Psychiatric drugs or “psychotropics” are prescribed to treat psychiatric disorders and/or psychiatric symptoms. These medications are typically classified according to the disorder/disturbance for which they are most usually employed. Hence, anti-psychotics are prescribed for psychotic conditions like schizophrenia or psychotic symptoms such as delusions (false fixed beliefs), hallucinations (perceptions without a stimulus) or near-delusional ideas such as paranoia/suspiciousness. Similarly, as would be expected, anti-depressants are typically prescribed for depressive disorders; anti-anxiety medications for anxiety disorders; etc.

However, in real clinical practice, the use of psychiatric drugs is not so straightforward. Medications classified in a particular manner (e.g. anti-psychotics) are quite commonly prescribed in a patient who may not have a primary diagnosis that clearly falls under that classification.

• Example 1: A patient with Alzheimer’s disease may be prescribed an anti-psychotic medication even though the primary diagnosis is not psychosis. The Alzheimer’s patient has a primary dementing condition that compromises intellectual and memory functioning, but he/she may also have accessory psychotic symptoms (such as a false belief that a misplaced object has been stolen).
• Example 2: A patient with major depression may be prescribed an anti-anxiety medication even though the primary diagnosis is not an anxiety disorder. The primary diagnosis is depression, but severe anxiety may also complicate the depression such that anti-anxiety medication prescription is deemed adjunctively helpful.

Psychiatric disorders often have overlapping symptoms. For example, apathy might be encountered in depression, schizophrenia, dementia, or be part of a behavioral syndrome following a stroke. Anxiety is regularly seen in panic disorder, depression, obsessive-compulsive disorder, post-traumatic stress disorder, and Alzheimer’s disease. Therefore, medications that might alleviate apathy or anxiety can appropriately be prescribed in very different conditions.

Quite often, psychiatric signs and symptoms do not clearly fit into an easily pigeonholed diagnostic category. The condition may be what is called “sub-syndromal” or may not have yet fully declared itself, like a “brewing” infection that is not fully manifest. Medications may be prescribed in such a circumstance on the basis of what the clinician believes is the most likely diagnosis or might prevent progression of the symptoms to a full-blown syndrome.

Confusingly, psychiatric medications, even if they are classified one way, may have a broader clinical effectiveness profile. For example, medications developed initially as anti-depressants have now also been demonstrated to be effective in anxiety and panic disorders and obsessive-compulsive disorder. One drug may have multiple effective applications. Some anti-epilepsy medications are also effective as “mood stabilizers”, hence have application in the treatment of bipolar disorder or uncontrollable impulsive aggression. The patient does not have epilepsy, yet the medication is effective in treating a serious behavioral problem. Ritalin, which is synthetic amphetamine (a stimulant), is commonly and (paradoxically) effectively prescribed in children with Attention Deficit/Hyperactivity Disorder (ADHD). Yet Ritalin – because of its stimulant properties – is also effectively prescribed in elderly patients with apathetic withdrawal.

With the above in mind, it is important to emphasize that the category of agent (anti-psychotic; anti-depressant; anti-anxiety; etc.) that a prescribed drug falls under does not necessarily define the disorder affecting the patient. For example, just because a patient is on an anti-psychotic medication frequently prescribed to treat schizophrenia does not necessarily mean that the patient has a diagnosis of schizophrenia.

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