payment page
Biological Interventions
Psychoactive medications are drugs designed to treat mental disorders by interaction with neurotransmitters in the central nervous system (CNS). These medications target possible biochemical imbalances associated with mental health conditions, offering relief from symptoms and improving overall functioning. However, while effective, psychoactive medications can also cause side effects, some of which may be significant.
Antianxiety Drugs
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 and anxiety.
Side effects: Side effects may include drowsiness, light-headedness, dry mouth, depression, nausea, 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 discontinued.
Antidepressant Drugs
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): Includes phenelzine (Nardil).
Tricyclics: Includes 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 must 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
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 administered.
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 must be carefully monitored. 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.
Lithium
One drug used in the treatment of bipolar disorders is lithium.
Effects: Lithium prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate.
Side effects: Lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse.
Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
|
Psychoactive Drug |
Used to treat… |
Common types |
Effects |
Side Effects |
|
Antidepressants |
Depression and anxiety disorders |
SSRIs (e.g., fluoxetine) and SNRIs (e.g., venlafaxine |
Increase the availability of neurotransmitters like serotonin and norepinephrine, which regulate mood. |
May cause nausea, weight changes, or sexual dysfunction |
|
Antianxiety Drugs (These drugs can be highly effective in the short-term but may lead to dependency if used long-term.) |
Anxiety disorders and acute stress |
Benzodiazepines (e.g., lorazepam or alprazolam) |
Enhance the effects of GABA, a neurotransmitter that calms the nervous system. |
Drowsiness, reduced coordination |
|
Mood Stabilizers (This drug requires careful monitoring due to the risk of severe side effects.) |
Bipolar disorder |
Lithium |
Stabilizes mood swings by balancing neurotransmitters. |
Kidney damage, thyroid issues, or toxicity |
|
Antipsychotic Medications (Tardive dyskinesia may persist even after the medication is discontinued.) |
Schizophrenia and other psychotic disorders |
Typical antipsychotics (e.g., haloperidol) and atypical antipsychotics (e.g., risperidone) |
Typical antipsychotics target dopamine receptors to reduce symptoms like delusions and hallucinations. Atypical antipsychotics affect both dopamine and serotonin, with fewer motor-related side effects. |
Tardive dyskinesia is a potential side effect of long-term use. It is a movement disorder involving involuntary movements of the face, tongue, or limbs. |
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 being administered.
- 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 drug.
- 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 psychotherapy.
- 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 testing.
- 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.
Assessing the Effectiveness of Therapeutic Approaches
The effectiveness of a particular therapeutic approach can be assessed in three ways: client testimonials, providers’ perceptions, and empirical research.
Clients who get treatment for psychological problems often testify to their effectiveness. However, such testimonials can be unreliable for several reasons:
Regression toward the mean: People often go into treatment because they are in extreme distress. When their distress becomes less extreme, they may attribute this to the treatment’s effectiveness. But even without treatment, extreme distress tends to decrease. The tendency for extreme states to move toward the average when assessed a second time is called regression toward the mean.
The placebo effect: People often feel better after being in treatment because of their expectations that they will improve.
The justification of effort effect: People may believe that treatment was effective because they spent time, effort, and money on it. If people work hard to reach a goal, they are likely to value the goal more. This phenomenon is called justification of effort.
Providers’ Perceptions
Treatment providers can say whether a treatment is effective, but this can be unreliable for several reasons:
- Regression toward the mean affects providers’ perceptions of success. They may believe that a client who entered treatment in crisis became less extremely distressed because of the treatment. However, such an improvement may have occurred without any intervention.
- Providers’ perceptions may be biased because clients often emphasize improvements to justify discontinuing treatment.
- Providers may also have biased perceptions because they continue to hear from past clients only when those clients were satisfied with treatment. They don’t often hear from clients who found treatment ineffective.
Empirical Research
Another way to assess effectiveness is through careful empirical research. Research has shown that some treatments are more effective for a particular problem than a placebo or no treatment. These treatments are known as empirically validated treatments. Researchers must conduct two or more studies in order to conclude that a specific treatment is effective for a particular problem.
Research shows that psychotherapy works for many psychological problems. Although people who do not receive therapy also sometimes improve with time, people who do receive therapy are more likely to improve. Research also shows that all approaches to therapy are about equally effective, though certain kind of therapies do seem somewhat more effective for specific problems.
