Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1981 Mar;134(3):223–233.

Psychopharmacology in Medical Practice—The Benefits and the Risks

Robert L Sack 1, James H Shore 1
PMCID: PMC1272608  PMID: 7269559

Abstract

Psychopharmacology has become a major approach to treatment in primary medical care. However, combined psychiatric and medical illness can give rise to some challenging diagnostic problems. Furthermore, drug treatment of patients with such illnesses can involve important drug-disease interactions and drug-drug interactions. One should keep in mind the issues that arise when an emotionally troubled patient would benefit from a psychotropic drug but a concurrent medical illness complicates this treatment. An awareness of both the medical and psychiatric issues involved may make successful treatment possible.

Full text

PDF
223

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adler R. H. Psychotropic agents in the management of chronic pain. J Human Stress. 1978 Jun;4(2):13–17. doi: 10.1080/0097840X.1978.9934981. [DOI] [PubMed] [Google Scholar]
  2. Amsterdam J., Brunswick D., Mendels J. The clinical application of tricyclic antidepressant pharmacokinetics and plasma levels. Am J Psychiatry. 1980 Jun;137(6):653–662. doi: 10.1176/ajp.137.6.653. [DOI] [PubMed] [Google Scholar]
  3. Ananth J. Psychopharmacology and psychosomatic illness. Psychosomatics. 1975;16(3):124–128. doi: 10.1016/S0033-3182(75)71194-5. [DOI] [PubMed] [Google Scholar]
  4. Arora R. B., Madan B. R. Antiarrhythmic action of minor and major tranquilizers. Pharmacol Ther B. 1979;4(3):633–656. doi: 10.1016/0163-7258(79)90008-1. [DOI] [PubMed] [Google Scholar]
  5. Bassuk E., Schoonover S. Rampant dental caries in the treatment of depression. J Clin Psychiatry. 1978 Feb;39(2):163–165. [PubMed] [Google Scholar]
  6. Bennett W. M., Singer I., Coggins C. J. A guide to drug therapy in renal failure. JAMA. 1974 Dec 16;230(11):1544–1553. [PubMed] [Google Scholar]
  7. Bielski R. J., Friedel R. O. Prediction of tricyclic antidepressant response: a critical review. Arch Gen Psychiatry. 1976 Dec;33(12):1479–1489. doi: 10.1001/archpsyc.1976.01770120083009. [DOI] [PubMed] [Google Scholar]
  8. Bigger J. T., Giardina E. G., Perel J. M., Kantor S. J., Glassman A. H. Cardiac antiarrhythmic effect of imipramine hydrochloride. N Engl J Med. 1977 Jan 27;296(4):206–208. doi: 10.1056/NEJM197701272960407. [DOI] [PubMed] [Google Scholar]
  9. Blackwell B. Psychotropic drugs in use today. The role of diazepam in medical practice. JAMA. 1973 Sep 24;225(13):1637–1641. [PubMed] [Google Scholar]
  10. Brogden R. N., Heel R. C., Speight T. M., Avery G. S. Nomifensine: A review of its pharmacological properties and therapeutic efficacy in depressive illness. Drugs. 1979 Jul;18(1):1–24. doi: 10.2165/00003495-197918010-00001. [DOI] [PubMed] [Google Scholar]
  11. Bunney W. E., Jr, Davis J. M. Norepinephrine in depressive reactions. A review. Arch Gen Psychiatry. 1965 Dec;13(6):483–494. doi: 10.1001/archpsyc.1965.01730060001001. [DOI] [PubMed] [Google Scholar]
