Time to concentrate on human factors in mental illnessBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4377 (Published 12 July 2011) Cite this as: BMJ 2011;343:d4377
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In his article, Dr. Sami Timimi has addressed the issue of dubious
effectiveness of psychotropic drugs . It was suggested that these drugs
have varying degrees of neurotoxicity, create abnormal mental states
rather than correct them, and are different from illicit drugs only
through who provides them and how they are subsequently used rather than
because of discoveries of some particular therapeutic potency.
Researchers have identified illicit drug abuse/addiction as a "brain
disease" involving changes in the structure and neurochemistry of the
brain of the drug user . The major neurotransmitters involved in
developing substance abuse/dependence are the opioid, catecholamine, and
gamma-aminobutyric acid (GABA) systems . A person with too little or
too much endogenous neurotransmitter activity or too little/too much
activity of endogenous antagonists may be at risk for developing
psychiatric disorders or substance dependence . Therefore substance
abuse may be the form of 'selftreatment', especially in state in which two
or more psychiatric disorders occurs in a single patient at the same time
(up to 50 percent of addicts have a comorbid psychiatric disorder).
As described by Dr. Timimi, psychotropic drugs may produce abnormal
mental states similar to some of the illicit drugs, that may be lifesaving
for some at certain points in their distress. However, they are in fact
different from illicit drugs. Psychotropic drugs are prescribed by a
psychiatrists or general practitioners, hence under control, followed by
the diagnosis based on careful clinical assessment of patient's mental
state and detailed family history for psychiatric disorders.
We agree that we can put money into better understanding the factors
that have the effects on outcome of mental health as social factors
outside of treatment and the therapeutic relationship within treatment.
However, as the irrefutable evidence points to biological etiology of
psychiatric disorders that involves changes in the structure and
neurochemistry of the brain , there is no holistic treatment of
vulnerable patients without psychotropic drugs. Therefore drug companies
losing interest in psychiatry seems to be transient and further studies
focusing on the new drugs for mental health treatment are warranted.
1. Timimi S. Time to concentrate on human factors in mental illness.
2. Sadock, B.J., Sadock, V.A. Kaplan & Sadock's Synopsis of
Psychiatry: Behavioral Sciences/Clinical Psychiatry. Tenth edition.
Lippincott Williams & Wilkins. 2007.
3. Robinson, T.E., Berridge, K.C. The neural basis of drug craving:
An incentive-sensitization theory of addiction. Brain Research Reviews
Competing interests: No competing interests