How (we think) medicines work, to help you…
Learn more about your
medicines
Introduction
Section one:
How the brain works (the brain, brain cells, synapses and transmitters)
Section two:
Sections available include how we think medicines work for:
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Depression, OCD, PTSD, anxiety, eating disorders, panic, social anxiety
Bipolar mood disorder
Psychosis and schizophrenia
Anxiety
Sleep and insomnia
Dementia and Alzheimer’s Disease
ADHD
Section three:
Tolerance, dependence and addiction
Combined help
The small print: This booklet is to help you understand about how we think medicines may work for mental health problems.
V01.11 [6-2017] ©2017 MisturaTM Enterprise Ltd (www.choiceandmedication.org). Choice and MedicationTM indemnity applies only to licensed subscribing
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Stephen Bazire, 2017
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Introduction
The philosophical bit
The aim of this book is to help you to
understand medicines for mental health
problems a bit better. If you understand
how medicines might be working you may
then be able to use them better. And then
get the best out of them.
To the best of our current knowledge*
 Our universe started with a bit of a bang
about 18.8b years ago
 Our sun was formed about 4.6b years
ago
 The earth and moon were formed
shortly afterwards
 Life started developing and evolving on
our planet about 3.8b years ago
 There may have been several false starts
and there were several mass extinctions
(just like there is at the moment)
 Dinosaurs ruled the earth from 160m to
66.5m years ago
 Then, about 66.5m years ago, the 15Km
wide Chicxulub meteorite hit Mexico,
wiped out about 75% of all species,
ended the dinosaur era and created the
conditions for other mammals to take
over
 One of those mammals that evolved was
the humans. And we’ve taken over.
* To probably misquote Prof. Brian Cox, if you
measure something three different ways and the
answer is the same each time, it’s probably the
right answer. You can’t be 100% certain but you
can be pretty sure.
In terms of evolution, once we’re past
reproduction age, everything else is a bit of
a bonus. None of us live forever on earth –
very few of us will have many more than
100 trips round the sun.
So, as long as you can survive, differences
don’t matter much to the species as a
whole. They do to the individual, but not
overall. If parts of you are a bit different it
doesn’t really matter. Differences may even
be an advantage or a disadvantage.
How we are and what we look like depends
on many things:
1. Our genes
 We have up to about 20,000 genes (half
from each parent) on 23 chromosomes
 Genes control how we’re built e.g. sex,
hair colour, eyes etc.
 Some control which liver enzymes we
have – and these may change how we
react to some medicines.
 Some genes will control the structure
and receptors we have in our brain. Each
receptor has lots sub-types and variants
 Genes control many other things too.
Think of the humble Brussels sprout. What you think
of Brussels sprouts depends on whether or not you
can taste a chemical in them called PTC. If you can’t
taste PTC, you love sprouts. If you can, they taste
evil. Whether or not you can like them depends on
whether your genes code for a taste of PTC.
2. Environment, experience and time
Our environment e.g. family, upbringing, life
events, what we eat, illnesses and stress,
will mould how we grow and develop.
But what has this got to do with
medicines?
The biggest difference between people is
our brain. The brain is extraordinarily
complex. Each one is unique in billions of
ways. Sometimes it is wired up one way,
sometimes another.
The brain is also always changing over time
(minute to minute, day by day, month by
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month) and reacts to events and adapts to
these.
Not all of the changes are for the better in
the 21st Century, when we are all expected
to function fully all the time. And of course
as we get older things don’t always work as
well as they used to.
How we at C&M think of it is that if you
need to take a bit of a chemical to make the
body work better that’s a real bonus. And if
that is in the brain we shouldn’t think of it
any differently to physical health. Does
anyone have a stigma if they need a bit of
extra thyroid? Pain-killers for arthritis?
Drugs to reduce blood pressure? The same
should be true of the brain. If you feel
rubbish and something helps you feel better
or can cope better, that’s great. They’d
have loved that 200 years ago.
As someone once said to me “Life may not
be perfect on medicines but it’s a whole lot
better than without.”
Choice of medicines
The effects of all medicines are different
and depend on:
 Their chemical structure or shape, and
their chemical group
 The dose
 How and when it is taken e.g. timing
 Your genes.
