Brain plasticity: what are the possible effects of psychotropic drugs on the brain-mind?
Man is a complex system in which mind and body are in all respects two sides of the same coin in a relationship of interdependence and synergy. Our brain-mind changes as a result of environmental stimuli, but even a drug, especially if taken for a long time and in significant doses, can generate changes in the physiology of the brain.
Advertising message This statement of Aristotle is today more current than ever, in fact we know that man can neither be thought of nor studied outside the context and physical and social environment in which he lives and develops from birth; man is a social animal in that he is conceived, born, grows and develops through relationships and always within an environmental and socio-cultural context.
On the other hand, experience, through contact with the environment and relationships with others, generates changes in our nervous system and alters our behavior through learning. These changes affect man on several levels: biological, psychological, physiological, behavioral. This is because man is a complex system, where mind and body must be conceived, and to all intents and purposes, two sides of the same coin, in a relationship of interdependence and synergy, so much so that we could say that every somatic process has a psychic consideration and vice versa. Already Kandel in 1996 had suggested that mind and brain should be conceived in an equation relationship, since all normal and pathological mental processes derive from the brain and all reactions at the neurobiological and neurophysiological level will alter our behavior, causing changes in all the body system. The link between the mental and the cerebral is in fact constituted by emotions, which in their exquisitely relational essence act as a direction in the interdependence between soma and psyche. Every emotion is present and acting in both the mind and the body.
In fact, every emotion, as well as every mood, feeling, sensation, etc. activates in our body the release of specific chemical substances that will alter the neurochemistry of the body starting from that of the brain, but also the psychic processes of the mind and the behavior of the subject .
For example, when we live in a particularly stressful situation, our body produces Cortisol, also called “stress hormone”, a hormone that if released in excessive doses can also compromise the proper functioning of the immune system, thereby affecting our psycho-physical well-being; when we fall in love instead our body produces a cocktail of hormones that has the effect of a drug in us, these hormones, oxytocin, serotonin, adrenaline, make us feel good, euphoric, happy, with the head a little in the clouds and some difficulty concentrating. Oxytocin in particular is the hormone that acts as the main “regulator” of pro-relational behaviors, including: the formation of couple bonds, parental care behaviors, both in males (in males, vasopressin in particular) and in females, the predisposition to attachment behaviors, friendship and affiliation relationships (Marazzini, Roncaglia, Piccinni, Dell’Osso, 2008). High oxytocin is proportional to the monogamy of animals, while polygamous individuals of the same species have lower OXT levels and in females (vole prairie) the receptive sexual response is oriented towards forming a stable couple relationship, stimulating desire of closeness between individuals (Panksepp, 1998). Oxytocin, in fact, also called “Love Hormone”, has a fundamental role in the individual’s development process as it regulates relational and healing needs through direct action on the reptilian brain (oxytocin, in fact, it is an acelcholine neutralizer that if present at high levels can be toxic producing aggressive attitudes). The latter, which is configured as the matrix of the mammal-emotional brain, is the seat of our primitive instincts, and regulates behaviors suitable for individual survival by means of satisfying the basic needs: hunger, thirst, sleep etc. These behaviors are in turn attributable to the effect in the body of the release of serotonin, a hormone that is produced by our “second brain”: the intestine, the seat of primitive emotions (Panksepp, 2011). It is a recent discovery by Michael D. Gershon (1998), which states: it is the seat of our primitive instincts, and it regulates behaviors aimed at individual survival by means of satisfying basic needs: hunger, thirst, sleep etc. These behaviors are in turn attributable to the effect in the body of the release of serotonin, a hormone that is produced by our “second brain”: the intestine, the seat of primitive emotions (Panksepp, 2011). It is a recent discovery by Michael D. Gershon (1998), which states: it is the seat of our primitive instincts, and it regulates behaviors suitable for individual survival by means of satisfying basic needs: hunger, thirst, sleep etc. These behaviors are in turn attributable to the effect in the body of the release of serotonin, a hormone that is produced by our “second brain”: the intestine, the seat of primitive emotions (Panksepp, 2011). It is a recent discovery by Michael D. Gershon (1998), which states:
When the emotional brain evolves from the mammalian one, it forms two systems: the limbic system, used for pleasure and mediated by dopamine, and the mesolimbic system, regulated by the hypothalamus, used for affective functions and mediated by oxytocin-vasopressin. Recent studies have shown that the neuronal circuits and endocrine processes of the OXT system (oxytocin system, neuropeptide more abundant than the hypothalamus) are present only in mammals, supporting in this species the fundamental evolutionary function of control and inhibition of the activity of the reptilian brain, allowing healing and attachment behaviors (Ibidem). The involvement of oxytocin and vasopressin in relation to the different forms of attachment, from infantile to parental, to couple, then raised the hypothesis of the existence of various neuronal circuits involved in the regulation of reproductive, caring and attachment behaviors, and in general of all pro-social behaviors. This small parenthesis to highlight how all behaviors, from the most instinctive to the most rational, involve complex body processes that take place on several levels starting from the neurobiological one. The link between what has just been reported and the study of psychopharmacology is that there are chemical substances which, if taken by the body, are capable of provoking neurobiological and neurophysiological reactions in the same way as environmental and social stimuli. Knowing the physiology of the brain is fundamental as psychotropic drugs act precisely in specific brain areas, i.e. at the cortical, limbic,
Psychopharmacology in fact studies the effect that some chemicals, also called drugs, have on the body, in particular on an emotional, cognitive and behavioral level. Let’s not forget that the WHO defines drugs as substances used to modify physiological systems or pathological states for the benefit of those who receive it. We talk about medicine when a drug is administered for therapeutic purposes, that is, to help the body modify or correct certain functions. For this reason, psychopharmacology can be considered a hybrid science that requires knowledge also from a psychological, neurobiological, pharmacological, etc. point of view.
