Pharmacological Properties of Psychopharmaca in Relationship to their Clinical Indications

Abstract

Empirical evidence for psychopharmacological treatment has grown over the past decade substantially. While it was quite difficult to perform metaanalyses 20 years before, we now have a large body of evidence available to perform metaanalytic studies, not only on data published in the literature, but also on individual databases called a pooled-analysis. The field moved from eminence-based psychiatry to evidence-based psychiatry. Since indications for psychotropic agents are with a few exceptions given for diseases and not syndromes, it is obvious that the available empirical database is diagnosis-driven. However, recent developments in psychopharmacology indicate that medications primarily used for one diagnosis can also be useful for other diagnoses as we learnt from the serotonin-reuptake-inhibitors (SSRIs), which were firstly used for depression and then for different forms of anxiety disorders. A recent example is quetiapine, for which the first indication was schizophrenia, then bipolar disorder and now depression and general anxiety disorders. Does this mean a denosologisation of psychopharmacology? Not really, however recent developments could be indicative that trials should be performed not only on a diagnostic but also on a syndromatology-level as has been shown for suicidality within schizophrenia, but for instance not in depression.