Biological Therapies : Videos & Practice Problems

Drug therapies encompass four main classes: antipsychotics, antidepressants, anti-anxiety medications, and mood stabilizers. Antipsychotics treat schizophrenia by blocking dopamine and serotonin receptors, while antidepressants, including SSRIs, elevate mood by inhibiting serotonin reuptake. Anti-anxiety medications, or benzodiazepines, enhance GABA activity for calming effects. Mood stabilizers, primarily lithium, address both manic and depressive episodes in bipolar disorder. Understanding the mechanism of action and potential side effects is crucial, as many patients discontinue use due to unpleasant effects or insufficient efficacy.

Drug Therapies

This video, we're just going to be introducing drug therapies. So there are four main classes or types of drug therapies that we use. So in this video, we're just going to briefly go over each of them and then we will have a separate video diving into each one in more detail. So, our first drug class is antipsychotics. Antipsychotics are primarily used to treat schizophrenia as well as any disorder that involves symptoms of psychosis.

Next up, we have antidepressants, which are primarily used to treat depression, but they are also used to treat obsessive-compulsive disorder and anxiety. Next, we have anti-anxiety medication, which as I'm sure you could guess is used to treat anxiety primarily. These are also sometimes called tranquilizers because they have a calming, tranquilizing effect. And then finally, we have mood stabilizers, and these are primarily used to treat bipolar disorder. And you might have noticed our naming convention is a little different here.

We have, like, anti, anti, anti, and then mood stabilizer, which is a little bit weird. But basically, with these three types of medication, we're trying to move away from psychosis, away from depression, and away from anxiety. But with bipolar disorder, we have people at these two extremes of mania and depression. So rather than just moving away from that, we're trying to essentially stabilize the mood and get them to kind of like an equilibrium. So that's why we have a different naming convention for those.

Alright. So before we dive into each of those, there is an important term that I want to go over with you, and that is mechanism of action. So when I say mechanism of action, I'm going to be referring to the biochemical interaction through which that drug produces an effect. Essentially, what that means for us is that we want to be understanding what neurotransmitter that drug is targeting and whether it's trying to increase or decrease levels of that neurotransmitter. And then one last thing that's important to be aware of is that while these drugs can absolutely be very helpful, many people actually stop taking them due to the side effects.

So as we go through each type of drug, I am going to be pointing out some specific side effects that are often associated with that drug that people may find particularly unpleasant. Alright, that is our introduction to drug therapies, and I will see you guys in the next one. Bye-bye.

Example 1

Okay, so for this one we're just going to be drawing a line matching each disorder with the class of medication that would be used to treat it. So first up, we have bipolar disorder and like we talked about with bipolar disorder, of course, the person is fluctuating between these two extremes of mania and depression, and so we want to essentially stabilize them. Right? So, we're going to be using a mood stabilizer to do that. Next up, we have anxiety and this one is nice and easy because we typically would be using an anti-anxiety medication for that person.

Next, we have obsessive-compulsive disorder and obsessive-compulsive disorder is typically going to be treated using antidepressants. Although there are other medications you could use, antidepressants are probably the most common. We'll put a line there. And then finally, we have schizophrenia, the main symptom of schizophrenia, of course, being psychosis. We would want that person to be treated with antipsychotics.

So, we'll draw a line there. Alright, and there you guys have it and I will see you in the next one. Bye bye!

Which class of drugs are also called tranquilizers?

• A. Antipsychotics.
• B. Antidepressants.
• C. Antianxiety.
• D. Mood Stabilizers.

Answer: (C)

Antipsychotics

In this video, we're going to be going over antipsychotics in more detail, and you can see we have everything set up in this table, and we're going to make a table just like this for every single class of drugs. But just to quickly orient you to how these tables are set up, we have our definition of the drug which we've already seen in our first lesson. We have the purpose of the drug. Along the left here, we have the type of drug. We also have the generation that will be relevant to some types of medication and not others.

