6 21 13 METHODS OF THERAPY C H A P T E R 1 6 BIOLOGICAL TX Popular Why Gene6c basis of some dx Brain abnormali6es associated with some dx Promo6on of biomedical solu6ons 1 6 21 13 DRUGS Most common biological tx Alter producGon of or response to chemical messengers MAIN CLASSES OF DRUGS USED IN THE Tx OF MENTAL AND EMOTIONAL Dx ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE ANTIPSYCHOTICS Used primarily in the tx of schizophrenia and other psycho6c dx Can reduce agita6on delusions hallucina6ons shorten schizophrenic episodes O ers liMle relief from jumbled thoughts di culty concentra6ng apathy emo6onal atness di culty interac6ng with others O label and inappropriate uses major depression bipolar dx au6sm ADHD demen6a etc ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE EXAMPLES First genera6on Thorazine Haldol Second genera6on Clozaril Risperdal Zyprexa Seroquel ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 2 6 21 13 HOW THEY WORK Psychoses are thought to be caused by an excess of dopamine therefore an6psycho6c drugs may Block or reduce e ects or levels of dopamine Increase e ects of serotonin which inhibits dopamine ac6vity ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE THE DARK SIDE Side e ects may include Involuntary muscle movements may develop into tardive dyskinesia Extreme weight gain 24 100lbs year leads to increased risk of diabetes stroke sudden heart failure 90 of an6psycho6cs are second genera6on but are they any beMer than the older cheaper drugs Ine ec6ve tx for impulsive aggressiveness associated with ADHD demen6a etc ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE ANTIDEPRESSANTS Used primarily in the tx of mood disorders including depression anxiety phobias and OCD Non addic6ve ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 3 6 21 13 EXAMPLES Monoamine oxidase inhibitors MAOIs Nardil Tricyclic an6depressants Elavil Tofranil Selec6ve serotonin reuptake inhibitors SSRIs Prozac Zoloh Lexapro Paxil Celexa ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE HOW THEY WORK MAOIs Elevate levels of norepinephrine and serotonin by blocking an enzyme that deac6vates them Tricyclics Elevate levels of norepinephrine and serotonin by preven6ng the reabsorp6on reuptake of these neurotransmiMers by the transmijng neuron SSRIs Similar to tricyclic an6depressants but speci cally target serotonin MAOIs tricyclics and SSRIs are about equally e ec6ve ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE THE DARK SIDE Side e ects may include physical symptoms including dry mouth headaches cons6pa6on nausea restlessness GI problems weight gain and sexual dysfunc6on ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 4 6 21 13 ANXIOLYTICS Commonly prescribed for pa6ents who complain of unhappiness anxiety or worry ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE EXAMPLES Valium Xanax A6van Klonopin Beta blockers ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE HOW THEY WORK Increase the ac6vity of the neurotransmiMer GABA Beta blockers slow the heart rate and lower blood pressure ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 5 6 21 13 THE DARK SIDE Should not be used over a long period of 6me Risk of dependence Beta blockers are not approved for anxiety dx ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE LITHIUM CARBONATE Usually prescribed to treat bipolar dx Example Lithium May work by modera6ng levels of norepinephrine or by protec6ng neurons from overs6mula6on by glutamate ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE THE DARK SIDE Short term side e ects include tremors Long term side e ects include kidney damage Require careful monitoring Too liMle will not help Too much will be toxic ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 6 6 21 13 CAUTION Why should you be cau6ous Be a cri6cal thinker and a smart consumer Remember your goal is to get be er a drug company s goal is to sell their product ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE WHAT TO KEEP IN MIND Publica6on bias the tendency for academic journals to publish posi6ve ndings This drug worked really well but not nega6ve This drug sucks or ambiguous We re not sure if this is a good drug or a bad drug ndings ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE WHAT TO KEEP IN MIND I feel be er Is it the pill or something else Placebo e ect the apparent success of a medica6on or tx due to the pa6ent s expecta6ons or hope rather than to the drug or tx itself About half of all depressed pa6ents respond to an6depressants Of these only about 40 are responding to biological e ects of the drug Across numerous studies the placebo e ect appears to be the driving force behind these medica6ons usefulness Why The psychological expecta6on of improvement seems to produce similar changes in the brain as do drugs ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE 7 6 21 13 WHAT TO KEEP IN MIND What don t researchers and clinicians know SSRIs and suicidality Even if the drug is meant to be taken for the rest of your life it can be approved aher just a few weeks months or years Almost no research to examine risks and bene ts of combining di erent treatments Why am I being prescribed this mx Once the drug has been approved by the FDA it can be prescribed for any condi6on and or popula6on ANTIPSYCHOTICS ANTIDEPRESSANTS ANXIOLYTICS LITHIUM CARBONATE DIRECT BRAIN INTERVENTION Prefrontal lobotomy Invented by Moniz in 1935 for which he won the Nobel prize Destroy connec6ons between prefrontal lobes to other areas Hypothesis reduce emo6onal sx without impairing intelligence Observa6on pa6ents were apathe6c withdrawn and unable to take care of themselves 40 000 in the United States including JFK s sister Rosemary PREFRONTAL LOBOTOMY SHOCK THERAPY DIRECT BRAIN INTERVENTION Shock therapy Electroconvulsive therapy ECT Electrode is placed on one side of the head and a brief current is turned on which causes a seizure Today pa6ents are given muscle relaxants and anesthesia Used in the treatment of severe depression but sx return within a few weeks or months PREFRONTAL LOBOTOMY SHOCK THERAPY 8