Monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s. Initially, they were used first in the treatment of tuberculosis but were soon used as antidepressants. These drugs act by blocking the effects of enzymes called monoamine oxidases. MAOIs destroy catecholamines (epinephrine, dopamine and serotonin), which act as neurotransmitters in the brain. By preventing the elimination of catecholamines, MAOIs alter the chemical balance of the brain, resulting in an improvement of depressive conditions. Their side effects include: orthostatic hypotension, diarrhoea, peripheral edema, hypertensive crisis and numerous interactions with other types of food and drugs. It takes a few weeks of use before they start exerting their beneficial effects.
A little later came the development of tricyclic antidepressants, and benzodiazepines were introduced in the early 1960s. Because of their sedative, hypnotic, anxiolytic, anticonvulsant, anaesthetic and muscle relaxant properties, benzodiazepines soon began to be widely prescribed in the treatment of anxiety and insomnia. These drugs have more moderate side effects than the older barbiturates, and they include: excessive sedation, anterograde amnesia, exhaustion, ataxia, drowsiness, decreased cognitive and psychomotor performance.
Tricyclic antidepressant (TCAs) drugs act by inhibiting the reuptake of monoamines. These are antidepressant drugs, whose therapeutic effect results in an improvement of mood, release of psychomotor inhibition typical of people with depression and an increase in appetite. Their efficacy has been demonstrated in several studies in recent decades and have now replaced almost all MAOIs. They have several side effects, including: extrapyramidal disorder (acute dystonia, akathisia, parkinsonism, tardive dyskinesia and rabbit syndrome), anticholinergic effects (dry mouth, constipation, tachycardia, urinary retention, visual accommodation disturbances, impaired memory), adrenaline effects (orthostatic hypotension, dizziness, tachycardia, trembling, delayed ejaculation in men and in general a decrease in sexual desire), antihistamine effects (drowsiness, hypotension, increased appetite, weight gain, abnormal psychomotor and cognitive activities). It should also be remembered that during the intake period it is good to avoid the consumption of alcoholic beverages, since alcohol increases the probability of incurring the above-mentioned side effects. Interactions occur when combined with anticholinergic drugs and poisoning occurs if taken in excessive amounts.
SSRI (Selective Serotonin Reuptake Inhibitors) antidepressants were invented in the 1980s and 1990s and used in the treatment of obsessive-compulsive disorder and bad cases of depression. They act on the reuptake of serotonin, a neurotransmitter widely used by the brain, preventing physiological elimination and thus limiting the effects of a deficiency. SSRI drugs are commonly used in the treatment of generalised anxiety disorder as they produce the addictive effects typical of anxiolytic drugs. However, it is necessary to take them for at least 15-20 days before their therapeutic effect can be felt. These kinds of drugs may produce various side effects, including loss of appetite, nausea, insomnia, trembling, sexual dysfunction (e.g. delayed ejaculation in men and anorgasmia in women), headache and dizziness.
There are also at least two other types of drugs that may be used for the treatment of anxiety. These are Beta-blockers and atypical neuroleptic drugs.
Beta-blockers are mainly used to control of systemic arterial hypertension and the treatment of Myocardial Infarction. They act on the central nervous system controlling heart rate and blood pressure. They act by inhibiting the beta receptors of the sympathetic nervous system. In the psychiatric field they are mainly used to alleviate some of the physical symptoms caused by anxiety, such as palpitations, sweating and trembling, but also to control the level of anxiety in public situations. The side effects of beta-blockers include: exhaustion, depression, confusion, hallucinations, memory loss, psychosis, disorientation, decreased libido and impotence.
Atypical neuroleptics were introduced to minimise the side effects of conventional antipsychotics without affecting therapeutic efficacy. These new-generation drugs act more selectively than their predecessors on the dopaminergic system, in other words on the apparatus that manages the dopamine neurotransmitter. Atypical neuroleptics are used primarily in the treatment of schizophrenia and other psychotic problems. They reduce the presence of delusions and hallucinations, at the same time as alleviating the behavioural abnormalities typical of psychotic patients. If taken by an individual who is not psychotic, they do not cause an actual state of sedation but rather a strong insensitivity to environmental stimuli and a significant flattening of emotions. The most common side effects of these drugs are: heaviness of head, numbness, weakness, fainting, dry mouth and difficulty in visual accommodation, impotence, constipation, urinary difficulties, skin sensitization (discoloration and rashes) alteration of the menstrual cycle, an increase in weight, increased body temperature, blood pressure fluctuations, and they can accentuate the tendency to have convulsions in epileptic patients.
Many psychological problems arise from maladaptive thinking patterns. Such negative thinking patterns certainly cannot be modified by a drug. This relates to inappropriate behaviour, the kind of behaviour that make a person feel bad; the only way to stop the pain is to identify the inappropriate thought and behavioural patterns and replace them with healthier and constructive ones. Only qualified professionals have the experience and skills required to do this for patients who have these problems. Drugs are often associated with psychotherapy and the results obtained from this synergy are generally good. On the one hand we have a drug that reduces the patient’s negative symptoms, allowing, among other things, to place them in a suitable condition to face psychotherapy. On the other hand, there is the actual treatment, the one based on the patient-therapist relationship, which by searching for and analysing the causes of the difficulties will lead to patients recovering, even permanently, from their illnesses. Once this occurs, the drugs are no longer needed and they can be gradually discontinued. In contrast, treatment based solely on taking drugs will never bring patients to rid themselves of the causes of their pain once and for all.