complex understanding of not only the cause of this mental illness, but improving treatment for those who suffer.
To conclude, we have examined how these six different mental illnesses can manifest and impact the lives of those who suffer. Although the cause for many of these illnesses remain unknown, researchers are working to uncover what parts of the brain are affected in each of these and working to identify specific areas of the brain that malfunction and cause these disorders. Fortunately, with trial and error of antidepressants, antipsychotics, anti-anxiety meds and other clinical pharmaceuticals these disorders can be managed to a degree. With medications, psychotherapy and a clinician designed treatment plan, there is hope for a brighter future for those who struggle with these disorders until research reveals the answers we need.