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This chapter describes the main drugs used in affective disorders. Many drugs produce euphoria in normal subjects and some of these, at least temporarily, lighten mood in depressed patients. However, a characteristic of antidepressant drugs is that they have little effect on mood in normal subjects, yet restore normal mood in patients with clinical depression. Similarly, some drugs which are effective in mania (lithium, carbamazepine) have little effect on mood in normal subjects.

This chapter describes drugs that exert major actions on reward and punishment systems and are all drugs of dependence. Some have potent effects on pain systems and are of therapeutic importance (narcotic analgesics), but all are also used as recreational agents because of their rewarding properties. Antidepressant drugs and drugs which induce depression also affect reward and punishment systems.

This chapter describes neurotrophins as regulators of visual cortical plasticity. It illustrates that brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are popular candidate molecules for synaptic plasticity. It supports the hypothesis that antidepressant drugs might increase neuronal plasticity in the cortex at least partially by activating BDNF signaling in brain. This chapter also shows the role of antidepressants as enhancers of plasticity, which is consistent with the fact that these drugs are successfully employed for the treatment of many neuropsychiatric disorders in addition to depression, including anxiety, obsessive-compulsive disorder, chronic pain, and eating disorders.

It wasn't until I had a profound personal experience with mental illness in my family that I started covering psychiatry and psychology. In the late 19905, my son, Alex, was diagnosed with bipolar disorder. A few years later, my daughter, Alicia, began suffering from repeated bouts of severe depression. Even after they became ill, I resisted turning my reporting to mental health. But as I continued to experience the suffering that these illnesses can cause, I finally succumbed. If I was going to help my children, I needed to learn a lot more about psychiatry, both research and treatment. With a background covering research, I could have confined my reporting to published studies and conferences, the bread-and-butter of science coverage. But I quickly realized that by taking that approach, I would be getting only a small piece of the story. For one thing, research in the behavioral sciences is, as I had always suspected, at a rather primitive stage. Researchers know far more about the heart, the kidneys, and tumor cells than they do about the brain. That's understandable; the brain is a far more complex organ. The scandal, however, is that what is known about the brain is rarely taught to psychiatrists. “Most of the more advanced training for psychiatric residents is really apprenticeship training in which brain science plays little or no part,” write the Harvard psychiatrist J. Allan Hobson and the writer Jonathan A. Leonard in their book, Out of Its Mind: Psychiatry in Crisis (2002). “The brain science knowledge of many practicing psychiatrists remains mostly informal or even anecdotal, leaving psychotherapy and psychopharmacology separated, isolated, and diminished at a time when brain science has the ability to nourish and combine them in an empowering fashion.” The message to reporters is that if we are to understand psychiatry, psychology, and mental illness, and write capably about them, we must do more than peruse the scientific journals and attend the neuroscience meetings. We need to get out there in the trenches, by which I mean the homes and the minds and hearts of the families who are suffering from mental illness.

Over the past three decades, the media has bombarded the public with a seemingly endless array of risks, from the familiar to the exotic: hormone replacement therapy, anthrax, mad cow disease, SARS, West Nile virus, radon, vaccine-associated autism, childhood obesity, medical errors, secondhand smoke, lead, asbestos, even HIV in the porn industry. A drumbeat of risks to worry about, big and small, with new studies often contradicting earlier ones and creating further confusion. It's gotten so bad that some people feel like they're taking their lives in their hands just trying to order a meal at a restaurant. “Will it be the mad cow beef, the hormone chicken, or the mercury fish?” asks an imperious waiter in one of my favorite cartoons from the Washington Post. “Urn ... I think I'll go with the vegetarian dish,” the hesitant diner responds. “Pesticide or hepatitis?” the waiter asks. The diner, growing ever more fearful, asks for water. The waiter persists: “Point source, or agricultural runoff?” Perhaps it's time for the media to become part of the solution rather than continuing to be part of the problem. Ideally, science journalists could lead the way toward improved risk coverage that moves beyond case-by-case alarms—and easy hype—to a more consistent, balanced approach that puts the hazard du jour in broader perspective. The challenge is to create stories with chiaroscuro, painting in more subtle shades of gray rather than extremes of black and white. Too often, as my late Washington Post colleague Victor Cohn once said, journalists (and their editors) gravitate toward stories at either extreme, emphasizing either “no hope” or “new hope.” Unfortunately, today's “new hope” often becomes tomorrow's “no hope” (which is a good reason for avoiding words like “breakthrough” or “cure” in the first place). Hormone replacement therapy (HRT) is a classic example of this yo-yo coverage. In the '60s and '70s, the media helped overpromote hormones as wonder drugs for women, promising everlasting youth as well as a cure for hot flashes. Concerns rose, however, with reports of possible links to cancers of the breast and uterus. Later, when the uterine cancer risk was shown to return to normal by adding an additional hormone, the publicity about HRT became mostly positive again, emphasizing its potential to protect against bone loss and heart disease.