|PSY 101 Treatment of Psychological D/Os II: Biomedical ... Therapies (Selected)|
This chart below summarizes the major modes of biological/medical treatment (right hand column) for the most serious mental disorders along with the general psychotherapeutic & social therapies in the far right column. The columns from the left (Cause, Result, Disorder) summarize what we've already covered, i.e., how the disorder may have arisen. What is new are the treatments listed on the right. (Treatment = Tx; Prescribed medication = Rx)
Tx: Anxiety Disorders
- The goal of anti-anxiety medications (Rxs) is to reduce the experience of tension, nervousness, and apprehension experienced by the patient. Since there appears to be a reduction in the amount of GABA (an inhibitory neurotransmitter), the chemical mechanisms for treating anxiety are to increase the amount of GABA available.
Tx: Major Depressive Disorder
- Both Valium and Xanax are used frequently to treat anxiety. They work quickly (ca. 15-30 min.) and are effective in reducing feelings of nervousness, etc. HOWEVER, they have side-effects:
- Individuals can become rather drowsy and lightheaded when using any anti-anxiety medication. Anyone driving or operating heavy equipment needs first to gauge how they respond to these Rxs.
- These medications are often habit forming and can lead to long term addiction.
- Alcohol is also a chemical which increases the amount of GABA. When alcohol is used at the same time as either Valium or Xanax, there is a real risk to the patient that the inhibitory effects of GABA will become dangerous, that is, too heavy sedation may result in difficulty breathing. The effects of alcohol and medications are INTERACTIVE and MULTIPLICATIVE, not additive.
- There are three general types of anti-depressant medications. They are
- MAO Inhibitors (MAOIs): These are medications that inhibit the enzyme monoamine oxidase which normally breaks apart neurotransmitters like serotonin and norepinepherine. By inactivating the MAO, there is more neurotransmitter molecules available.
- Tricyclics: These are medications that block the reuptake of the various neurotransmitters including serotonin, and norepinepherine. By allowing these neurotransmitter molecules to remain in the synaptic cleft, it is hypothesized that they can have a prolonged effect.
- SSRIs (Selective Serotonin Reuptake Inhibitors): As I discussed the other day, the SSRIs like Prozac, Zoloft, and Celexa block the reuptake of serotonin molecules back into the presynaptic membrane. While this type of medicine to treat depression is newer than tricyclics or MAOIs, they are not actually more effective in helping relieve depression, but they do not have some of the less desirable side-effects of those other medications.
Tx: Manic-Depressive Disorder
- TIME: Antidepressant medications do NOT work very rapidly. It takes anywhere from 14 to 28 days for them to have a maximum effect. They are NOT like anti-anxiety meds and patients need to be warned not to expect changes coming very rapidly. However, between 50 and 70% of depressed patients--particularly those with moderate to severe depression--will experience significant relief from their depression within a month.
Tx: Psychotic Disorders (Schizophrenia)
- Tx for Manic-Depressive (Bipolar) Disorder usually involves the use of lithium carbonate (Carbolith, Eskalith, etc.) which has two sets of effects: (1) it reduces the symptoms of mania and (2) it serves a protector/prophylactic against the appearance of depression. It is used on a long-term basis.
- Lithium carbonate is usually introduced at a lower dosage level which is gradually increased until the patient has a sufficient level of the medicine in his/her bloodstream. High doses of this drug can be fatal and, so, prescribing doctors monitor via blood tests how much medicine a patient is receiving. Each patient has a different metabolism and thus needs to be treated individually.
- It is not really understood how lithium carbonate has its effect on the brain.
- Other medications used to treat manic-depression include anti-seizure or anti-epilepsy drugs such as Depakote, some of which have a similar effect to lithium carbonate.
- Antipsychotic medications are used to treat schizophrenia (SCZ). They are most effective in reducing the positive symptoms of the disorder, i.e., hallucinations, delusions, agitation, confusion, disordered thinking. They are much less effective in reducing negative symptoms like apathy, lowered levels of emotional responsiveness, and withdrawal. There are a multiple number of medications belonging to the chemical family called phenothiazines; the early successful drug to treat SCZ was Thorazine.
- Tardive dyskinesia: Patients treated for a long period of time with the phenothiazines may develop a condition called tardive dyskinesia. This appears in 30-40% of chronic patients taking antipsychotic medications for many years. It is an irreversible disorder resulting in repeated, involuntary movements of the neck, head, and tongue.
- Atyptical antipsychotics: A new class of drugs called atypical antipsychotics (e.g., Clozaril) are available to treat SCZ. These drugs are not all that more effective in relieving the symptoms of SCZ, but they do not seem to induce tardive dyskinesia. Unfortunately, however, a notable percentage of patients on these types of meds do develop diabetes.
This page was originally posted on 12/03/03 and last updated on December 6, 2015