Surgical and Invasive Interventions
Surgical and invasive interventions are treatment approaches used for severe psychological disorders when other methods, such as medication and therapy, have proven ineffective. These treatments include psychosurgery, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).
Psychosurgery involves the surgical alteration of brain tissues to treat mental disorders. This method is used only in extreme cases where other treatments have failed, and its application is rare today due to advancements in less invasive therapies. One historical form of psychosurgery is the lobotomy, which involved severing connections in the prefrontal cortex to reduce symptoms of severe mental illness. Lobotomies were associated with significant side effects, such as personality changes and cognitive impairments. Though they were popular in the mid-20th century, they are now considered outdated and unethical. Modern psychosurgery may involve lesioning (targeting and removing specific brain regions) to treat conditions like severe epilepsy or obsessive-compulsive disorder (OCD) under strict ethical guidelines.
Transcranial magnetic stimulation (TMS) is a non-surgical procedure that uses magnetic fields to stimulate nerve cells in the brain. It is primarily used to treat major depressive disorder and is considered when other treatments, like medication, are ineffective. During TMS, a magnetic coil is placed against the scalp, delivering painless pulses to specific brain areas involved in mood regulation. TMS is generally well-tolerated, with common side effects including mild headaches or discomfort at the stimulation site.
Electroconvulsive therapy (ECT) is a medical procedure that involves delivering controlled electrical currents to the brain to induce a brief seizure. It is used to treat severe conditions such as major depressive disorder, bipolar disorder, and catatonia, especially when rapid symptom relief is needed, or other treatments have failed. Modern ECT is administered under general anesthesia with muscle relaxants to minimize discomfort. While highly effective for some individuals, ECT can cause side effects, such as temporary memory loss or confusion.
Effectiveness of Treatments
What are generally considered to be the most effective treatments for various disordres are listed below:
|
Specific Disorder |
Most Effective Treatment |
|
Panic disorders |
Cognitive therapy |
|
Specific phobias |
Systematic desensitization |
|
Obsessive-compulsive disorder |
Behavior therapy or medication |
|
Depression |
Cognitive therapy |
|
Post-traumatic stress disorder |
Exposure therapy |
Therapist Factors
Research shows that the effectiveness of therapy does not depend on the level of training or experience of the therapist or on the type of mental health professional providing therapy. However, the effectiveness of therapy does depend on the skill of the therapist. The most effective therapists tend to be empathic, genuine, and warm.
Who Benefits from Treatment?
Clients who are likely to benefit from therapy share some common features:
- Motivation to get better
- Family support
- Tendency to deal actively with problems rather than avoid them
Clients who are less likely to benefit from therapy also share some features:
- Hostility and negativity
- Personality disorders
- Psychotic disorders
- Motivation to get better
- Family support
Can Therapy Be Harmful?
Under some conditions, therapy can be harmful to the client. Clients may be harmed if:
- Therapists engage in unethical behavior, such as having sexual relationships with clients.
- Therapists act according to personal prejudices or are ignorant of cultural differences between themselves and their clients.
- Therapists coerce clients into doing things they don’t want to do.
- Therapists use techniques that research has not demonstrated as being effective.
- Therapists lead their clients to produce false memories of past traumas through careless use of techniques such as hypnosis or free association.
Seeking Treatment
Although many people experience psychological problems over their lifetime, not everyone seeks treatment. Not everyone is willing to get psychotherapy for problems they experience. More women than men get psychotherapy, and people who are more educated and who have medical insurance are also more likely to seek treatment.
Barriers to Getting Treatment
People may not seek treatment even if they feel they need it. Common barriers to getting treatment are:
- Concerns about the cost of treatment
- Lack of health insurance
- The stigma associated with getting psychological treatment
Psychotherapy for Cultural and Ethnic Minorities
Modern psychotherapy is based on individualistic values, and many researchers have argued that such therapy may not be readily applied to ethnic minorities in the United States. Ethnic and cultural minorities may face several barriers to receiving psychotherapy:
- Some cultural groups may be hesitant to seek help from professionals, particularly in institutional settings such as hospitals and clinics. They may instead prefer to seek informal help from family, friends, elders, and priests.
- Cultural minorities may find it difficult to get psychotherapy services because therapists who speak their language are unavailable.
- Therapists trained to treat mainly white, middle-class clients may not be familiar with or responsive to the needs of clients from different ethnic and cultural backgrounds.