The choice of medicines is based on:
 Drug – we have very little to guide us
yet on which one to choose
 Dose – getting the right balance
between the effects we want and the
ones we don’t want. You need enough
to reduce the symptoms without giving
you side effects that are worse than the
symptoms
 Side effects – which ones you get and
how you and your body can cope with
them.
Symptoms and problems will change with
time, so drugs and doses may need to be
changed or at least tweaked sometimes.
That’s not a failure, that’s life.
What this book is based on is huge amounts
of research over the years. We will try to
give you an overview of a very complicated
topic.
But, remember, you are unique. There is no
such thing as an average brain, just as
there isn’t an average for most things. Like
the Americans who designed an aircraft
pilot’s seat to fit the average airman size,
only to find that not a single pilot was
actually of “average” size!
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Section one – how the brain works
1.1 The brain
It may be that “Your head tells you that you need to take medication, but your heart says you
don't want to". In order to help you make your own decisions, it is useful to have an idea about
how medicines work. This is the aim of our booklet.
In order to try to understand a little about how medicines are thought to work, it is best to first
learn a few facts about the human brain. Each human being has:
One head and one brain.
Each brain has somewhere around 10,000,000,000 brain
cells. These brain cells are called neurones.
Each brain cell has many links or connections with other
brain cells. These are through nerve fibres (called axons).
These are the wiring that connects brain cells.
There are about 4 million miles of nerve fibres or axons in
each brain. That’s enough to stretch to the moon and back
eight times.
All nerve fibres have branches. Many can have up to
10,000 branches in them.
At the end of each nerve fibre is a junction with another
brain cell. These junctions are called synapses (circled in
the drawing).
As you can see, overall the brain is an extraordinarily complex part of the body.
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1.2 Synapses (the junctions between brain cells)
Synapses are very important because:
1. They are the way that brain cells talk to each other
2. Synapses are of the same basic design everywhere in the body e.g. in the brain, the heart,
the legs etc.
3. There are rather a lot of them in each brain - probably around 100,000,000,000
4. If we can get chemicals (e.g. medicines) into the gap between them in the brain, we can
affect the way in which brain cells talk to each other. We can calm messages down or boost
them.
 For example, caffeine, alcohol, paracetamol, some laxatives and triptans for migraine are
all chemicals that get into synapses and can calm down or boost messages in the brain.
A synapse looks a bit like this:
In the drawing you will see the following:
 Axons – these are nerve fibres. A neurone (brain call) has thousands of axons
 Transmitters - these are small chemicals used by brain cells as messengers. They are
stored in the vesicles in the nerve ending ready to be released. There is only one type in
each nerve ending. A transmitter that is used in the brain is called a neurotransmitter.
 Vesicles – these are the little packages that contain the transmitter.
 Receptors - these are structures on the surface of the receiving axon which have a slot
designed just for the transmitter. Think of it like this: if the transmitter is a key, receptors
are the lock into which they fit. A bit like a Yale key and a Yale lock.
 Enzymes - these surround the synapse and break down any spare transmitter that might
leak out. This stops any spare transmitter setting off the next nerve.
 Calcium channels – these control the action of glutamate and noradrenaline, which are the
main excitatory or alerting messengers. They speed up or slow down the effects of
glutamate and noradrenaline
 Reuptake pump – this sucks any spare or used transmitter back up into the nerve ending.
It can then be reused.
On the next page we’ll show you how it all works.
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1.3 What happens when a message is passed from one brain cell to
another
1
An electrical message or impulse is sent from the brain cell
down one of the nerve fibres towards the synapse. It travels
down the nerve fibre a bit like an electrical ‘Mexican Wave’.
Some messages travel at over 250 miles an hour. Others can be much
slower e.g. pressure at 150mph and pain at 2mph. This is why when you
stub your toe you feel the pressure just before the pain.
2
This message arrives at the synapse at the end of the axon.
When it arrives it triggers the chemical transmitter to be
released from the vesicles in the nerve ending.