We have our mechanism of action or that biochemical interaction of how the drug actually produces an effect. And then finally, we have some notes on specific side effects of these drugs. So definitely be aware of what information your professor is expecting you to know and focus in on those parts of the table. Feel free to disregard information that is irrelevant to you. Alright.

So for our antipsychotics, the main purpose of these drugs is to essentially shorten schizophrenic episodes and to, as we talked about, reduce the symptoms of psychosis. There are two types of antipsychotics. We have typical and atypical antipsychotics and we're going to begin with our typical antipsychotics. These are also called first-generation antipsychotics just because they are literally older. This was the first type of antipsychotic that was developed back in the 70s and 80s when we were first making this type of medication. So it just literally came first.

The main mechanism of action here is that these drugs essentially block dopamine receptors. They were fairly effective but they did have pretty severe side effects for a lot of people. Many people experienced muscle rigidity as well as involuntary muscle movements. We would commonly see things like ticks or tremors. And as you may recall from chapter three, dopamine is very important for movement and muscle regulation, and so interfering with dopamine receptors was interfering with people's ability to control their movement.

Over time, we developed some better antipsychotics and these are called atypical antipsychotics, also known as second-generation antipsychotics. This is our more contemporary medication. This is what most people would be receiving nowadays and these drugs work by blocking both dopamine and serotonin receptors. One easy way to remember the difference between these two drugs is that our first-generation antipsychotics only affect one neurotransmitter—dopamine. And our second-generation antipsychotics affect two neurotransmitters: dopamine and serotonin. Dopamine is always being targeted and then those second-generation ones added a second neurotransmitter, that, of course, being serotonin.

These in general had fewer side effects and we did see fewer side effects regarding movement, generally speaking. However, second-generation antipsychotics do tend to affect metabolism a bit more. They often have an effect on people's glucose regulation and we do sometimes see pretty extreme weight gain with these drugs. Now, just as a general note about all antipsychotics, they, for the most part, improve the positive symptoms of schizophrenia. As you may recall from our last chapter, that includes the psychosis, the delusions, the hallucinations, agitation, disorganized thinking—those types of symptoms—but they don't really have much effect on our negative symptoms.

So, you know, things like apathy, emotional flatness, amotivation, antipsychotics generally do not improve on those types of symptoms. They really focus on targeting the psychosis. Alright. So those are our antipsychotics, and I will see you guys in our next video. Bye bye.

Which of the following correctly explains the difference between typical and atypical antipsychotics?

• A. Typical antipsychotics target dopamine; atypical antipsychotics target dopamine and serotonin.
• B. Typical antipsychotics help with negative symptoms; atypical antipsychotics help with positive and negative.
• C. Typical antipsychotics increase brain dopamine; atypical antipsychotics decrease dopamine.
• D. Typical antipsychotics are used for more extreme cases; atypical antipsychotics are used for more mild cases.

Answer: (A)

Antidepressants

In this video, we're going to be talking about antidepressants. But before we dive into that, we're just going to do a quick refresher on some things that we learned way back in chapter three because it is relevant to how our antidepressants work. So as you may recall, neurotransmitters that are in the synapse between the presynaptic and postsynaptic neuron can get removed in three ways through degradation, diffusion, and reuptake. Now, diffusion is not relevant to us today, don't worry about that, but we're going to quickly go over degradation and reuptake. So degradation is essentially when neurotransmitters get broken down by enzymes.

Okay. So we have all these little triangular neurotransmitters here and these little enzymes are coming in and just breaking them into little pieces and then it all just kind of floats away after that. So that is degradation. And then we have reuptake, which is when neurotransmitters get reabsorbed into the presynaptic terminal. Remember, this one is kind of like recycling, so the neuron that originally released all those neurotransmitters basically sucks them all back up and then it can use them again.

So those are the two processes to keep in mind as we go through the mechanism of action for our antidepressants. Alright, so like we talked about, these are going to be used to treat depression, anxiety, and OCD, and the purpose of them is to essentially elevate mood and increase energy. And we're going to have three main types of antidepressants here. So the first one are called monoamine oxidase inhibitors, also known as MAOIs, and these are a first-generation antidepressant very, very rarely used nowadays, and the way that these work is by preventing the degradation of norepinephrine, serotonin, and dopamine. I'm going to go over side effects at the end because pretty much all antidepressants have pretty similar side effects.