Advertising message We can trace the history of psychopharmacology to the experiments of Kraepelin (1880) who tested common substances and medical products on psychological tasks in healthy subjects, but the term “psychopharmacology” was coined in 1920 by the American pharmacist Macht to describe the effects of drugs on some neuromuscular coordination tests. In 1949, then Australian John Cade introduced Lithium as a mood stabilizer in the treatment of manic depressive syndrome, in 1953 Laborit discovered the antipsychotic effects of chlorpromazine (psychosis and schizophrenia), in 1954, Nathan Kline published the results of his study on the administration of reserpine to 700 psychiatric patients (hypertension) and the same year Frank Berger discovered the first anxiolytic, meprobramate.
Medicines are therefore substances capable of producing an effect on behavior by means of an action on the nervous system, which is why they are also called psychoactive substances. Psychotropic drugs, in particular, produce their effect by altering the neurochemistry of the brain and producing different effects depending on the site of action on which it acts. In practice, all brain functions can be altered by psychotropic drugs.
Returning to the mind-brain equation of Kandell (1996) it is important that a psychotherapist is aware of the drug therapy that his patient follows, just as it is important that he has a constructive dialogue with the neurologist, the psychiatrist and in general with all the professionals involved in the case and who knows at least the basics of psychopharmacology. This is because, as underlined several times, the drug causes alterations on several levels in the patient so you must be able to recognize and distinguish what are the effects of a drug (from simple use, to addiction, intoxication, abstinence, etc.) from what can be symptomatic manifestations linked to particular psychopathological states.
The first thing to investigate about drug therapy is compliance with the dosage indicated by the specialist and patient compliance. The psychotherapist should not enter on the doctor’s indications, but certainly must maintain a professional relationship with the latter, based on collaboration and cooperation with the aim of aiming at the patient’s well-being.
Furthermore, in the therapeutic process it is not possible to neglect to deal with the topic “drug therapy” in order to try to understand together with the patient the meanings that the latter attributes, the experiences and any repercussions on the functioning tout court in everyday life. For a psychotherapist, sometimes the pharmacological therapy of his patient becomes a conditio sine qua cannot establish the therapeutic alliance, as it is necessary to mitigate the patient’s symptoms before he can think about any intervention.
A very important concept, in continuity with what has just been reported, is that the drug would not only have an effect on the symptom, mitigating it or in some cases eradicating it, but could in some circumstances be “curative”, generating not only functional, but changing also structural on the nervous system; this could happen in particular during the developmental age. This concept can be explained through the thesis of neuronal plasticity (Fields, 2012). As mentioned above, our brain undergoes the influence of experience with the environment and with others, specifically we know that the first phase of plastic brain processes occurs when the synaptic efficacy is changing in relation to the neurotransmission, while long-term changes also require the help of gene expression and protein synthesis, in such a way as to no longer carry out a simple functional change, but also a structural, physical change, of the neural connections which are therefore remodeled according to the lived experience, determining the uniqueness of each individual (Downing & Zoeller, 2000). Now taking up the concept that a drug acts on our brain causing neurochemical alterations, as it does the experience, when the prolonged intake of the drug acts on the synaptic effectiveness of that specific area of the brain, we may not be more than faced with a functional change of the same, but faced with a structural change;
Therefore our brain-mind changes, following environmental stimuli, especially if protracted and intense, both at a functional and physiological-structural level (Kandell, 2005); even a drug (especially if taken for a long time and in significant doses) can generate changes in the physiology of the brain, changes that, it is necessary to specify, can prove to be beneficial and beneficial for the patient. An innovative concept and undoubtedly to be deepened with further research and theoretical contributions, but very important if seen in the light of clinical practice as psychotherapists.
I conclude with this thought: I believe that for us psychotherapists a basic knowledge of the structure and functioning of the nervous system, of psychopharmacology and psychiatry is fundamental, this precisely in the light of the individual’s psychosomatic unity and the need to study it through a holistic view. Ultimately, I would conclude by stressing that, although following the treatments that medicine offers us is right and sensible, sometimes it may not be sufficient to stick to this alone, and this also applies to psychology: knowledge must circulate and that medicine and psychology build an open dialogue in theory and practice with a view to both cure and prevention.