Medication is taken to treat a biological condition. We are focusing here on understanding medication for the purposes of mental illness and health. Medication should be prescribed by a qualified medical practitioner, and the effects of taking that medication should be reported back to them so that adjustments and changes can be made.
Most medication directly target aspects of our brain, since our minds are seated there. A few modify aspects of our non-brain biology, which often has an indirect change to our brain. As stated, our brain seats our mind, the conscious awareness of self that is an emergent phenomena to our ability to not just react to the world, but to plan a response to what is presently or predicted to happening around us.
There are 8 major neurotransmitters that we need to consider.
- Dopamine, which begats Noradrenaline, which begats Adrenaline; (Dopaminergic line)
- Serotonin, which begats Melatonin; (Serotonergic line)
- Endorphins, which facilitates the dopamine line;
- Oxytocin, which facilitates endorphins: and
- Endocannabinoids, which we don’t really understand yet, but affect alertness and pain perception.
You are probably familiar with the story of Goldilocks and the Three Bears, where Goldilocks has broken into the Bears house and is steal their food. One of the porridges is too hot (too much), another is too cold (too little) and the other is just right (in the zone). Your brain tries to regulate the amount of each neurotransmitter in parts of your brain to be “just right”, in the Goldilocks Zone of “good” in a process called homeostasis. Your mood and behaviours can boost this up a bit, or down a bit, but not by much.
Sometimes our brain has troubles regulating the amount to be in the zone. This could be because the “zone” level is actually not good, such as ADHDers whose brains don’t make enough Dopamine, and subsequently have Noradrenaline and Adrenaline being low too (not all ADHDers). This can also be disrupted because the building blocks to making that neurotransmitter are bottlenecked, such as being malnourished – you can’t make something from nothing.
The brain is complex and there are many regions. For most of Mental Health, the medications generally target the forebrain for Cognition, the midbrain for Feeling and Task Initiation, the Hindbrain for the managing the rest of the body. For example, several different SSRI medications target different parts of each of these in different ways. The medication we are trying to tweak a neurotransmitter might be working well, but in the wrong part of the brain.
Each medication is trying to boost or suppress, to some extent, one or more of these. Boosting can be an agitate or agonist to make more, reuptake inhibitor to kind of increase efficiency, or suppressing the past that takes the neurotransmitter away. Suppression can be an antagonist to reduce production, a blocker to interfere with delivery, or something that speeds up clearing the neurotransmitter.
Other brain functions that we may be trying to address is various aspects of your sympathetic or parasympathetic system. Sympathetic is to do with arousal, that is wakefulness, alertness and preparedness and is often medications that upregulate (increase) the dopaminergic neurotransmitters. Some forms of anxiety are where you are too alert and too prepared, so toning this down a bit can be helpful. Parasympathetic is to do with taking time, sleep and relaxing. It can be hard to think straight when we can’t sleep properly and reset. These are generally managed via histamine, GABA and serotonin medications. Sympathetic and Parasympathetic can both be switched on, even though they should be opposite.
Another important aspect to consider is the endocrine system. This regulates our hormones, which includes our sex hormones (oestrogen + progesterone, testosterone) and our stress / action hormones (body adrenaline, body noradrenaline and cortisol). Disruptions to our pituitary gland (in our head), thyroid (neck) and gonads (ovaries and testicles) can cause weight, temperature, mood and cognition related problems.
Pain is awful. Our endorphins prioritise trying to manage pain, which often leaves a deficit that interferes with feeling happy. Pain can be physical or psychic. There are five major medicines to address physical pain:
- NSAIDS (ibuprofen)
- Acetaminophen (paracetamol)
- Noradrenaline to the hindbrain (SNRI, Tricyclics)
- Opioids (which directly affect endorphins, also includes canabis)
- Antiepileptic medications (Gabapentin, pregabalin, oxcarbazepine)
These medications will hopefully free up enough endorphins to feel happy again.
Most medications have a primary effect, which is often the category it is named for, and frequently secondary and tertiary effects. For example Sertraline is primarily an SSRI, select seraphim reuptake inhibitor for the front and midbrain; secondarily it acts as a dopamine reuptake inhibitor, tertiarily it is an indirect noradrenaline booster and delays ejaculation.