We're just going to go straight into our next type of antidepressant, which are tricyclics. These are also one of our first generation, so not very commonly used nowadays, and these worked by blocking the reuptake of both norepinephrine and serotonin. And then finally, we have our selective serotonin reuptake inhibitors, much better known as SSRIs. And this is our second generation of antidepressants. These are very, very commonly used nowadays.

You might have heard of things like Prozac, Celexa, Zoloft. All of those are types of SSRIs. And the name is a bit of a mouthful, but it's actually a wonderfully intuitive name because, essentially, how these work is by inhibiting the reuptake of serotonin. So basically, we are blocking the reuptake of serotonin. Now this is kind of a lot to remember, but one thing that always helps me is that if I'm thinking about these three types of antidepressants in order, we can basically do a countdown to think about how many neurotransmitters they're going to be targeting.

So our MAOIs are going to be targeting three neurotransmitters, our tricyclics target two, and then our SSRIs target just one and, of course, that one is right there in the name, so that's nice and easy. And then degradation really only happened with those MAOIs and, again, those really are not used anymore. The most important one for you to understand are the SSRIs because these are very, very commonly used nowadays. Now kind of switching gears and looking at side effects, like I said, most antidepressants have pretty similar side effects. Some specific ones include weight gain, sexual dysfunction, emotional blunting, which is essentially having like a diminished emotional response.

So quite often people on antidepressants will report that they don't really feel sad anymore but they also don't feel anything, and that can be extremely unpleasant for people. And then we also frequently see sleep disturbances and this can kind of go either way. Some people experience insomnia and some people just sleep a ton and they can't really feel energized or awake. Now, in general, SSRIs have fewer side effects, which is one of the reasons that they are the preferred method of treatment nowadays. To be clear, SSRIs can absolutely cause any of these or any normal medication side effects.

I don't want to give the impression that they don't have any, but generally speaking, compared to those first-generation antidepressants, they do usually have fewer side effects for people. Alright. So, those are our antidepressants. Great job with that one, guys, and I will see you in the next one. Bye bye.

Which of the following statements about antidepressants are true?
I. All first and second-generation antidepressants target serotonin reuptake.
II. Second-generation antidepressants generally have fewer side effects.
III. Monoamine oxidase inhibitors (MAOI) increase the amount of serotonin in the synaptic gap.

• A. I & II.
• B. I & III.
• C. II & III.
• D. I, II, & III.

Answer: (C)

Anti-anxiety

This video, we're going to be talking about anti-anxiety medications. The purpose of these drugs is to have a calming and tranquilizing effect on the body. So like we talked about, these are also called tranquilizers and they're also known as benzodiazepines. One really well-known example of these drugs is Xanax. It's a very, very popular anti-anxiety medication.

So the mechanism of action here, the way that these drugs work is basically by increasing levels of gamma-aminobutyric acid, our old friend GABA from chapter three. So you guys might remember that GABA is the major inhibitory neurotransmitter in the brain. So, basically, we are increasing these inhibitory signals in the brain and that is going to have a nice calming and tranquilizing effect on the person. So, if, you know, if they have racing thoughts, constant worry, racing heartbeat, by increasing all those inhibitory signals, we're going to help that person down regulate, slow those thoughts down, and have a nice calming effect. Now, some specific side effects that we often see with anti-anxiety medication include drowsiness and sedation.

And of course, like we talked about, these are tranquilizers, so we do expect to see some level of, you know, kind of a sedative effect, but if the dosage is not correct, these drugs can just completely knock people unconscious. It's important to be aware of, especially if the person, you know, typically operates heavy machinery or is responsible for other people in their daily life. Anti-anxiety medication can also cause disorientation and confusion in people, and in some cases, they can cause slowed respiration as well. So, by increasing all those inhibitory signals in the brain, that can have some kind of negative physiological side effects for some people. Now, one thing to be aware of with anti-anxiety medication is that they really are designed for acute short-term usage.

