Pharmacological and Dynamic Factors in Psychotropic Drug Therapy

Some practitioners use psychotropic drugs as part of the totality of treatment. As the essence of therapy there is a commitment to do all that is possible to help the patient, including the adjunctive use of such medication. To comprehend what goes on in drug treatment, it is helpful to think in the following terms: the primary therapeutic pharmacology of the drugs, its so-called side effects, and the extra-drug factors involved, in short the dynamics of drug therapy. This is an artificial separation undertaken for purposes of clarification. Once understood separately, one begins to appreciate their interrelatedness and interreactions as they cooperate in reverberating, interresonant circuits.

Administration of a psychotropic drug is aimed at a specific, desireable therapeutic action. Factors to be considered are the drug's chemistry, route of administration, inner metabolism and excretion rate, functioning of kidneys and liver, individual drug resistance and sensitivity, the use of other drugs, etc. In these connections, certain questions may arise, for example, the peculiar psychic reactions to the drug, which have to be explored and evaluated. If a patient has been doing well on a particular drug for a time and then responds no longer, or begins to show an unexpected and strange psychic reaction, the physician might well wonder along the following lines: Has the pharmacy made a mistake? Has the patient continued taking the drug? Has something altered within the patient? When one reaches the latter question, it is highly important to consider the possibility that the patient has developed liver or brain pathology. If the liver is affected in some way by the drug, as in drug hepatitis, or if viral hepatitis has occurred, the alternation of detoxified or breakdown products may well lead to an alteration of psychic effects.

An example of the above occurred in a patient who, after being on chlorpromazine maintenance therapy for several years, suddenly