3
The transmitter travels across the gap from the first nerve
fibre to the next/receiving axon. The transmitter hits a
receptor on the other side. It fits into it just like a key fitting
into a lock.
4
When the transmitter hits the receptor, the receptor changes
shape. This is the trigger for changes inside the nerve ending.
These changes set off an electrical message in that axon
which then travels down the axon to the brain cell.
5
The message arrives at the brain cell, which then decides
what to do. Meanwhile, the synapse deals with the
transmitter.
6
Most of it is taken back up again into the nerve ending i.e. it is
recycled. This is called re-uptake. Some transmitter is broken
down by the enzymes.
7
The axon and synapse is then ready for next message.
Other things to know:
 Messages are only passed in one direction
 There is only one type of transmitter per synapse
 The transmitter allows an electrical message to be turned into a chemical message and back
into an electrical message
 When a receptor is hit by a receptor, there is usually a quick effect. There may also be a
slower effect sometimes that may affect the way the brain cell works
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1.4 Transmitters or neurotransmitters
There are over about 100 different known transmitters in the brain, but about 10 of them do
99% of the work. These transmitters in the brain tend to be grouped together in pathways.
Each group or pathway seems to have specific roles in the brain.
Transmitter
Serotonin or
5-HT
The main things it seems to do
In the brain, serotonin helps control
mood, emotions, sleep/wake, feeding
and temperature
In the body, serotonin helps control
blood pressure and your intestines.
Dopamine
The first pathway in the brain
(there are three controls muscle tension. It tells the
main groups or muscles to relax.
pathways of
The second pathway controls
dopamine
"perceptions" e.g. emotions, reward,
neurones in the drive, pleasure, appetite and deciding
brain)
what is real or important.
The third pathway controls a
hormone called prolactin.
Noradrenaline
(NA)
(also called
norepinephrine
or NE)
Acetylcholine
(ACh)
In the body, noradrenaline controls
the heart and blood pressure.
In the brain, it controls sleep,
arousal, wakefulness, mood, focus,
attention, emotion and drive.
In the body, acetylcholine passes the
messages that make muscles tighten
up. In the brain, it controls arousal,
memory, how well you learn tasks,
and remember things.
In the brain it keeps us awake.
In the body it is part of the immune
system.
Glutamate acts as an "accelerator" or
alerter in the brain
Some problems if it gets out of balance
Too much serotonin in the brain and you
may feel sick, less hungry, and get
headaches or migraines.
Too little in the brain and you may feel
depressed, feeling suicidal and sleep badly.
Not enough dopamine in the first pathway
and your muscles tighten up (e.g. as
happens in Parkinson’s Disease).
Too much dopamine in the second pathway
leads to an overactive brain i.e. too much
“perception" e.g. you may see, hear or
imagine things that are not real.
Too little dopamine in this pathway and
your prolactin goes up, leading to stopping
periods and starting breast milk production.
Too much noradrenaline and you may feel
anxious, jittery, panicky and shake.
Too little noradrenaline in the brain and
you may feel depressed, sleepy and dizzy.
Too little in your body can give you a dry
mouth, blurred vision and constipation. If
you have too little in the brain you may
become confused, sleepy, slow at learning
and have a poor memory.
Histamine
Too little and we become sleepy
Too much can lead to too much
inflammation e.g. as in hay fever
Glutamate
Too much and you may become anxious
and some parts of your brain may become
overactive, psychotic or have seizures. Too
little and you become sleepy or sedated.
GABA (Gamma- GABA acts as a "brake" in the brain,
Too much and you become sleepy,
AminoButyric
relaxes it and helps give it a sense of forgetful or sedated. Too little and you may
Acid)
well-being.
become anxious, restless and excited.
We don’t always know why but some of these transmitters can get out of balance e.g. you can
have too much or too little. This can then be the cause the symptoms.
Nearly all known mental health medicines act in one of several ways:
1. Block the receptors, to reduce the effects from having too much of a transmitter
2. Boost the message by e.g. by stimulating receptors or blocking the transmitters’ reuptake,
which increases their activity. This reverses the effect of having too little transmitter.
3. Block the enzymes - this stops the breakdown of transmitter, increasing how much is there.
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