Do We Know How Psych Meds Work?

Tackling one kind of anti-medication attitude

Sometimes you’ll hear people dismissing psychiatric medications with the argument that no one knows how they work. However, there’s a lack of clarity to these statements that, at least in my opinion, casts psychotropic meds in an unfair light.

If we’re going to about how medications work, that incorporates a couple of distinct concepts.

Part A is what the drug does in the body. What receptors, enzymes, etc. does it interact with, and what is the nature of that interaction?

Part B is how that produces the therapeutic effect. Say we know drug A binds to receptor X — so what? How does that interaction with receptor X lead to a therapeutic benefit?

For most psychiatric medications, science has done a pretty good job of establishing Part A, i.e. what receptors they act at and what they do while they’re there.

So to say we don’t know how they work, full stop, is misleading.

Let’s look at ketamine as an example. It’s been around for a while as an anaesthetic, and it’s known to work on NMDA and AMPA receptors, affecting the activity of the neurotransmitters glutamate and GABA. Great, so what? Well, it appears to boost levels of the protein brain-derived neurotrophic factor (BDNF), which promotes the creation of new synaptic connections in the brain.

Okay, but what’s the connection to ketamine’s antidepressant effect? That’s where things get more iffy, especially since other drugs that act the same way at NMDA receptors don’t have the same therapeutic effect as ketamine.

Another medication where there’s an element of mystery is lithium.

Lithium does a lot of different things: it affects the enzyme inositol monophosphatase, it affects G-proteins that move substances in and out of cells, it regulates gene expression for growth factors, it affects downstream signal transduction cascades, and it affects the neurotransmitter GABA.

So, lithium gets around. Is it known exactly what part of its activity in the human body produces the therapeutic benefits? Nope. Does that make it a sketchy medication? No. Sure, it has side effects, but like any other medication there needs to be an individual weighing of pros and cons.

The key point here is that the medical field isn’t throwing meds at us without having any clue what they do in the body.

And sometimes, the mechanism of action of the side effects is actually better understood than the therapeutic effects.

When ketamine finally gets Health Canada approval I’m certainly not going to be waiting around for science to figure out which component of its activity is responsible for the therapeutic effect. I just want to feel better.

Originally published at on October 17, 2019.

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle |

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle |