Treatment Techniques 2: Biological Therapies

four major types of psychotropics

1. antipsychotics
2. antidepressants
3. mood stabilizers
4. anxiolytics

What do antipsychotics (neuroleptics) treat?

psychotic behavior

major neurotransmitter affected by antipsychotics

↓ dopamine

* blocks receptor

common side effects for antipsychotics

1. motor abnormalities
* Receptors are not selectively blocked.

What neurotransmitter alteration causes schizophrenia?

↑ dopamine

What do antidepressants (ADs) treat?

1. unipolar depression
2. anxiety

major neurotransmitters affected by antidepressants

1. ↑ serotonin
2. ↑ norepinephrine
3. ↑ dopamine

1st line antidepressants

1. SSRI (selective serotonin reuptake inhibitors)
2. SNRI (seretonin-norepinephrine reuptake inhibitors)

common side effects of 1st line antidepressants

1. GI distress
2. sexual dysfunction

2nd line antidepressants

1. TCA (tricyclic antidepressants)
2. MAOI (monoamine oxidase inhibitors)

What is the mechanism of action for MAOIs?

inhibits enzyme that degrades monoamines

common side effects for 2nd line antidepressants

1. blood pressure changes

What do mood stabilizers treat?

bipolar disorders (manic-depression)

Which drugs are used as mood stabilizers?

1. lithium
2. select anticonvulsants
3. select antipsychotics

What do anxiolytics treat?

anxiety

major neurotransmitters affected by anxiolytics

↑ GABA

* depresses brain activity
* use only short term due to addiction risk

Which drugs are used as anxiolytics?

1. antidepressants
2. benzodiazepines

How long do psychotropics usually take to have a therapeutic effect?

4-6 weeks

* exception of benzodiazepines

reasons for medication non-compliance by mentally-ill patients

1. impatience leading to premature drug discontinuation
2. side effects
3. symptoms of mental illness
4. financial factors

types of brain stimulation techniques

1. electroconvulsive therapy (ECT)
2. repetitive transcranial magnetic stimulation (rTMS)
3. magnetic seizure therapy
4. vagus nerve stimulation (VNS)
5. deep brain stimulation (DBS)

electroconvulsive therapy (ECT)

using an electrical stimulus to the brain to induce a generalized seizure to improve mood

process of electroconvulsive therapy (ECT)

1. Patient is given a muscle relaxer to prevent injury and anesthesia to reduce consciousness.
2. frontotemporal placement (unliateral or bilateral)
3. generalized seizure for ≥ 30 seconds

indications for using electroconvulsive therapy (ECT)

mood disorders


1. treatment-resistant depression/mania
2. severe depression or mania
3. pregnant depressed patients

contraindications for using electroconvulsive therapy (ECT)

no absolute contraindications


1. caution if patient has vascular disease

↑ BP during seizures

initial side effects of ECT

1. cardiac arrhythmia
2. headache
3. confusion
4. memory loss for recent long-term memory
5. learning problems

long-term side effects of ECT

1. no permanent memory system problems
* memory abilities normalize after a few months post-treatment

What is the effectiveness of ECT?

generally safe and effective


1. rapid clinical improvement of mood episode
2. used to treat the acute phase of illness (NOT PREVENTION STRATEGY)

What is repetitive transcranial magnetic stimulation (rTMS) used for?

depressed patients who have failed at least one medication trial

mechanism of action for repetitive transcranial magnetic stimulation (rTMS)

stimulation of the prefrontal cortex using electromagnetic pulses

* no inducing seizures

side effects of rTMS

minimal side effects


1. scalp discomfort at stimulation site

How long does rTMS take to have a therapeutic effect?

4-6 weeks

* daily sessions of 45 mins

effectiveness of rTMS

not as effective as ECT

* fewer side effects than ECT

What is magnetic seizure therapy (MST) used for?

mood disorders

T/F: Magnetic Seizure Therapy (MST) is an approved technique for improving mood disorders.

False: It is still experimental and not yet approved.

mechanism of action for MST

combination of rTMS and ECT


1. electromagnetic stimulation (rTMS)
2. produces focal seizures (ECT)

What is Vagus Nerve Stimulation (VNS) used for?

treatment-resistant depression

mechanism of action for VNS

electrical stimulation of the vagus nerve using an implanted wire in the neck and a pacemaker device in the chest

How long does VNS take to have a therapeutic effect?

several months

What is deep brain stimulation (DBS) used for?

severe, treatment-resistant obsessive-compulsive disorder

mechanism of action for DBS

electrical stimulation using an implanted electrode and a pacemaker device in the chest

side effects of DBS

1. risk of infection
2. brain hemorrhage

How long does DBS take to have a therapeutic effect?

several months

psychosurgery

surgery that destroys brain tissue to change behavior

purpose of prefrontal lobotomy

to treat mental disorders by cutting the nerves connecting the frontal lobes to the emotion centers of the brain

Who is psychosurgery approved for today?

patients with severe and treatment-resistant obsessive-compulsive disorder (OCD)