The Biomedical Therapies

Biomedical Therapy The previous sections all covered psychotherapy, where directed conversation is used to try to resolve problems. The other, often used with more severe disorders, is biomedical therapy. Biomedical therapy physically changes the brain’s functioning by altering its chemistry with drugs, or affecting its circuitry with electroconvulsive shock, magnetic impulses, or psychosurgery.

Drug Therapies By far the most widely used biomedical treatments today are the drug therapies. Since the 1950s, discoveries in psychopharmacology (the study of drug effects on the mind and behavior) have revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from hospitalization and confinement. Thanks to drug therapy, the resident population of mental hospitals is a small fraction of what it was half a century ago. Like with most drugs, psychopharmaceuticals are subjected to drug testing. A double-blind procedure is used, with the drug being compared to a placebo on patients. Many drugs have shown to be useful through double-blind procedure, especially for conditions like severe depression.

Antipsychotic Drugs The drug therapy revolution began with serendipitous discoveries that certain drugs, used for other medical purposes, calmed patients with psychoses (disorders in which hallucinations or delusions indicate some loss of contact with reality). These antipsychotic drugs (drugs that treat schizophrenia and other psychoses), such as chlorpromazine, dampened responsiveness to irrelevant stimuli. Thus they help block or reduce the “positive” symptoms of schizophrenia, such as auditory hallucinations and paranoia.

Most antipsychotic drugs act as antagonists (remember that word. ) Most antipsychotic drugs act as antagonists (remember that word?). They are similar enough to dopamine to occupy its activity. This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia. Antipsychotics also have powerful side effects. A lack of dopamine can produce sluggishness, tremors and twitches, like in Parkinson’s. (A side note: A drug that helps with Parkinson’s, L-dopa, increases dopamine levels, and has hallucinations as a side effect). Newer drugs have reduced twitching, but can cause obesity and diabetes instead.

Antianxiety Drugs Like alcohol, antianxiety drugs, like Xanax and Ativan, control anxiety and agitation by depressing the nervous system. As such, they should never be combined with alcohol. Antianxiety drugs are often used in combination with psychological therapy. One antianxiety drug, D-cycloserine, acts upon a receptor that, when combined with psychotherapy, can cause the extinction of learned fears.

A common criticism for drug therapies is that they reduce symptoms without trying to resolve the underlying problems. They can also be used as ongoing treatment, and a person may begin “popping a Xanax” at the first sign of tension or stress. They can also be very addictive, with people developing a dependency. Towards the end of the twentieth century, outpatient treatment for anxiety disorders more than doubled.

Antidepressant Drugs Antidepressant Drugs are a category of antianxiety drugs and are used to treat depression, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. They were originally named for their ability to lift people out of a depressive state, but is a bit of a misnomer now because of the variety of disorders they treat. These drugs are agonists; they work by increasing the availability of certain neurotransmitters, such as norepinephrine or serotonin, which elevate arousal and mood, and appear scarce in people with depression and anxiety.

The “Wonder Drug” Fluoxetine, known more commonly by its name brand Prozac, falls into this category of agonist. The mostly commonly prescribed drugs in this group, including Zoloft and Paxil, work by blocking the reabsorption and removal of serotonin from synapses (reuptake). Given their now more widespread use in the treatment of other disorders like anxiety and strokes, they are often called selective serotonin reuptake inhibitors, or SSRIs. Some older drugs blocked the reuptake of both serotonin and norepinephrine. While effective, these would often cause dry mouth, weight gain, hypertension, or dizzy spells.

Alternatives to Antidepressants While medicine can be effective, it’s not the only way to “lift spirits”. Aerobic exercise, which calms anxiety and boosts mood, can do just as much good for people with mild to moderate depression as the drugs. Cognitive therapy is also beneficial, as it allows people to discuss their woes and change their thinking. Ultimately, after accounting for natural recovery and the placebo effect, medicine has a pretty small impact on people with mild to moderate depression. However, for those with severe depression, medicine can be essential.

Mood-Stabilizing Medications As well as the anti-drugs we’ve talked about, psychiatrists (remember, psychiatrists prescribe medicine, psychologists don’t) also use mood-stabilizing drugs. For those suffering the emotional highs and lows of bipolar disorder, the simple salt lithium can be an effective mood stabilizer. This was discovered in the 1940s, when physician John Cade gave lithium to a patient with severe mania who become perfectly well in less than a week. About 7 in 10 people with bipolar disorder benefit from a long-term daily dose of lithium, and it also reduces the risk of suicide in patients with bipolar disorder (1/6th as likely as not taking lithium). Lithium in town water supplies have also been shown to reduce suicide rates (in Japan) and violent crime rates (in Texas).

Electroconvulsive Therapy Electroconvulsive therapy (ECT), is a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient. More commonly called “shock treatment”, the original version had patients strapped down to a table and were shocked while conscious, which would cause convulsions and knock them unconscious. It gained a barbaric reputation for this (and its portrayals in media) which it still has today. These days, the patient is given muscle relaxants and a general anesthetic (which knocks you out), and the psychiatrist runs the current through them for 30 to 60 seconds. The patient remembers nothing from the treatment, and after several weeks, 80% of people show significant improvement with minor memory loss and no brain damage.

Criticisms of ECT The reasons why or how ECT works is still unknown, and this makes many people uncomfortable, and propagates the barbaric label. Some skeptics say it works as nothing more than a placebo, and that some of those who go through a “fake” or placebo ECT (knocked out but no shock) also benefit. The FDA (Food and Drug Administration) states that ECT is more effective than placebo, however.

Magnetic Stimulation Depressed moods seem to improve when repeated pulses surge through a magnetic coil held to a person’s skull. This painless procedure, called repetitive transcranial magnetic stimulation (rTMS) is performed on wide awake patients over several weeks. Unlike ECT, rTMS produces no seizures, memory loss, or other serious side effects (besides the occasional headache). Like ECT, the exact mechanics for how this works are unknown, but it’s possible that it’s due to stimulation of the left frontal lobe, which is (relatively) inactive during depression.

Psychosurgery Psychosurgery is surgery that removes or destroys brain tissue in order to change behavior. Due to its irreversible and invasive effects, it is the most drastic and least used of the biomedical therapies. In the 1930s, physician Egas Moniz developed what is now the best-known psychosurgery: lobotomy. Lobotomy was used to calm “uncontrollably emotional or violent patients” by cutting the nerves that connected the frontal lobes together, which control emotion. This was done by knocking the patient unconscious and jamming what was basically an icepick into their eye sockets, then wiggling the ice pick around to destroy the nerves. Between 1936 and 1954, tens of thousands of people were lobotomized. While lobotomies have long since fallen out of practice, microsurgery is practiced for extreme cases, mostly for seizures.

Therapeutic Lifestyle Change Biomedical isn’t only medicine and surgery. Changing thoughts and lifestyles is now the focus of psychologists. There is an established program that focuses on these points to reestablish healthy brain function: Aerobic Exercise (running, sports, etc): At 3 days a week, 30 minutes each time Adequate Sleep: At least 7 to 8 hours a night Light exposure: At least 30 minutes in the morning under a light box Social Connections: Spending less time alone, at least two meaningful engagements a week Antirumination: Identifying and redirecting negative thoughts Nutritional supplements: Vitamins, including fish oil (omega-3 fatty acid [supports brain function])