So they're designed to kick in very quickly and be prescribed over the course of like weeks or months. However, they are often prescribed for much longer than that, for even like years and years for some people. And it is very, very common for people who do use these drugs in the long-term to develop tolerance and to require higher and higher dosages in order to get that tranquilizing effect. Now, I do want to be really clear that, you know, tolerance is something that can happen with almost any type of drug, but out of all of the drug classes that we have talked about in this course, tolerance most commonly happens with anti-anxiety medication. It's just a very easy drug to develop tolerance to and to constantly be needing higher dosages in order to get, again like that tranquilizing effect.

Alright. So, those are anti-anxiety medications and I will see you guys in the next one. Bye bye.

Why might a psychiatrist be hesitant to prescribe a patient benzodiazepine?

• A. Benzodiazepine require months to take effect.
• B. Benzodiazepine can interact with specific foods, raising blood pressure.
• C. Patients can have adverse side effects, including involuntary muscle twitching.
• D. Patients can have adverse side effects, including drowsiness and sedation.

Answer: (D)

Mood Stabilizers

Alright, in this video we're going to be going over mood stabilizers and like we talked about these are used primarily to treat bipolar disorder. So the main purpose of mood stabilizers is going to be to treat both the depressive and the manic episodes. So with bipolar disorder, we don't want to just be giving antidepressants usually because that's really only treating half of the person's symptoms. And for some bipolar patients, taking antidepressants can actually trigger manic episodes. So, we really need a medication that stabilizes the mood and treats both of those types of symptoms.

So, the main type of drug that we use here is a drug called lithium. The mechanism of action for lithium is actually not fully understood. We don't really know how it works. Lithium seems to do a lot of different things in the brain and that can even vary from person to person, so we don't totally know how it works, but for many bipolar patients if we get that dosage right it can be a really effective mood stabilizer. Now, like all of our drug classes, it does come with some negative side effects, and a lot of the negative side effects of lithium kind of involve the kidneys. So something that we can see is excessive thirst as well as excessive urination because the person is taking in so much water because they're constantly getting signals of being thirsty.

We can also see pretty extreme weight gain and a lot of that is water weight because the person is taking in so much excessive water. And then finally, with long-term use, especially if dosage is not quite right, we can see kidney dysfunction, but again that would be more with long-term use. Now, one thing to be aware of is that for bipolar patients who do not respond well to lithium or maybe can't take it because they have a pre-existing kidney condition, anticonvulsant medication can sometimes be used to treat bipolar disorder as well. So, this of course is the type of medication that you would give a person who has a seizure disorder or epilepsy typically. And we're not going to go over this in any more detail, you don't have to know the mechanism of action or anything, but just be aware that anticonvulsant medications can be effective mood stabilizers for people who don't respond well to lithium.

Alright, so those are our mood stabilizers and I'll see you guys in the next one. Bye bye.

Example 2

Alright, so here we have a true/false question. If it's false, we're going to be choosing the answer that would best correct the statement. Our statement: The mechanism of action for lithium is not well understood at this time, and that's true, so that makes our job kind of easy. Our answer here is A. Like I talked about, we do have a lot of research trying to understand lithium.

It seems to do a lot of different things. It targets many neurotransmitters. It seems to increase neuronal activity, but right now, as of the recording of this video, there is just not enough research, definitive research, to truly be able to say what the mechanism of action of lithium is. So our answer here is A, and there you go.

Which class of medications work through increasing GABA activity?

• A. Antipsychotics.
• B. Antidepressants.
• C. Antianxiety.
• D. Mood Stabilizers.

Answer: (C)

Which class of medication is known for targeting serotonin?

• A. Typical antipsychotics.
• B. Antianxiety.
• C. Antidepressants.
• D. Mood stabilizers.

Answer: (A)

If a patient presents with hallucinations, blunted affect, and delusions, which medication is a psychiatrist likely to prescribe?

• A. Atypical antipsychotic.
• B. Tranquilizer.
• C. Lithium.
• D. SSRI.

