According to Census Bureau Data, half of American adults aged 18-24 reported experiencing anxiety and depression symptoms in 2023. Meanwhile, 90 percent of US adults believe the country is currently experiencing a mental health crisis.
Clinical psychopharmacology is a specialty field that combines traditional psychological interventions with psychotropic medication to treat patients suffering from mental health disorders and improve well-being.
This article includes a brief history of clinical psychopharmacology, outlines promising breakthroughs and emerging trends in the field, and addresses key barriers to treatment such as pervasive stigmas regarding mental illness.
The emergence of modern clinical psychopharmacology
For thousands of years, various drugs have been used to help treat physical pain and mental disorders. However, it wasn’t until the mid-20th century that effectual medications became readily available to the public. Even then, little was known about the underlying biological and neurological causes of mental illness.
Three key discoveries by pioneers of clinical psychopharmacology include:
- In 1937, Dr. Charles Bradley discovered that the stimulant amphetamine sulfate helped children with diagnosed behavioral disorders become less aggressive and perform better academically. Eventually in 1956, the stimulant methylphenidate was released as a treatment for attention-deficit/hyperactivity disorder (ADHD).
- In 1949, Dr. John Cade conducted research to find a treatment for mania and discovered that lithium injections resulted in major improvements, but it wasn’t until 1970 that the FDA approved lithium for this purpose.
- Also in 1949, Dr. Henri Laborit experimented with phenothiazine antihistamine in an attempt to improve the effects of anesthesia. By the mid-1950s French and American psychiatrists showed that a newly synthesized form, chlorpromazine, could reduce delusions, agitation, and hallucinations in patients with psychosis.
The 1950s saw the clinical use of the first two antidepressants: imipramine, the first drug in the tricyclic antidepressant (TCA) family, and a monoamine-oxidase inhibitor (MAOI) called iproniazid that had previously been used to treat tuberculosis. These medications served as critical research tools for neurobiology and psychopharmacology and represented a major shift in psychiatric care of people with depression.
In the late 1980s the introduction of the selective serotonin reuptake inhibitor (SSRI) Prozac again transformed the pharmacological landscape and paved the way for a next generation of antidepressants—including serotonin norepinephrine reuptake inhibitors (SNRIs)—which were designed to target specific neurotransmitter pathways.
Clinical psychopharmacology and mental health
Today, clinical psychopharmacologists require specialized knowledge in the primary principles of pharmacology, including what the body does to medication and what medication does to the body, as well as neuroscience, biochemistry, clinical science, and pathophysiology.
Doctors will use this expertise to evaluate whether psychotropic medications should be used as part of an overall treatment plan. The process typically begins with a patient interview regarding their behavioral and medical history, including symptoms, as well as a thorough physical examination.
A psychiatrist will also consider which types of medications and substances the patient currently uses to evaluate potential drug interactions, as well as consult with members of an integrated healthcare team.
The final phase involves using the best available research to prescribe medication if indicated, which necessitates considering new available therapeutics, FDA regulatory status, and pharmacogenomic factors (or how a person’s genetics may affect how they respond to medications).
Psychotropic medication may be prescribed for psychological conditions including:
- Attention-deficit/hyperactivity disorder
- Anxiety disorders
- Addiction disorders
- Depressive disorders
- Panic disorder
- Posttraumatic stress disorder (PTSD)
- Psychotic and related disorders such as schizophrenia
- Bipolar and related disorders
- Neurodevelopmental and neurocognitive disorders
Recent breakthroughs and emerging trends
Although the development of new psychotropic medications has slowed over the last couple of decades, scientists are exploring how to use existing drugs in the treatment of mental health disorders. Technological advances, such as digital therapeutics (DTx), also serve as vital treatment resources for patients to supplement mental health care between therapy sessions.
Psychedelic-assisted psychotherapy
In recent years, there has been increasing interest in the emerging field of psychedelic-assisted psychotherapy, which combines biological therapies and psychotherapy, in the treatment of depression and other mental health disorders.
For example, a prescription version of ketamine was approved by the FDA in 2019 to treat severe depression that has not improved with other therapies. According to one study, the use of ketamine nasal spray and an oral antidepressant helped patients with treatment-resistant depression stay in stable remission 16 weeks into treatment. Although it usually take weeks for patients to feel the benefits of SSRIs, ketamine can start to take effect within approximately 40 minutes.
Recent studies suggest that psychedelic psychotherapy has the potential to transform the treatment of mental health disorders. Although more comprehensive research is required, one theory is that psychedelic states may allow people to let go of strongly held maladaptive beliefs and thought patterns that inform how they view the world and themselves while allowing for healthier new approaches to life’s challenges.
A promising new study on the effectiveness of MDMA (in conjunction with talk therapy) in treating PTSD found that 72 percent of people who received the drug no longer met the diagnostic criteria for the disorder by the end of the trial, compared to 48 percent of those in the placebo group.
Although they are not yet approved for therapeutic use, researchers are studying how psychedelics may be used to treat other psychiatric conditions, including personality disorders, bipolar depression, and anorexia nervosa. Clinical trials have also been conducted on the effectiveness of using LSD to treat alcoholism.
Cognitive behavior therapy (CBT) and digital therapeutics
Cognitive behavioral therapy is a form of psychological treatment that has been proven effective in patients with addiction, anxiety disorders, depression, eating disorders, marital issues, and severe mental illness.
CBT strategies may help enhance patient quality of life by teaching them how to:
- Recognize and correct distorted thinking patterns
- Employ problem-solving skills to cope with adversity
- Develop enhanced self-confidence
- Face, rather than avoid, their fears
- Use role playing to prepare for difficult interactions with others
- Learn how to quiet the mind and relax the body
Although CBT is not new, its use in digital therapeutics (DTx) to help improve mental health outcomes is.
