16.2 Biomedical Therapy Notes

16.2 Biomedical Therapy

Overview of Biomedical Therapy Options

  • Biomedical therapy refers to treatments focusing on biological or physiological explanations for mental illness, primarily targeting the brain.

  • Early historical theories related to mental illness, although discredited, serve as critical touchpoints in the evolution of modern treatments.

Historical Context

  • Hippocrates and the Theory of Humors

    • Believed that mental illnesses were caused by an imbalance of four bodily fluids (humors): blood, black bile, yellow bile, and phlegm.

    • Too much black bile was associated with depression; too much blood with aggression and mania.

    • Treatments included exercise, dietary changes, and alterations in sexual behavior.

  • Trephination

    • An ancient practice involving drilling holes into the skull, believed to release demons or evil spirits.

    • Evidence dates back up to 12,000 years with findings from various locations like East Africa, South America, and France.

Modern Biomedical Treatments

Electroconvulsive Therapy (ECT)

  • A treatment historically associated with shock therapy aiming to induce controlled seizures to treat severe depression.

  • Initial therapy methods were considered brutal, involving insulin shock or hydrotherapy.

  • Evolution of ECT:

    • ECT has undergone significant modifications to become a safer treatment environment.

    • Early treatments resulted in severe side effects, including memory loss and sometimes were not therapeutically beneficial.

    • Currently, ECT is used as a last resort for severe long-term depression or bipolar disorder when other treatments have failed.

    • Modern ECT involves careful monitoring and sedation for patient safety, with sessions typically administered three times a week for two weeks or longer.

    • Reliable side effects include temporary loss of recent memories.

    • Possible Mechanism of Action: ECT may support brain plasticity by promoting new growth and eliminating unused neural synapses

    • ECT is effective but still considered a last resort due to remaining unknowns about its mechanisms (Boukert et al., 2014; Slate et al., 2017).

Therapeutic Drug Options

  • The pharmaceutical industry has significantly contributed to mental health treatment through psychoactive drugs.

  • Key Concerns:

    • Reliance on drugs vs. exploring therapeutic options, ethicality of over-prescription, and understanding the placebo effect in treatment efficacy.

Classes of Psychoactive Drugs

  1. Antidepressants

    • Monoamine Oxidase Inhibitors (MAOIs):

    • Discovered in the 1950s; block breakdown of serotonin, norepinephrine, and dopamine, increasing their availability and thereby boosting mood.

    • Tricyclic Antidepressants:

    • Invented in the late 1950s to 1960s; block neurotransmitter reuptake, thus uplifting brain levels of serotonin and norepinephrine.

    • Common side effects include weight gain, constipation, dry mouth, and dizziness.

    • Selective Serotonin Reuptake Inhibitors (SSRIs):

    • Developed in the late 1980s; work solely on serotonin reuptake and are currently the most popular antidepressant class.

    • Examples: fluoxetine and paroxetine.

    • New Generation Options:

    • Serotonin-norepinephrine reuptake inhibitors (SNRIs) and ketamine are recent advancements for treating those resistant to SSRIs.

  2. Anti-Anxiety Drugs (Anxiolytics)

    • Designed to alleviate excessive worry and anxiety.

    • Main drugs: benzodiazepines such as chlordiazepoxide, diazepam, and alprazolam enhance GABA activity.

    • While effective short-term, these drugs pose risks of addiction.

  3. Stimulants

    • Commonly used for ADHD; improve attention and concentration by enhancing the release of dopamine and norepinephrine.

    • Significant historical examples: amphetamine and methylphenidate (Ritalin).

  4. Antipsychotics

    • Developed for schizophrenia; categorized into typical (e.g., chlorpromazine) and atypical drugs that may also block serotonin receptors.

    • Unwanted side effects include movement disorders and weight gain, though atypical antipsychotics generally yield fewer adverse effects.

  5. Mood Stabilizers

    • Used primarily for bipolar disorder to easily manage mood swings.

    • Lithium, the first mood stabilizer, impacts sodium transport in neurons, although its efficacy and mechanisms are still partially understood.

    • Anticonvulsants (e.g., valproic acid, lamotrigine) are also effective mood stabilizers.

Controversies Surrounding Biomedical Therapies

  • The increasing prescription rates for antidepressants spark debates regarding over-reliance, efficacy, the placebo effect, and the stigma attached to their use.

    • Prescription numbers for antidepressants grew from 18.4 million in 1998 to 70.9 million in 2018 (Bagoics et al., 2021).

    • Some studies suggest that several well-known antidepressants did not perform significantly better than placebos (Kirsch et al., 2008).

    • Issues are raised about the potential for over-medication, particularly when environmental factors might contribute to mental states.

Additional Biomedical Approaches

  1. EMDR (Eye Movement Desensitization and Reprocessing)

    • Formulated for PTSD, the therapy helps reshape memory storage of traumatic events through guided eye movements, yet its efficacy remains debated amidst mixed study results.

  2. Biofeedback

    • Aims to provide control over involuntary functions (e.g., heart rate) by measuring physiological responses; encourages relaxation techniques to manage stress and mood.

  3. Light Therapy (Phototherapy)

    • Common in treating Seasonal Affective Disorder (SAD) by mimicking natural light to boost serotonin and help regulate circadian rhythms.

  4. Transcranial Magnetic Stimulation (TMS)

    • Non-invasive treatment delivering magnetic pulses to the brain’s cortex to potentially improve mood; used in treatment-resistant depression and OCD.

  5. Deep Brain Stimulation (DBS)

    • Involves surgically implanting electrodes to stimulate specific brain regions; regarded as a last resort for severe depression.

  6. Exercise

    • Questionable effects: Some studies show improvement in anxiety and mood, while others suggest increased anxiety levels can occur.

    • Recommended exercises include rhythmic and aerobic activities, typically low to moderate intensity, performed regularly (3x a week).

Effectiveness of Biomedical Therapies

  • Varying effectiveness examples:

    • ECT yields rapid effects for depression yet benefits are transient (Tokutsu et al., 2013).

    • Lithium's long-term efficacy in bipolar treatment is inconsistent (Karney & Goodwin).

    • Antipsychotic effectiveness is mainly for positive symptoms (e.g., hallucinations), but less so for negative symptoms (e.g., emotional lack).

    • Antidepressants’ effectiveness relative to placebos raises concerns about reliance on pharmacotherapy alone.

    • Newer methods like TMS and DBS are promising yet pose implementation complexities.

  • Integration of biomedical therapies with psychotherapeutic practices has widespread support amongst professionals, advocating a combined treatment approach for optimal outcomes.