Answer: (A)

A patient comes in showing signs of depression. They are prescribed an SSRI but after 3 weeks, they are displaying symptoms of mania. Which medication may be more appropriate?

• A. SNRI.
• B. Tricyclic.
• C. MAOI.
• D. Lithium.

Answer: (D)

Review of Drug Classes

Alright. So we just learned a lot of stuff. To make things a bit easier for you guys, we have put everything into one nice big review table. Hopefully, that makes studying a little bit easier for you. So I'm going to run through this review table with you just briefly now in this video.

I'm not going to spend much time on side effects, but obviously those are there in case you need them as well. Alright, so we're going to begin by reviewing our antipsychotics. These are used mainly to treat schizophrenia and what they're going to do is shorten our schizophrenic episodes and reduce the symptoms of psychosis. So, these are going to be helping a lot with the positive symptoms of schizophrenia, things like hallucinations, delusions, agitation, but they're not going to be doing much for the more negative symptoms like we talked about. And we have two types of antipsychotics.

We have our typical, also known as first generation, so these are less commonly used nowadays, and these worked by blocking dopamine receptors. Nowadays, we have our atypical or our second generation antipsychotics much more commonly used and these work by blocking both dopamine and serotonin receptors. And remember, our little trick is that our first generation antipsychotics only affect one neurotransmitter while our second generation antipsychotics affect two neurotransmitters, so that one is kind of easy to remember. Alright, moving on to our antidepressants, we have three main types of antidepressants. We have our MAOIs.

This is one of our first generation and these worked by preventing the degradation of three neurotransmitters: norepinephrine, serotonin, and dopamine. We also have our tricyclics, also a first generation so less commonly used nowadays, and these worked by blocking the reuptake of both norepinephrine and serotonin. And then finally, we have our SSRIs, our selective serotonin reuptake inhibitors, that nice intuitive name, bit of a mouthful but very intuitive, and this is our second generation. These are very, very commonly used nowadays and these work of course by blocking the reuptake of serotonin. So we have our nice memory tool where we can basically count down to see how many neurotransmitters they are affecting.

So MAOIs affect three neurotransmitters, tricyclics affect two, and then our SSRIs affect just one. And we're not going to go over side effects like I said, but worth noting is that our SSRIs generally have fewer side effects than we saw with those first generation antidepressants. All right. Moving into our antianxiety medication. Again, the purpose of these is to kind of have a very fast acting tranquilizing effect for the person.

These are our benzodiazepines also known as tranquilizers. We don't have a generation to worry about with these and they work by increasing the activity of GABA which is our main inhibitory neurotransmitter. So by increasing GABA, we are inhibiting the brain helping calm things down. Right? And then finally, we have our mood stabilizers.

These are used for bipolar patients because they can treat both depressive and manic episodes and our main drug here is lithium. Again, we don't have a generation to worry about and we don't really understand how lithium works. Right? We know it does a lot of different things in the brain and that it can even vary from person to person, but it is a very effective mood stabilizer for many bipolar patients. Alright.

So that is our review of all of our drug classes. Great job with these guys, and I will see you in the next one. Bye bye.

Considerations Regarding Drug Therapies

This video, we're just going to talk about a few considerations to be aware of when we're thinking about drug therapies. So the first is just the efficacy of non-medical treatment because quite often other interventions like traditional therapy or psychotherapy are going to lead to very similar or if not greater improvements than drug therapy alone. And that is just because drug therapy is going to be targeting the biological root cause of symptoms, while psychotherapy is going to be providing people with insights and helping them gain new skills and abilities to deal with their symptoms in the long term. So quite often, even if a person is doing drug therapy and it is working well for them, it's nice to be pairing it with psychotherapy to help that person gain those more long-term skills. Our next point here is something that we've been talking about the entire way through, and that is just the side effects of many of these medications.

