by Dave Piltz
Neurotransmitters
Neurotransmitters are the Paul Revere’s of the brain. They allow one neuron to interact and communicate with another neuron, thus providing the mechanism for cells to perform the functions they are meant to perform (Patterson, Albala, McCahill, & Edwards, 2010). These neurotransmitters or chemicals provide the brain the fuel needed for the various areas of the brain to function optimally. They work by allowing one cell’s synapse to send the needed message to the other cell’s dendrite thus beginning the messaging needed for the cell to function. Each neurotransmitter neatly fits into a corresponding receptor and those neurotransmitters that are not needed, are either returned to the sending neuron to be broken down and recycled or destroyed in the synaptic gap (Patterson et al., 2010).
Common neurotransmitters are Acetylcholine, Dopamine, Gamma-aminobutyric acid (GABA), Glutamate, Norepinephrine, and Serotonin. Acetylcholine affects the body globally and the receptor sites are affected by many medications with psychotic medications having side effects. Dopamine seems to be involved in psychotic disorders and the cardiovascular system. Various non-psychotic and non-depression medicines affect dopamine receptor sites while certain antipsychotic and antidepressant medicines intentionally affect dopamine receptor sites. GABA seems to be connected to anxiety and substance abuse. Various medications affect GABA receptor sites along with drugs such as alcohol, benzodiazepines, and barbiturates. Certain antianxiety medications specifically target GABA receptor sites. Norepinephrine deals with a variety of bodily systems especially dealing with cardiovascular and depression. A variety of medications affect norepinephrine receptor sites with certain antidepressants specifically targeting these sites. Serotonin is associated with a gambit of bodily issues such as depression, gastrointestinal and sexual. Selective serotonin reuptake inhibitors or SSRI’s intentionally target these receptor sites (Patterson et al., 2010).
Mood Disorders Effects on Neurotransmitters
Mood disorders such as depression or major depressive disorder and dysthymia or dysthymic disorder at its most basic level affect how a person feels. This is in and of itself not an issue, but when how a person over times consistently feels sadness, loneliness, dejection, etc. it can affect the normal day-to-day functioning of the person. In some cases these feelings are caused by environmental factors such as trauma, loss, or disease and again are not an issue until over time the feelings are persistent. In other cases there may or may not be environmental factors but the person still feels consistently sad, lonely or dejected (Patterson et al., 2010).
These mood disorders tend to affect, regardless of the biosocial reason, the neurotransmitters of norepinephrine, serotonin, and dopamine. How the neurotransmitters are affected is not completely known as it could be a lack of the actual neurotransmitter or a malfunction in how the neurotransmitter communicates from one cell to another, or what happens to the neurotransmitter after it is successfully communicated to the cell. The goal of medicine would be to balance the neurotransmitters in both sending and receiving to what would be considered a normal range. However, since neurotransmitters and their associated medicines can affect several areas of the body, medications can reduce or minimize one or several symptoms while creating other symptoms or side effects. Most commonly SSRI’s (selective serotonin reuptake inhibitors are used to deal with mood disorders (Patterson et al., 2010).
Bipolar disorder not only has the depression symptoms but also has periods of extreme happiness or gladness. Due to its unique nature, antidepressants such as SSRI’s are used in addition to other therapy. Typically lithium is used to treat bipolar although anticonvulsants are used with uncertain scientific reason. Lithium seems to not affect the actual neurotransmitters or receptor sites but seems to work inside the cell in a unknown manner. For bipolar disorder dealing with neurotransmitters are secondary to the treatment and complimentary (Patterson et al., 2010).
Cognitive Disorders Effects on Neurotransmitters
Cognitive disorders such as the various forms of dementia deal with a person’s ability of their executive functioning of their brain to work correctly in daily functioning. This inability of the executive functioning such as problem solving, processing emotions, understanding environmental situations, etc. can create feelings associated with mood disorders. In some cases the cognitive disorder is due to other biosocial issues and not neurotransmitters such as vitamin deficiencies, endocrine or infectious disorders, toxins (alcohol, drug, medications, heavy metals), brain tumors or physical structure, or inflammation. In these situations management of the cognitive disorder is based on the actual issue (Patterson et al., 2010).
