Conceptual and pragmatic clinical implications of dichotomizing psychotropics as targeting physiology - physiomodal and pathology - pathomodal

Summary Conventional antidepressant, antipsychotics and mood stabilising drugs share several characteristics. Firstly, they have a slow onset of action with benefits accruing late that is broadly mediated by long term homeostatic processes. Response generally predicts long term maintenance effects. They have little or no effect on the mental state of healthy individuals and can be conceptualised as targeting elements of pathophysiology. We can term them pathomodal. In contrast, psychotropic agents that are repurposed recreational drugs also share several effects. They have a rapid effect on mood states or perception and risk withdrawal symptoms that are generally the phenomenological mirror image of their acute effects and hence risks accrue late. Notwithstanding some heterogeneity, long term benefits are less clear than acute effects. Lastly, their effects are evident in all people who take them, and they can therefore be conceptualised as targeting elements of physiology. We can term them physiomodal. This categorisation has several implications for both research design and clinical care.