And these unpleasant side effects can and do lead to pretty high levels of discontinuation. So some research shows that between one third and one half of the people who take drug therapy for their psychological disorders discontinue usage because they find the side effects so unpleasant. So this is a, you know, pretty prominent issue. And something in a similar vein is that with a lot of these medications, getting the appropriate dosage can be quite difficult to achieve. And when you're constantly tweaking dosage, that can make side effects worse, which can encourage people to want to discontinue use of that medication.

So that's something to keep in mind. And then finally, we also want to be aware of the unknown risks of any medication because quite often drugs are tested on a relatively small subset of the population. Quite often, they're not tested on children, adolescents, pregnant people, the elderly, even just people with higher BMIs. And so people in any of those populations should be aware that drugs may have not been extensively tested on them and we may not really know what the long-term effect of that drug could be for that population. Alright, so we are going to wrap up, this video by talking about a very, very famous effect that we see in psychology called the placebo effect and this is highly relevant to any type of medication.

So the placebo effect is essentially when an intervention leads to improvement due to the expectation of improvement. So essentially, this is when a person taking a drug gets better not because of the active ingredients in the drug but just because they expect to improve because they are taking a drug. So basically, in order to test drug efficacy, what we do is we give one group of people a placebo, which is basically a sugar pill, that has no active ingredients. And then we would compare that placebo group to a group who receives the drug with the active ingredients and if the placebo group shows improvement we call that a placebo effect. And this is important to be aware of because patients very, very frequently show improvement when they take placebos.

A really, really cool example of this came from Kirsch and colleagues back in February 2008. They did a huge meta-analysis on 47 clinical trials regarding antidepressants. And they found that approximately eighty percent of the effects and improvement that they were seeing was due to the placebo effect. And that antidepressants were really only effective for people who had the most severe depression. And for people who had mild to moderate depression, they were mainly improving because of that placebo effect.

It can be quite strong, and it's very important to be aware of how powerful that effect can be. Now before we wrap up, I do want to make a really, really important note here, which is that medication can be and often is both life-changing and life-saving for many, many people. I do not want to give the impression that drug therapy is bad in any way. It's wonderful that we have the drugs available that we have today, and we should absolutely be using them. We just also want to be aware of any potential downsides that could make them difficult for some people to be taking.

Alright. Great job with that one, guys, and I will see you in the next one. Bye bye.

Example 3

Alright. So for this one, for each situation here, we're going to list a consideration that a doctor or practitioner should have to take into account before prescribing medication to the person. And I did write out my answers a little bit just so that you're not watching me write for the next three minutes. So let's go into the first one, which is Joe goes to his general practitioner complaining of low mood and feeling apathetic lately. He asks to be put on medication for depression.

So in this case, it sounds like it's a pretty new development for Joe, and the symptoms, while certainly unpleasant, don't sound like they are the most severe quite yet. So his practitioner might want to think about whether something like psychotherapy could also be effective in this instance. Like, should we be jumping straight to antidepressant medication necessarily? And maybe the answer is yes, but we should at least be considering psychotherapy as an option in a case like this. Alright.

So, Michelle is pregnant and showing signs of depression. She thinks medication might be helpful. So in this case, because Michelle is pregnant, we would want to consider which medications have been tested on pregnant people and which medications we know for a fact would be safe for both the pregnant person as well as the fetus.

Finally, Kathleen has anxiety and wants to start taking Xanax. Kathleen works in construction and frequently operates heavy machinery. So we know that one of the most common side effects of anti-anxiety medication is often drowsiness and sedation. Right? We want those meds to have a tranquilizing effect, but sometimes if the if the dosage is not appropriate, they can make people extremely drowsy. And because she frequently operates heavy machinery, we would really want to be aware of those side effects and how they, you know, how this medication is affecting her and make sure that her dosage is really appropriate for her. Alright, so that is our example here and I will see you guys in the next one.

Bye bye!

Which of the following is an example of the placebo effect?

• A. A patient starts feeling better after a few weeks of cognitive behavioral therapy.
• B. A patient in a drug trial shows improvement while taking a new medication inhibiting norepinephrine reuptake.
• C. A patient shows reduced symptoms of depression after joining a community support group.
• D. A patient in a drug trial shows improvement while taking a pill without active ingredients.

