An Evolutionary Approach to Clinical Pharmacopsychology

Rantala, Markus J.; Luoto, Severi; Krams, Indriķis

doi:10.1159/000480709

Cited by 8 publications

(2 citation statements)

References 9 publications

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“…In addition, it merely alleviates the symptoms rather than removing the underlying problem that causes the eating disorder, thus providing a suboptimal long-term solution (cf. Rantala et al, 2017).…”

Section: Current Eating Disorder Treatmentmentioning

confidence: 99%

Eating Disorders: An Evolutionary Psychoneuroimmunological Approach

et al. 2019

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Eating disorders are evolutionarily novel conditions. They lead to some of the highest mortality rates of all psychiatric disorders. Several evolutionary hypotheses have been proposed for eating disorders, but only the intrasexual competition hypothesis is extensively supported by evidence. We present the mismatch hypothesis as a necessary extension to the current theoretical framework of eating disorders. This hypothesis explains the evolutionarily novel adaptive metaproblem that has arisen when mating motives conflict with the large-scale and easy availability of hyper-rewarding but obesogenic foods. This situation is exacerbated particularly in those contemporary environments that are characterized by sedentary lifestyles, ever-present junk foods, caloric surplus and the ubiquity of social comparisons that take place via social media. Our psychoneuroimmunological model connects ultimate-level causation with proximate mechanisms by showing how the adaptive metaproblem between mating motives and food rewards leads to chronic stress and, further, to disordered eating. Chronic stress causes neuroinflammation, which increases susceptibility to OCD-like behaviors that typically co-occur with eating disorders. Chronic stress upregulates the serotonergic system and causes dysphoric mood in anorexia nervosa patients. Dieting, however, reduces serotonin levels and dysphoric mood, leading to a vicious serotonergic-homeostatic stress/starvation cycle whereby cortisol and neuroinflammation increase through stringent dieting. Our psychoneuroimmunological model indicates that between-individual and within-individual variation in eating disorders partially arises from (co)variation in gut microbiota and stress responsivity, which influence neuroinflammation and the serotonergic system. We review the advances that have been made in recent years in understanding how to best treat eating disorders, outlining directions for future clinical research. Current evidence indicates that eating disorder treatments should aim to reduce the chronic stress, neuroinflammation, stress responsivity and gut dysbiosis that fuel the disorders. Connecting ultimate causes with proximate mechanisms and treating biopsychosocial causes rather than manifest symptoms is expected to bring more effective and sophisticated long-term interventions for the millions of people who suffer from eating disorders.

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Section: Current Eating Disorder Treatmentmentioning

confidence: 99%

Eating Disorders: An Evolutionary Psychoneuroimmunological Approach

et al. 2019

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“…The choice of drug will vary depending on the needs. Rantala et al (2017), on the other hand, have adopted an evolutionary perspective. In their publication on evolutionary pharmacotherapy, the authors question the legitimacy (purposefulness) of pharmacotherapy for depression, and not just the achievement of a short-term treatment goal.…”

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confidence: 99%

When drug-centred psychopharmacology meets person-centred psychopharmacotherapy – antidepressants

Murawiec¹

2023

Psychiatr Psychol Klin

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A vibrant discussion on the monoamine theory of depression and the use of serotonergic modulators in the treatment of this disorder was triggered by a systematic review published by Moncrieff et al. in “Molecular Psychiatry” in 2022. Many experts considered this work as referring to a hypothesis that now is only of historical significance. Another publication, co-authored by Moncrieff, proposed a useful approach to both action and clinical use of psychopharmacotherapy. The drug-centred model postulates that psychoactive agents are substances that affect symptoms indirectly, by exerting specific effects on physiological phenomena underlying mental, emotional and behavioural processes. When planning therapeutic strategy, it should be assessed whether the expected effects of a given medication on mental function and behaviour may prove beneficial in a particular life situation of the person being treated. Therefore, pharmacotherapy can be considered in terms of its impact on mental functions, which may turn out positive (not only for depression, but also for anxiety and other disorders), rather than targeting a specific abnormality. The paper presents different approaches within this framework, including a model based on creative person-centred narrative psychopharmacotherapy (CP-CNP) described by Jakovljević. Combining drug-centred and person-centred psychopharmacotherapy may be the basis for understanding the pharmacological treatment of mental disorders. In the context of the controversy aroused by Moncrieff et al., it can be pointed out that agents known to modulate serotonin transmission modify certain serotonin-mediated mental functions, which may aid the treatment of depression and many other conditions. Therefore, it is not a mechanically understood antidepressant effect. Serotonin modulators are useful in the treatment of depression, as evidenced by both scientific research and the experiences of millions of patients. However, these drugs have a complex, multistage action, which needs to be considered to avoid misunderstandings and oversimplifications.

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