Digital therapeutics use software platforms to provide research-based and validated interventions to treat mental and behavioral health disorders. They require a prescription by a licensed practitioner and can be used alone or in conjunction with medication and CBT (or another form of psychotherapy) as part of a treatment plan.
Digital therapeutics may also help eliminate gaps in access to mental health treatment by:
- Delivering therapies via smartphones, tablets and other technologies
- Increasing patient access to safe and effective therapies
- Providing privacy and lessening the stigma associated with certain traditional therapies
- Offering access to support for patients between sessions with their clinicians
- Providing care in multiple languages including English, Spanish, Arabic, German, and French
Hurdles in clinical psychopharmacology treatment
According to 2023 key findings by Mental Health America, close to one third (28 million) of adults reported they did not receive treatment for their mental illness, with 42 percent citing a lack of affordability as the primary reason.
Below is an overview of some of the many barriers to the effective treatment of mental health disorders.
Stigmas regarding mental illness
A major factor that leads people to avoid seeking help is fear that they will be marginalized or discriminated against due to stigmas regarding mental illness. These stigmas may stem from a lack of understanding, cultural differences, or inaccurate representations of mental illness in media.
Although the emergence of clinical psychopharmacology and increased knowledge of the genetic or medical nature of mental health disorders has helped to reduce the prevalence of stigmas surrounding mental health, it has not eliminated them.
Three types of stigmas identified by researchers include:
- Self-stigma: Negative beliefs and internalized shame that people with mental disorders feel about their own condition
- Public stigma: Adverse or discriminatory attitudes others have about mental illness
- Institutionalized stigma: Systemic limitation of opportunities for people with mental health issues through policy
Not only do stigmas affect individuals with mental illness, but they can also negatively impact relationships with family, friends, and co-workers. Seeking help for mental illness may also conflict with cultural or familial values, such as emotional restraint or a distrust of the mental healthcare system, serving as an additional barrier to care.
Self-stigmas in people diagnosed with severe mental illness may lead to lower self-esteem, increased psychiatric symptoms, lessened hope, increased isolation, fewer work, school or social opportunities, relationship and work problems, and a reduced likelihood of maintaining treatment.
Hearing the personal stories of people dealing with mental illness can be a powerful way to reduce these stigmas and change public perceptions. For example, when celebrities like Demi Lovato, Micheal Phelps, and Taraji P. Henson openly address their mental health challenges, it can start a dialogue, make the topic more relatable, and help people dealing with similar issues to feel seen.
Tips from the National Alliance on Mental Illness (NAMI) on how to help reduce stigma include:
- Educating yourself and others about common mental health misperceptions
- Speaking openly about mental health, including sharing on social media
- Normalizing the idea that mental illness is on par with physical illness in terms of the necessity of treatment
- Calling out problematic or stigmatizing language in conversation and in the media
- Showing compassion and promoting empowerment over fear and shame
Accessibility issues
In the United States, there are numerous barriers to access to quality mental health treatment. As mentioned above, affordability is a significant one. Even with insurance or financial assistance, copays and deductibles can be exorbitantly expensive, and for many individuals, this financial burden is too high to allow for consistent treatment.
The combination of high demand for mental health care services and a major shortage of qualified mental health practitioners is another key obstacle. According to 2023 data from the Health Resources and Services Administration, 164 million Americans live in federally designated Mental Health Professional Shortage Areas.
Although the availability of virtual therapy and digital therapeutics can improve access to care, they require a smartphone or laptop and a reliable internet connection, which may not be readily available in rural and low-income communities.
There are also distinct racial disparities in accessibility, with survey data suggesting that in 2019, white adults were more likely than Black and Hispanic Americans to receive mental health treatment. Implicit bias, language barriers, and a lack of diverse representation in mental health practitioners may all contribute to this gap in care. Accordingly, enhancing diversity in psychology and related fields could help lead to more equitable access.
Lack of education, awareness, and patient compliance
While the signs of physical injury or illness are often obvious, that is not always the case with mental illness. Symptoms of mental health disorders and behavioral conditions may be subtle or even dismissed as characteristic of an individual’s attitude or personality. For example, one of the stigmas of depression is the belief that someone living with it is simply lazy or antisocial.
A lack of comprehensive mental health education is another hurdle to treatment. If people in distress don’t recognize clinical symptoms of serious conditions—or share their disordered thoughts with others—they will be unlikely to seek or receive treatment from a clinical psychopharmacologist. That’s why targeted public education and awareness campaigns on the symptoms of mental illness, as well as resources for help, are critical.
The effectiveness of most psychopharmacological interventions is also heavily dependent on continuous patient adherence to treatment plans. Unfortunately, there are many factors that may cause a person to cease treatment. In the case of psychotic and cognitive disorders, impairment of insight and a failure to recognize the need for treatment can create further complications. The good news is that some pharmaceutical companies are now focusing research on treatment methods (such as longer-lasting injectables) that may provide more secure, consistent drug delivery.
The future of clinical psychopharmacology
In addition to the emerging trends in clinical psychopharmacology illustrated above, continued research focused on identifying the brain circuits or receptors involved in mental health disorders may help to spur the development of more targeted psychotropic medications.
Breakthroughs in neuroscience research have been slow due to the inherent complexity of the brain and its component mechanisms. However, in 2019 the FDA approved the first drug to treat post-partum depression, Zulresso, after decades of research into the biology of neurosteroids and observations on postpartum hormone change.
As advances in epigenomics and genomics help scientists to better understand why certain populations are more vulnerable to psychiatric disorders, it may lead to the discovery of new neuroscience-driven medications with fewer side effects that can be used in concert with psychological therapies to improve patient outcomes.
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