When drug-centred psychopharmacology meets person-centred psychopharmacotherapy – antidepressants

Abstract

A vibrant discussion on the monoamine theory of depression and the use of serotonergic modulators in the treatment of this disorder was triggered by a systematic review published by Moncrieff et al. in “Molecular Psychiatry” in 2022. Many experts considered this work as referring to a hypothesis that now is only of historical significance. Another publication, co-authored by Moncrieff, proposed a useful approach to both action and clinical use of psychopharmacotherapy. The drug-centred model postulates that psychoactive agents are substances that affect symptoms indirectly, by exerting specific effects on physiological phenomena underlying mental, emotional and behavioural processes. When planning therapeutic strategy, it should be assessed whether the expected effects of a given medication on mental function and behaviour may prove beneficial in a particular life situation of the person being treated. Therefore, pharmacotherapy can be considered in terms of its impact on mental functions, which may turn out positive (not only for depression, but also for anxiety and other disorders), rather than targeting a specific abnormality. The paper presents different approaches within this framework, including a model based on creative person-centred narrative psychopharmacotherapy (CP-CNP) described by Jakovljević. Combining drug-centred and person-centred psychopharmacotherapy may be the basis for understanding the pharmacological treatment of mental disorders. In the context of the controversy aroused by Moncrieff et al., it can be pointed out that agents known to modulate serotonin transmission modify certain serotonin-mediated mental functions, which may aid the treatment of depression and many other conditions. Therefore, it is not a mechanically understood antidepressant effect. Serotonin modulators are useful in the treatment of depression, as evidenced by both scientific research and the experiences of millions of patients. However, these drugs have a complex, multistage action, which needs to be considered to avoid misunderstandings and oversimplifications.