  12. Chambers G., Kerry R. J., Owen G. Lithium used with a diuretic. Br Med J. 1977 Sep 24;2(6090):805–806. doi: 10.1136/bmj.2.6090.805-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Couch J. R., Hassanein R. S. Amitriptyline in migraine prophylaxis. Arch Neurol. 1979 Nov;36(11):695–699. doi: 10.1001/archneur.1979.00500470065013. [DOI] [PubMed] [Google Scholar]
  14. Dell A. J. A comparison of maprotiline (Ludiomil) and amitriptyline (1). J Int Med Res. 1977;5 (Suppl 4):22–24. [PubMed] [Google Scholar]
  15. Evans-Prosser C. D. The use of pethidine and morphine in the presence of monoamine oxidase inhibitors. Br J Anaesth. 1968 Apr;40(4):279–282. doi: 10.1093/bja/40.4.279. [DOI] [PubMed] [Google Scholar]
  16. Fann W. E., Janowsky D. S., Davis J. M., Oates J. A. Chlorpromazine reversal of the antihypertensive action of guanethidine. Lancet. 1971 Aug 21;2(7721):436–437. doi: 10.1016/s0140-6736(71)90152-8. [DOI] [PubMed] [Google Scholar]
  17. Forrest F. M., Forrest I. S., Serra M. T. Modification of chlorpromazine metabolism by some other drugs frequently administered to psychiatric patients. Biol Psychiatry. 1970 Jan;2(1):53–58. [PubMed] [Google Scholar]
  18. Gottschalk L. A., Bates D. E., Fox R. A., James J. M. Psychoactive drug use. Patterns found in samples from a mental health clinic and a general medical clinic. Arch Gen Psychiatry. 1971 Nov;25(5):395–397. doi: 10.1001/archpsyc.1971.01750170011002. [DOI] [PubMed] [Google Scholar]
  19. Granacher R. P., Baldessarini R. J. Physostigmine. Its use in acute anticholinergic syndrome with antidepressant and antiparkinson drugs. Arch Gen Psychiatry. 1975 Mar;32(3):375–380. doi: 10.1001/archpsyc.1975.01760210109008. [DOI] [PubMed] [Google Scholar]
  20. Greenblatt D. J., Allen M. D., MacLaughlin D. S., Harmatz J. S., Shader R. I. Diazepam absorption: effect of antacids and food. Clin Pharmacol Ther. 1978 Nov;24(5):600–609. doi: 10.1002/cpt1978245600. [DOI] [PubMed] [Google Scholar]
  21. Greenblatt D. J., Shader R. I., Franke K., MacLaughlin D. S., Harmatz J. S., Allen M. D., Werner A., Woo E. Pharmacokinetics and bioavailability of intravenous, intramuscular, and oral lorazepam in humans. J Pharm Sci. 1979 Jan;68(1):57–63. doi: 10.1002/jps.2600680119. [DOI] [PubMed] [Google Scholar]
  22. Greenblatt D. J., Shader R. I., Koch-Weser J. Psychotropic drug use in the Boston area. A report from the Boston Collaborative Drug Surveillance Program. Arch Gen Psychiatry. 1975 Apr;32(4):518–521. doi: 10.1001/archpsyc.1975.01760220130014. [DOI] [PubMed] [Google Scholar]
  23. Greenblatt D. J., Shader R. I., Koch-Weser J. Slow absorption of intramuscular chlordiazepoxide. N Engl J Med. 1974 Nov 21;291(21):1116–1118. doi: 10.1056/NEJM197411212912107. [DOI] [PubMed] [Google Scholar]
  24. Hackett T. P., Cassem N. H. Reduction of anxiety in the coronary-care unit. A controlled double-blind comparison of chlordiazepoxide and amobarbital. Curr Ther Res Clin Exp. 1972 Oct;14(10):649–656. [PubMed] [Google Scholar]
  25. Heiser J. F., Gillin J. C. The reversal of anticholinergic drug-induced delirium and coma with physostigmine. Am J Psychiatry. 1971 Feb;127(8):1050–1054. doi: 10.1176/ajp.127.8.1050. [DOI] [PubMed] [Google Scholar]
