Biomedical Therapies

1. Biomedical Therapies • Review: Drug or Placebo Effect? For many people, depression lifts while taking an antidepressant drug. But people given a placebo may experience the same effect. Double-blind clinical trials suggest that especially for those with severe depression, antidepressant drugs do have at least a modest clinical effect. • Psychopharmacology is the study of drug effects on the mind and behaviour. For 'mind' read brain. • First were the antipsychotic drugs, such as chlorpromazine (Andrew Laeddis was in withdrawals from this in 'Shutter Island'.) Diminished positive symptoms of schizophrenia, such as auditory hallucinations and paranoia. (Lehman et al., 1998). • Side effects: tardive dyskinesia -- involuntary movements of the facial muscles, such as grimacing.

2. Biomedical Therapies Cont'd • Risperdal and Zyprexa also control schizophrenia symptoms, but they increase the risk of obesity and diabetes. (Buchanan et al., 2010). • Antianxiety drugs depress CNS activity. • D-cycloserine acts upon a receptor that in combination with behavioural treatment, facilitates the extinction of learned fears. Experiments indicate that the drug enhances the benefits of exposure therapy and helps relieve the symptoms of PTSD. (Kushner et al., 2007). • In the last decade of the 20th, the rate of outpatient treatments for anxiety nearly doubled. The proportion of psychiatric patients receiving medication increased from 52 to 70%. (Olfson et al., 2004).

3. SSRI drugs • Aka Antidepressants, but better described as Selective Serotonin Reuptake Inhibitors. They slow the synaptic 'vacuuming-up' of serotonin. • Fig. 54.1 (m706 c 16.5 677) will be on the next exam. • Potential side effects: dry mouth, weight gain, hypertension & dizzy spells. (Anderson, 2000). • Administration by patch bypasses the intestines and liver, helping to reduce such side effects. (Bodkin & Amsterdam, 2002). • The drugs influence neurotransmitters within hours, but the full psychological effect (lifting of mood) requires four weeks. • Increased serotonin produces neurogenesis--the birth of new brain cells, perhaps reversing the stress-induced loss of neurons. (Becker & Wojtowicz, 2007).

4. Mood Stabilizers The simple salt lithium is an effective mood stabilizer. After suffering mood swings for years, 7 in 10 patients can become perfectly well in less than a week. (Snyder, 1986). It eases manic episodes, and to a lesser extent, lifts depression. (Solomon et al., 1995). It also protects neural health, thus reducing bipolar patients’ vulnerability to future dementia. (Kessing et al., 2010). Lithium reduces bipolar patients’ risk of suicide to about 1/6 of bipolar patients not taking lithium. (Tondo et al., 1997). Also effective is Depakote, a drug originally used to treat epilepsy and more recently found to control manic episodes associated with bipolar disorder.

5. Brain Stimulation Electroconvulsive Therapy aka Shock Treatment. Fig. 54.2 ECT is an effective treatment for severe depression in ‘treatment resistant’ patients who have not responded to drug therapy. (Bailine et al., 2010). Perhaps shock-induced seizures calm neural centers where overactivity produces depression. (Bolwig & Madsen, 2007). Placebo effect instead? Most ECT studies fail to contain a control condition in patients are randomly assigned to receive the same general anesthesia and simulated ECT without the shock. When given this treatment, the positive expectation is therapeutic without the shock. (Read & Bentall, 2010). Most endorsements are testimonials, not proofs.

6. rTMS and Psychosurgery Repetitive Transcranial Magnetic Stimulation: Depressed moods seem to improve when repeated pulses surge through a magnetic coil close to a person’s skull. Modest positive effects. (Daskalakis et al., 2008) rTMS may stimulate the brain’s left frontal lobe, which is relatively inactive during depression. (Helmuth, 2001). Repeated stimulation may cause nerve cells to form new functioning circuits through the process of long-term potentiation (LTP). Deep-Brain Stimulation focuses on a neural hub the bridges the thinking frontal lobes to the limbic system. This area is overactive in the brain of a depressed or temporarily sad person. (Mayberg, 2009) Prefrontal lobotomy: cutting the nerves connecting the frontal lobesto the limbic system. Makes zombies!