Answer: (D)

Brain Surgery and Stimulation

This video, we're going to be going over brain surgery and stimulation. So sometimes therapeutic techniques aim to directly change brain activity through either stimulation, like literally activating the neurons, or through physical modification of the brain. And this began with lobotomies back in the 1930s. You've probably heard of lobotomies before. They were used from the thirties right up to the sixties and seventies, and this was considered at the time a cure, quote-unquote, for depression and schizophrenia.

And essentially, lobotomies with very little precision severed connections in the frontal lobe, essentially brain damaging the patients. They were an extremely harmful procedure, and we stopped using them when we began to develop the first antipsychotic medications. So that's kind of the history of what we're dealing with, but all of the procedures that we're going to talk about today are much safer than lobotomies. All of these have been refined through years of research, they are precise, and they do not harm patients. So we are going to be going over three procedures and we're going to go over them in the order of least invasive to most invasive.

And just to be very clear, all of these treatments that we're going to talk about today are used as a last resort. So they are used when people are not improving with traditional psychotherapy or drug therapy or a combination of those two things. You know, if that is the case that is when we would step into these more direct stimulation or modification techniques. So, we are going to begin by talking about transcranial magnetic stimulation, also known as TMS, and like I said this is going to be our least invasive procedure. So, the main indication for using TMS is going to be severe depression.

It does have other uses but this is the most common use, and the procedure is actually quite simple. So basically, there is a coil which you can see here and this generates a magnetic field and this is just placed over the patient's head to stimulate the prefrontal cortex. So basically, it kind of generates a magnetic field and then we can purposefully depolarize neurons in that area and increase blood flow to that area or we could potentially deliberately decrease blood flow to certain areas of the brain. And what's really great about TMS is that it really has minimal side effects. Some people do report that it kind of feels like being flicked on the head, so it's a very, very powerful magnetic field.

You can feel it, but it doesn't actually hurt. It does not require anesthesia, and the patient can just get up and walk away right afterward. So that is TMS. Again, we can use that for severe depression. Next up, we have electroconvulsive therapy, something that you might have heard of before.

This is sometimes also called shock therapy. Now to be clear, the electroconvulsive therapy that we use today is nothing like the shock therapy that you might have heard of from decades ago that is sometimes featured in horror movies. We have very carefully refined this procedure over the decades and it is now much safer. Once again, our main indication here is severe depression, particularly when people are engaging in suicidal thoughts or behaviors. And for this procedure, it is a little bit more invasive than TMS.

We do put the patient under anesthesia, and they are given a muscle relaxant so that they can't tense up and hurt themselves. And then what happens is electrodes are placed on the side of the head and you can use one electrode or two depending on the patient's needs and then a brief current is turned on and then that current is basically going to trigger a very focused and controlled seizure and that will last for about one minute. Now, electroconvulsive therapy is actually extremely effective at improving mood. It's usually very, very fast acting. However, the effects tend to be very short-lived.

So, this therapeutic technique is particularly useful just to kind of get patients back to a level of functioning where traditional drugs or psychotherapy might be a little bit more productive and helpful for them. So it's very useful in those contexts. Alright. And finally, we have our anterior cingulotomy, and this is our most invasive procedure. This is a full-on surgery.

So the main indication here is once again going to be severe depression. This is also used to help, obsessive-compulsive disorder, again, obviously as a last resort treatment. And the anterior cingulate cortex, which is the part of the brain that we're targeting with this procedure, is known to play a role in both mood and anxiety, so that is why we're targeting this area of the brain. And you can see here, on our image that the anterior cingulate cortex is kind of in the frontal lobe there. So for the procedure here, the patient is going to be put under anesthesia and then an electrode is going to be inserted into a hole in the skull into the anterior cingulate cortex and then the tip of that electrode is going to be heated and a very small localized lesion is going to be created through that process.