  26. Hekimian L. J., Friedhoff A. J., Deever E. A comparison of the onset of action and therapeutic efficacy of amoxapine and amitriptyline. J Clin Psychiatry. 1978 Jul;39(7):633–637. [PubMed] [Google Scholar]
  27. Hollister L. E. Valium: a discussion of current issues. Psychosomatics. 1977;18(1):44–58. doi: 10.1016/S0033-3182(77)71104-1. [DOI] [PubMed] [Google Scholar]
  28. Jefferson J. W. A review of the cardiovascular effects and toxicity of tricyclic antidepressants. Psychosom Med. 1975 Mar-Apr;37(2):160–179. doi: 10.1097/00006842-197503000-00006. [DOI] [PubMed] [Google Scholar]
  29. Ketai R. Family practitioners' knowledge about treatment of depressive illness. JAMA. 1976 Jun 14;235(24):2600–2603. [PubMed] [Google Scholar]
  30. Klotz U., Anttila V. J., Reimann T. Cimetidine/diazepam interaction. Lancet. 1979 Sep 29;2(8144):699–699. doi: 10.1016/s0140-6736(79)92104-4. [DOI] [PubMed] [Google Scholar]
  31. Klotz U., Avant G. R., Hoyumpa A., Schenker S., Wilkinson G. R. The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest. 1975 Feb;55(2):347–359. doi: 10.1172/JCI107938. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kocher R. The use of psychotropic drugs in the treatment of chronic, severe pains. Eur Neurol. 1976;14(6):458–464. doi: 10.1159/000114773. [DOI] [PubMed] [Google Scholar]
  33. Levy B. F. Treatment of hypertension with pargyline hydrochloride. Curr Ther Res Clin Exp. 1966 Jul;8(7):343–346. [PubMed] [Google Scholar]
  34. Maas J. W. Biogenic amines and depression. Biochemical and pharmacological separation of two types of depression. Arch Gen Psychiatry. 1975 Nov;32(11):1357–1361. doi: 10.1001/archpsyc.1975.01760290025002. [DOI] [PubMed] [Google Scholar]
  35. Manheimer D. I., Davidson S. T., Balter M. B., Mellinger G. D., Cisin I. H., Parry H. J. Popular attitudes and beliefs about tranquilizers. Am J Psychiatry. 1973 Nov;130(11):1246–1253. doi: 10.1176/ajp.130.11.1246. [DOI] [PubMed] [Google Scholar]
  36. Muller C. The overmedicated society: forces in the marketplace for medical care. Science. 1972 May 5;176(4034):488–492. doi: 10.1126/science.176.4034.488. [DOI] [PubMed] [Google Scholar]
  37. Petersen V., Hvidt S., Thomsen K., Schou M. Effect of prolonged thiazide treatment on renal lithium clearance. Br Med J. 1974 Jul 20;3(5924):143–145. doi: 10.1136/bmj.3.5924.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Raisfeld I. H. Cardiovascular complications of antidepressant therapy. Interactions at the adrenergic neuron. Am Heart J. 1972 Jan;83(1):129–133. doi: 10.1016/0002-8703(72)90114-7. [DOI] [PubMed] [Google Scholar]
  39. Regier D. A., Goldberg I. D., Taube C. A. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry. 1978 Jun;35(6):685–693. doi: 10.1001/archpsyc.1978.01770300027002. [DOI] [PubMed] [Google Scholar]
  40. Rothstein G., Clarkson D. R., Larsen W., Grosser B. I., Athens J. W. Effect of lithium on neutrophil mass and production. N Engl J Med. 1978 Jan 26;298(4):178–180. doi: 10.1056/NEJM197801262980402. [DOI] [PubMed] [Google Scholar]