Alzheimer’s is believed to be linked to the amount of acetylcholine in the synapses and the acetylcholine receptors. Several medications work specifically with this neurotransmitter and associated receptor site. In addition Alzheimer patients deal with psychosis and agitation, depression, and insomnia in which other medications such as SSRI’s are used to affect the other neurotransmitters in the system (Patterson et al., 2010).
Substance Abuse Disorders Effects on Neurotransmitters
Substance abuse in and of itself does not specifically affect neurotransmitters. However, many of the reasons why someone may struggle with substance abuse such as dealing with anxiety or depression will affect neurotransmitters. Also, those dealing with substance abuse may have increased anxiety or feelings of depression from the substance abuse which affect neurotransmitters (Patterson et al., 2010).
Summary of the Workings of Psychotropic Drugs
All drugs have two modes of action. How it works in the body itself and how it deals with the symptoms it is trying to reduce or minimize. The former is called pharmacokinetics and the latter is called pharmacodynamics. Pharmacokinetics deals with how the drug is delivered, absorbed, metabolized, and expelled from the body. Pharmacodynamics deals with whether the drug does what is it supposed to do. Prescribers need to be conscious of both of these and their associated side effects (Patterson et al., 2010).
Mainly psychotropic drugs main function is to increase or decrease the amount of a neurotransmitter or its associated receptor site. In this manner, cells are able to function more closely to their primary function and produce the desired effect in a person’s behaviors, moods and/or feelings. However there are times in which the drug such as lithium seems to work inside a cell and not necessarily with the neurotransmitters (Patterson et al., 2010).
Importance of the Workings of Psychotropic Drugs for Marriage and Family Therapists
Marriage and family therapists are not able to prescribe medication but are trained to provide psychoeducation to their client and their client’s family and/or support. To be able to provide quality psychoeducation it is important for marriage and family therapists to understand not only intricacies of the disease and/or disorder but also the complexities of medication. Marriage and family therapists in providing psychoeducation should be versed in more than common side effects of medicines but also the basics of how drugs work in a body, how neurotransmitters work and specifically the neurotransmitters that may be affected by certain drugs. As marriage and family therapists provide therapy and treatment they can take into account in their treatment strategy what the medications are attempting to accomplish and the possible side effects (Patterson et al., 2010).
Marriage and family therapists need to speak intelligently about psychotropic medications without providing advice. When a client or family member of a client asks about a potential side effect, marriage and family therapists should be able to discuss the possible side effects and potential cognitive behavioral techniques to deal with the side effect if needed but not speak medically about the side effect. For example in some cases as SSRI’s are taking affect, there may be a span of time in which symptoms increase and the person needs to be able to deal with the situation. Marriage and family therapists if versed in psychopharmacology can provide therapeutic interventions and techniques to help the client and their family to manage the symptoms as the medication is working (Patterson et al., 2010).
Knowledge of psychopharmacology provides the marriage and family therapist another avenue to work with their clients and families about diagnosed disorders that are being managed by a doctor/psychiatrist. In addition when medicine is prescribed it provides the marriage and family therapist another world view or lens to view the therapeutic relationship. This lens focuses on how medications work, how neurotransmitters work, potential side effects and typical questions clients may have about their specific situation. Medications coupled with therapy provide the client a more comprehensive treatment option than just medication alone or therapy alone. Collaboration between health care providers is key, but when marriage and family therapists are knowledgeable with psychopharmacology that collaboration becomes easier than when they are not versed in it (Patterson et al., 2010).
References
Patterson, J. E., & Albala, A.A., & McCahill, M.E., & Edwards, T.M. (2010). The therapist’s guide to psychopharmacology: Working with patients, families, and physicians to optimize care. New York: Guilford Press.
Preston, J., & Johnson, J. (2014). Clinical psychopharmacology made ridiculously simple. 8th Miami, FL: MedMaster.
National Institute of Mental Health (NIMH). Brain basics [PDF Document]. Retrieved from: http://www.nimh.nih.gov/health/educational-resources/brain-basics/nimh-brain-basics_132798.pdf