Biomedical therapies include drug therapy, electroconvulsive therapy, and
Drug therapy, or psychopharmacotherapy, aims to
treat psychological disorders with medications. Drug therapy is usually combined
with other kinds of psychotherapy. The main categories of drugs used to treat
psychological disorders are antianxiety drugs, antidepressants, and
Antianxiety drugs include a class of drugs called
benzodiazepines, or tranquilizers. Two commonly used
benzodiazepines are known by the brand names Valium and Xanax. The generic
names of these drugs are diazepam and alprazolam, respectively:
Effects: Benzodiazepines reduce the activity of the
central nervous system by increasing the activity of GABA, the main
inhibitory neurotransmitter in the brain. Benzodiazepines take effect
almost immediately after they are administered, but their effects last
just a few hours. Psychiatrists prescribe these drugs for panic disorder
Side effects: Side effects may include drowsiness,
light-headedness, dry mouth, depression, nausea and vomiting,
constipation, insomnia, confusion, diarrhea, palpitations, nasal
congestion, and blurred vision. Benzodiazepines can also cause drug
dependence. Tolerance can occur if a person takes these drugs for a long
time, and withdrawal symptoms often appear when the drug use is
Antidepressants usually take a few weeks to have an effect. There are
three classes of antidepressants: monoamine oxidase inhibitors, tricyclics,
and selective serotonin reuptake inhibitors.
Monoamine oxidase inhibitors
(MAOIs): Include phenelzine (Nardil).
Tricyclics: Include amitriptyline (Elavil).
Tricyclics generally have fewer side effects than the MAOIs.
Selective serotonin reuptake inhibitors
(SSRIs): The newest class of antidepressants, including
paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety,
phobias and obsessive-compulsive disorder.
Effects: MAOIs and tricyclics increase the level of
the neurotransmitters norepinephrine and serotonin in the brain. SSRIs
increase the level of serotonin.
Side effects: Although antidepressants are not
addictive, they often have side effects such as headache, dry mouth,
constipation, nausea, weight gain, and feelings of restlessness. Of the
three classes of antidepressants, MAOIs generally have the most side
effects. People who take MAOIs also have to restrict their diet, because
MAOIs interact negatively with foods that contain the amino acid
tyramine, such as beer and some cheeses and meats. SSRIs have fewer side
effects than the other two classes of antidepressants. However, SSRIs
can cause sexual dysfunction, and if they are discontinued abruptly,
withdrawal symptoms occur.
Antipsychotic drugs are used to treat schizophrenia and other
psychotic disorders. They include chlorpromazine (Thorazine),
thioridazine (Mellaril), and haloperidol (Haldol). Antipsychotic
drugs usually begin to take effect a few days after they are
Effects: Antipsychotic drugs, or neuroleptics, reduce
sensitivity to irrelevant stimuli by limiting the activity of the
neurotransmitter dopamine. Many antipsychotic drugs are most useful for
treating positive symptoms of schizophrenia, such as hallucinations and
delusions. However, a new class of antipsychotic drugs, called
atypical antipsychotic drugs, also help treat the
negative symptoms of schizophrenia. They reduce the activity of both
dopamine and serotonin. Atypical antipsychotic drugs include clozapine
(Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical
antipsychotic drugs can sometimes be effective for schizophrenia
patients who have not responded to the older antipsychotic drugs.
Side effects: Side effects include drowsiness,
constipation, dry mouth, tremors, muscle rigidity, and coordination
problems. These side effects often make people stop taking the
medications, which frequently results in a relapse of schizophrenia. A
more serious side effect is tardive dyskinesia, a usually
permanent neurological condition characterized by involuntary movements.
To avoid tardive dyskinesia, the dosage of antipsychotics has to be
carefully monitored. The atypical antipsychotics have fewer side effects
than the older antipsychotic drugs and are less likely to cause tardive
dyskinesia. In addition, relapse rates are lower if people continue to
take the drug. However, the relapse rate is higher with these drugs if
people discontinue the drug.
Criticisms of Drug Therapies
Drug therapies are effective for many people with psychological disorders,
especially for those who suffer from severe disorders that cannot be treated in
other ways. However, drug therapies have been criticized for several reasons:
- Their effects are superficial and last only as long as the drug is
- Side effects can often be more severe and troubling than the disorder
for which the drug was given. This can cause patients to discontinue the
drugs and experience relapses.
- Patients often respond well to new drugs when they are first released
into the market because of the enthusiasm and high expectations surrounding
the drug. But such placebo effects tend to wane over time.
- The therapeutic window for drugs, or the amount
of the drug that is required for an effect without toxicity, varies
according to factors such as gender, age, and ethnicity. This makes it
difficult for physicians to determine the right dose of a
- New drugs, even those approved for long-term use, are often tested on
only a few hundred people for a few weeks or months. This means that the
risks of taking drugs long-term are unknown.
- Some critics point out that because of pressure from managed care
companies, physicians may overprescribe drugs rather than recommend
- Drugs are tested only on certain populations, for certain
conditions. Physicians, however, sometimes prescribe a drug for
conditions and populations that were not included in the
- Researchers who study the effectiveness of medications may be biased
because they often have financial ties to pharmaceutical companies.
- Freely prescribing drugs for psychological disorders gives the
impression that such disorders can be treated only biochemically. However,
the biological abnormalities present in such disorders can often be treated
by changing thoughts and behavior.
(ECT) is used mainly for the treatment of severe depression.
Electrodes are placed on the patient’s head, over the temporal lobes of
the brain. Anesthetics and muscle relaxants help minimize discomfort to the
patient. Then an electric current is delivered for about one second. The
patient has a convulsive seizure and becomes unconscious, awakening after
about an hour. The typical number of ECT sessions varies from six
to twenty, and they are usually done while a patient is hospitalized.
ECT is a controversial procedure. Research suggests that there are
short-term side effects of ECT, such as attention deficits and memory loss.
Critics of ECT believe that it is often used inappropriately and that it can
result in permanent cognitive problems. Proponents of ECT, however, believe that
it does not cause long-term cognitive problems, loss of memory, or brain damage.
They believe that it is highly effective and that it is underused because of
negative public ideas surrounding it.
Psychosurgery is brain surgery to treat a psychological disorder. The
best-known form of psychosurgery is the prefrontal lobotomy. A
lobotomy is a surgical procedure that severs nerve tracts in the
frontal lobe. Surgeons performed lobotomies in the 1940s and 1950s to treat
highly emotional and violent behavior. The surgery often resulted in severe
deficits, including apathy, lethargy, and social withdrawal.
Lobotomies are now rarely performed, but some neurosurgeons perform
cingulotomies, which involve destruction of part of the frontal
lobes. These surgeries are usually performed on patients who have severe
depressive or anxiety disorders and who do not respond to other treatments. The
effectiveness of these surgeries is unclear.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation
(TMS) is a recently developed, noninvasive procedure. It involves
stimulating the brain by means of a magnetic coil held to a person’s skull near
the left prefrontal cortex. It is used to treat severe depression.