  41. Salzman C., Kochansky G. E., Shader R. I., Porrino L. J., Harmatz J. S., Swett C. P., Jr Chlordiazepoxide-induced hostility in a small group setting. Arch Gen Psychiatry. 1974 Sep;31(3):401–405. doi: 10.1001/archpsyc.1974.01760150103015. [DOI] [PubMed] [Google Scholar]
  42. Sellers E. M., Greenblatt D. J., Giles H. G., Naranjo C. A., Kaplan H., MacLeod S. M. Chlordiazepoxide and oxazepam disposition in cirrhosis. Clin Pharmacol Ther. 1979 Aug;26(2):240–246. doi: 10.1002/cpt1979262240. [DOI] [PubMed] [Google Scholar]
  43. Shader R. I., Ciraulo D. A., Greenblatt D. J. Drug interactions involving psychotropic drugs. Psychosomatics. 1978 Nov;19(11):671-3, 677-81. doi: 10.1016/S0033-3182(78)70909-6. [DOI] [PubMed] [Google Scholar]
  44. Shader R. I., Georgotas A., Greenblatt D. J., Harmatz J. S., Allen M. D. Impaired absorption of desmethyldiazepam from clorazepate by magnesium aluminum hydroxide. Clin Pharmacol Ther. 1978 Sep;24(3):308–315. doi: 10.1002/cpt1978243308. [DOI] [PubMed] [Google Scholar]
  45. Shader R. I., Greenblatt D. J. Clinical implications of benzodiazepine pharmacokinetics. Am J Psychiatry. 1977 Jun;134(6):652–656. doi: 10.1176/ajp.134.6.652. [DOI] [PubMed] [Google Scholar]
  46. Snyder S. H., Yamamura H. I. Antidepressants and the muscarinic acetylcholine receptor. Arch Gen Psychiatry. 1977 Feb;34(2):236–239. doi: 10.1001/archpsyc.1977.01770140126014. [DOI] [PubMed] [Google Scholar]
  47. Snyder S., Greenberg D., Yamamura H. I. Antischizophrenic drugs and brain cholinergic receptors. Affinity for muscarinic sites predicts extrapyramidal effects. Arch Gen Psychiatry. 1974 Jul;31(1):58–61. doi: 10.1001/archpsyc.1974.01760130040006. [DOI] [PubMed] [Google Scholar]
  48. Solomon F., White C. C., Parron D. L., Mendelson W. B. Sleeping pills, insomnia and medical practice. N Engl J Med. 1979 Apr 5;300(14):803–808. doi: 10.1056/NEJM197904053001423. [DOI] [PubMed] [Google Scholar]
  49. Solow C. Psychotropic drugs in somatic disorders. Int J Psychiatry Med. 1975;6(1-2):267–282. doi: 10.2190/J3FN-GELM-65WA-3HBU. [DOI] [PubMed] [Google Scholar]
  50. Uhlenhuth E. H., Balter M. B., Lipman R. S. Minor tranquilizers: clinical correlates of use in an urban population. Arch Gen Psychiatry. 1978 May;35(5):650–655. doi: 10.1001/archpsyc.1978.01770290132013. [DOI] [PubMed] [Google Scholar]
  51. Vestal R. E., Kornhauser D. M., Hollifield J. W., Shand D. G. Inhibition of propranolol metabolism by chlorpromazine. Clin Pharmacol Ther. 1979 Jan;25(1):19–24. doi: 10.1002/cpt197925119. [DOI] [PubMed] [Google Scholar]
  52. Weinstein M. R., Goldfield M. Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry. 1975 May;132(5):529–531. doi: 10.1176/ajp.132.5.529. [DOI] [PubMed] [Google Scholar]
  53. Wetterhus S., Aubert E., Berg C. E., Bjerkeset T., Halvorsen L., Hovdenak N., Myren J., Roland M., Sigstad H., Guldahl M. The effect of trimipramine (Surmontil) on symptoms and healing of peptic ulcer. A double blind study. Scand J Gastroenterol Suppl. 1977;43:33–38. [PubMed] [Google Scholar]
  54. Whitehead W. E., Blackwell B., Robinson A. Why physicians prescribe benzodiazepines in essential hypertension: a phase IV study. Biol Psychiatry. 1977 Aug;12(4):597–601. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES