Within present-day society, it is not uncommon to come across discussions among medical or healthcare professionals regarding the use of psychoactive drugs or psychotropic substances for mental illnesses. Psychoactives are considered to be chemical substances that have the ability to alter brain function through action within the central nervous system. The effect on the central nervous system can present with changes in mood, behavior, or perception when administered (Science Daily 2017). Psychoactives can be found in a variety of medications, as well as alcohol, some plants and animals, and illegal drugs (Hartney 2017). These agents may be used in complex mental-health-related cases and the decision to initiate psychoactive drug use typically comes after a thorough assessment of the risks versus benefits of the therapy that has been performed.
Psychoactive drugs often are evaluated based on the following criteria: potential to cause addiction, chemical structure, common effects, and classification schedule from I–V. These criteria can aid with determining therapeutic use, understanding adverse effects, and ultimately determining which agent is used to address a specific condition. For example, if an individual presents with a history of drug abuse, a prescriber may seek to use an agent with a lower addiction potential. These criteria can prove vital when selecting which specific drug to initiate in any given patient case.
So how exactly did this class of agents originate? There is evidence to suggest that the use of psychoactive medications dates back at least 10,000 years and cultural use to about 5,000 years. Some notable examples include Native Americans and tobacco use, the use of khat by Ethiopians before contact with Europeans, and the chewing of the betel nut in Timor and Thailand (Sullivan and Hagen 2002). The history of psychoactives only serves to enhance our present day and future understanding of their action and use, which can be associated with both positive and negative outcomes depending on the type of agent.
Today, psychoactives are used frequently for mental-health-related conditions, and one of the most commonly recognized psychiatric diagnoses in the United States is an anxiety disorder (Hersen et al. 2007). Two of the most commonly prescribed psychoactives for anxiety include benzodiazepines, which provide immediate relief of symptoms, while long-term treatment is generally reserved for antidepressants, which can be used in conjunction with cognitive therapy (Taylor 2011). Benzodiazepines are used to treat anxiety because they boost the brain chemical gamma-Aminobutyric acid (GABA), an inhibitory neurotransmitter responsible for slowing down or ceasing excitability in nerve cells. Antidepressants, on the other hand, depending on the class they originate from (e.g., selective serotonin reuptake, inhibitors, selective norepinephrine reuptake inhibitors, or tryclic antidepressants), all focus on the activity and actions of other neurotransmitters in order to manage the symptoms of anxiety.
Another type of psychoactive agent, marijuana, has been studied in relation to its ability to produce anxiety relief. In 2014, researchers at Vanderbilt University identified the cannabinoid receptors by which marijuana produces its effects, and in the brain, these receptors can be involved in the regulation of anxiety. The study proved to be noteworthy in helping to better understand how cannabinoids can produce their specific behavioral effects and how their use in a limited capacity can help to reduce anxiety symptoms (Snyder 2014). Research into the use of psychoactives for anxiety management continues to grow and advance as new data become available. Recently, researchers recognized the important role of endogenous cannabinoids as a novel means of treating anxiety disorders (MacMillian 2017). The researchers reported that the development of endogenous cannabinoids-based treatment approaches that include anandamide or 2-AG signaling can provide greater therapeutic options for mood and anxiety disorders (MacMillian 2017).
While psychoactives may provide therapeutic benefits, there also are concerns related to adverse effects, addiction potential, and health burden that can be attributed to psychoactive drugs (Elliott et al. 2017). As a result, toxicologists are actively researching these compounds, taking into account several important factors in determining their effects. If an illegal psychoactive agent is identified within a human body that has suffered adverse effects, the evaluation must include the circumstances, the nature of the identified agent, the impact of pharmacogenetics, and the possible in vitro or in vivo production of the substance (Elliott et al. 2017). Within the area of toxicology-related psychoactive research, it is the goal of toxicology labs to identify potent drug analogs that can exist in the blood for a limited duration or urinary metabolites that once had unidentified structures, but are able to be identified. With advances in communication and information technology, toxicologists are better able to identify newer, novel agents, and they possess high-quality devices to analyze if the agents possess any therapeutic merit and/or application.
Psychoactives have become a mainstay in the treatment of certain mental disorders, and research endeavors continue to flourish in this area to provide therapeutic options for those suffering from mental-health disorders and other conditions. The ongoing research provides newfound hope for those who have experienced trials and errors with other agents and seek an effective, therapeutic option to treat their symptoms
Abimbola Farinde, PharmD, PhD, is a postdoctoral member of SOT. She currently is an adjunct faculty member in the College of Nursing and Health Care Professionals at Grand Canyon University.