Intended for healthcare professionals

Analysis

How do psychiatric drugs work?

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b1963 (Published 29 May 2009) Cite this as: BMJ 2009;338:b1963

By changing intracerebral supply/demand.

Alen J. Salerian, Nansen G. Saleri, and Justin Salerian "reviewed the
studies on core body and brain temperature’s influence on mood, mood
disorders and their treatment. Our review suggests the majority of
therapeutic strategies [pharmaceuticals] against mania are hypothermic
while thermogenic strategies are used to combat depressive disorders"(1).
The differences in mood and behaviour associated with the menstrual cycle
in women and between patients that are hypothyroid and those that are
hyperthyroid are consistent with this hypothesis.

Temperature is a measure of metabolic rate and hence of ATP
utilization. The inference is that therapeutic stategies that are
hypothermic reduce metabolic rate and those that are thermogenic increase
it. There is, however, another variable to consider the pH which has
related biochemical effects. In so far as this might be a reflection of
the balance between ATP utilization and synthesis drugs that are
thermogenic might either increase or decrease the availability of ATP if
the rate of utilization begins to exceed the rate of synthesis. The
converse applies to hypothermic strategies.

Particularly important might be the cyclical changes in brain
temperature and pH. Hence the suggestion that mood and behavioural
disturbances might be more effectively managed by monitoring and even
changing and pacing changes in intracerebral temperature and pH by
sterotactic means (2).

1. Brain temperature may influence mood: A hypothesis
Medical Hypotheses (2008) 70, 497-500
By Alen J. Salerian, MD, Nansen G. Saleri, PhD, Justin Salerian.

2. Richard G Fiddian-Green Stereotactic modulation of intracerbral
energetics. http://www.jnnp.com/cgi/eletters/75/7/1019#180, 21 Jun 2004.

Competing interests:
None declared

Competing interests: No competing interests

11 June 2009
Richard G Fiddian-Green
FRCS, FACS
None