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Future Trends

Psychopharmacology 101

For Non-prescribing

Mental Health Professionals -

A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T


New Diagnoses

New Drugs

New Treatments


Welcome to the Future Treatment Eras

(1) Asylums

(2) Freudian/Psychodynamic

(3) Psychopharmacologic

(4) Molecular Neurobiology (already started)


Molecular Neurobiology Era

Study of Neurons, neurological growth, and development at the molecular level

Treatments biologically focused and more precise than pharmacology era

Future treatments may fail to treat psychological since mental/emotional aspects are unobservable

Limited approach to unobservable drives and concepts have no place in this era


Molecular Neurobiology

“Brave New Vocabulary”

Akt, astroglia, biomarkers, brain repair, connectome, dendrites, dendritic spines, dentate

gyrus, DISC1, dysbindin, epigenetics, gene knockin, gene knock-out, glia, genome-wide association, study interneurons, microglia, mirror neurons, neuregulin, neurite extension, neurocognition, neuroimaging, neuroinflammation, neurogenesis,

neurogenetics, neuroplasticity, nitrosative stress, optogenetics, oxidative stress, pluripotent cells, progenitor cells, single nucleotide polymorphisms, subventricular zone, tractography


1. Akt (Protein Kinase B)

Thought to be Associated with cellular processes like metabolizing glucose, apoptosis, cell

proliferation, transcription, and cell migration.

Akt inhibitors being investigated as treatments for cancer, HIV, and Herpes Simplex Virus


2. Dentate Gyrus

Part of hippocampus (1 of 2 interlocking gyri composing hippocampus (other is Ammon’s horn)

New neurons forms here even in adulthood

Depression, stress, high blood sugar impair it


3. DISC1 (Disrupted in Schizophrenia 1)

Protein encoded by the DISC1 gene in humans

Participates in cell proliferation, differentiation, migration, neuronal, axon, and dendrite outgrowth, mitochondrial transport, cell-to-cell adhesion

Disruption associated of this protein associated with depression, bipolar disorder, & schizophrenia

Also associated with neural plasticity


4. Neuroregulins

Cell-to-cell signaling proteins

Family of 4 related proteins

  • Involved in developing Heart
  • Differentiating Schwann cells from oligodendrites
  • Neural development
  • Neuromuscular synapses
  • Linked to glutamate hypothesis of schizophrenia


5. Neurite Extension

Process by which neurons are generated from neural stem cells & progenitor cells

Form axons and dendrites

Failure to extend/grow causes problems with neuronal communication


6. Nitrosative Stress

Damage to cells and proteins due to excessive nitrogen

Body’s reaction for high NO concentration due to decreased NO


Causes transcription factors to increase or decrease DNA activity


7. Optogenetics

Procedure to observe/control neurons made sensitive to light

Allows for accurate/fast monitoring of living tissues

Treat disorders associated with neurons controlling their function


8. Oxidative Stress

Similar to nitrosative stress

Body’s reaction to buildup of oxygen

Leads to peroxides and free radicals

Drugs that stop/destroy free radicals are neurotrophic; major future market


9. Proteomics

Study of structure & function of proteins

Role proteins play in various cell types

Relevant to disorders like Alzheimers (ALZ) and schizophrenia


10. Subventricular Zone

Walls of lateral ventricles

Neurogenesis continues here into adulthood


  • I: Lines lateral ventricles
  • II: Possibly Neural Development
  • III: Oligodendrocytes & ependymal cells = unknown function
  • IV: Transition between astrocytes and parenchyma layer, contains large amounts of myelin


Computer Assisted Devices reduce our wrong diagnosing 40% of time


Drug advertising expanded

Blurring of lines between normal and beginning of disease

  • Depression expanded to include “adjustment disorders” and “premenstrual dysphoric disorder”
  • Normal memory loss will become “age related memory disorder” (nootropics & promnestics)
  • Grieving, now “Bereavement Disorders”
  • Addictions viewed as pathology of learning and memory
  • Fibromyalgia viewed as disorder on affective spectrum
  • Anti-depressants go over-the-counter


Future Pharmaceuticals

Sigma Ligands, “Sigma Enigmas,” MOA unknown  Example: Nuedexta®, Approved 2010

MOA: Exerts action via sigma-1 receptor agonist and NMDA receptor antagonism


FDA Approved: Acute treatment of Pseudobulbar Affect (PBA) – emotional lability

Lazaroids: Free-radical scavenging and membrane stabilizing

Corticotropin-Releasing Factor antagonists


Old Theories of Depression - Monoamine Revised/Down-regulation/Cortisol

New: Neurogenic Theory of Depression - Result of two new discoveries:

1. Existing neurons able to repair/remodel

2. Neurogenesis

  • Involves 2nd messengers
  • Protect neurons from damage
  • Promote health/stability of newly formed neurons
  • BDNF - Brain Derived Neurotrophic Growth Facto4


Nociceptives & Nootropics

(1) Treat pain associated with depression first

(2) Treat memory issues associated with mental illness first