Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

threshold. Thus, for example, while the average dosage of oxcarbazepine needed to prevent seizures typically ranges between 600mg and 1200mg per day, the average dosage needed to prevent psychiatric symptoms typically ranges between 150mg and 600mg per day. In fact, some psychiatric patients have been observed to respond to oxcarbazepine doses as low as 50-100mg per day. The same phenomenology has been observed with other anticonvulsants, such as gabapentin, depakote, lamotrigine, and topiramate [90]. Of course, lower dosing is also easier when treating psychiatric disorders because, unlike when treating seizure disorders, the therapeutic effect is observable almost immediately. What’s more, anticonvulsant stacking, which is commonly employed in neurology, is not only effective in psychiatry but is apt to be even more effective than in neurology because the target abnormality is entirely reversible. Indeed, it has been said that the potential benefits of anticonvulsants in the treatment of psychiatric disorders may overshadow those that have been observed in the treatment of seizure disorders [91]. Long-term, anticonvulsants may even be protective against the development of various disease states [67, 68]. IX. D irections for F uture R esearch Urgently needed are clinical studies comparing the benefits of focused neuroregulation to standard treatment for a variety of psychiatric disorders. Such studies should also compare the number of different medications needed to control symptoms, the side effect burden of those medications, and the duration of effect of those medications. They should also compare the effect of those medications on resting heart and respiratory rate measurements. If these studies yield promising results, longer-term prospective studies could be performed to assess the potential for early treatment with neuroregulators to delay or even prevent the development of various chronic diseases. X. C onclusion The well-recognized problems of diagnostic ambiguity, polypharmacy, and side-effect burden in the treatment of psychiatric disorders has the potential to be solved by shifting the treatment of these disorders from a symptom-based approach to a pathology-based approach. Guided by the MCNH hypothesis, neuroregulators could be started at comfortably low doses and then titrated rapidly to clinical improvement. Because neuroregulators work to normalize brain function, they can also be combined with one another just as they are in the treatment of epilepsy. Moreover, because neuronal hyperexcitability tends to dysregulate virtually every system of the body, treatment with neuroregulators could be as medically protective as it is psychiatrically beneficial. With less than half of all persons who need psychiatric care actually seeking care, and many of those who do seek care shying away from psychotropic medication, the need for better education about what abnormality is being treated and a more targeted approach that uses fewer medications, at lower doses, and with fewer side effects is evident. All of these needs could potentially be met by targeting what is hypothesized to be the underlying driver of mental illness. By seizing this long-awaited opportunity, we can strive toward a future in which behavioral healthcare, like other fields of medicine, is aimed at specific pathological processes, thus streamlining care, speeding recovery, and helping to overcome the long- held stigma of mental illness. Conflicts of Interest The author declares that he has no competing interests. R eferences R éférences R eferencias 1. Voineskos D, Daskalakas, ZJ, Blumberger, DM. Management of treatment-resistant depression: challenges and strategies. Neuropsychiatric Disease and Treatment 2020; 16: 221-234. 2. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D Report. American J. Psychiatry 2006; 163 (11): 1905-1917. 3. Kukreja S, Kalra G, Shah N, Shrivastava A. Polypharmacy inpsychiatry: A review. Mens Sana Monogr 2013; 11 (1): 82-99. 4. Mental health has bigger challenges than stigma. Rapid Report Mental Health Million Project 2021. https://mentalstateoftheworld.report/wp-content/ uploads/2021/05/Rapid-Report-2021-Help-Seeking. pdf. (Accessed 7/20/2023). 5. Conroy J, Lin L, Ghaness A. Why people aren't getting the care they need. American Psychological Association 2020; 51 (5). 6. 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