So this is a very precise procedure. We're creating a very tiny lesion in a very precise location. Now, unfortunately, with anterior cingulotomies usually only about half of patients are going to show meaningful improvement. Now, the one good thing is that because this procedure is so precise, the odds of there being any personality or cognitive side effects is pretty unlikely. So if the procedure doesn't work, it doesn't harm the patient really, it just is not always effective and obviously this is a very drastic last resort treatment.

Alright. So those are our three types of direct brain stimulation and modification that we might be using if our traditional psychotherapy or drug therapies are not working for patients. Great job with that one, guys, and I'll see you in the next one. Bye bye.

Example 4

Okay, so for this one, we're going to be matching each treatment in the box with its description. Then we're going to put a star next to the treatments that are used to treat severe depression. And then finally, we're going to place a triangle next to the least invasive treatment. So "a" here reads a procedure in which controlled seizures are induced using electrodes. So if we're using electrodes, we're probably doing electroconvulsive therapy, right?

So we will cross that off and put two here. Our next one reads a procedure in which a lesion is created in the anterior cingulate cortex, so that sounds like an anterior cingulotomy, right, so we'll put a three there. And then finally, "c" reads a procedure in which the prefrontal cortex is stimulated using a magnetic field and that is our transcranial magnetic stimulation, right, so we'll put a one there. Now, all of these can be used to treat severe depression and that is one of their most common applications. So we're going to put stars next to each of these and then finally our least invasive treatment is that TMS, that transcranial magnetic stimulation; that one does not require any anesthesia whatsoever.

The person can be awake. All of these other procedures involve anesthesia and anterior cingulotomies are considered a major type of surgery. Alright, so that is our example and I will see you guys in the next one. Bye bye.

Why might a clinician consider brain surgery or stimulation for a patient?

• A. They are often more effective than traditional treatment.
• B. They often work faster than traditional treatment.
• C. They are often cheaper than traditional treatment.
• D. They can be effective as a last resort when traditional treatment is not working.

Answer: (D)

Here’s what students ask on this topic:

What are the main classes of drug therapies used in treating psychological disorders?

Drug therapies for psychological disorders are categorized into four main classes: antipsychotics, antidepressants, anti-anxiety medications, and mood stabilizers. Antipsychotics are primarily used to treat schizophrenia and other disorders involving psychosis by blocking dopamine and serotonin receptors. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are used to elevate mood and treat depression, anxiety, and obsessive-compulsive disorder by inhibiting serotonin reuptake. Anti-anxiety medications, also known as benzodiazepines, enhance the activity of gamma-aminobutyric acid (GABA) to produce calming effects. Mood stabilizers, such as lithium, are used to manage both manic and depressive episodes in bipolar disorder. Understanding the mechanism of action and potential side effects of these drugs is crucial, as many patients discontinue use due to unpleasant effects. Combining drug therapy with psychotherapy can enhance treatment outcomes.

How do antipsychotics work in treating schizophrenia?

Antipsychotics are used to treat schizophrenia by targeting neurotransmitter systems in the brain. There are two main types: typical (first-generation) and atypical (second-generation) antipsychotics. Typical antipsychotics primarily block dopamine receptors, which helps reduce the positive symptoms of schizophrenia, such as hallucinations and delusions. However, they can cause severe side effects, including muscle rigidity and involuntary movements. Atypical antipsychotics block both dopamine and serotonin receptors, offering a broader mechanism of action. They generally have fewer movement-related side effects but may affect metabolism, leading to weight gain. While antipsychotics are effective in managing positive symptoms, they have limited impact on negative symptoms like apathy and emotional flatness. Understanding these mechanisms and potential side effects is crucial for effective treatment planning.

What are the side effects of antidepressants, and how do they differ among types?

Antidepressants can have various side effects, which may differ depending on the type. Common side effects include weight gain, sexual dysfunction, emotional blunting, and sleep disturbances. Monoamine oxidase inhibitors (MAOIs) and tricyclics, both first-generation antidepressants, are less commonly used today due to their side effects and dietary restrictions. MAOIs prevent the degradation of norepinephrine, serotonin, and dopamine, while tricyclics block the reuptake of norepinephrine and serotonin. Selective serotonin reuptake inhibitors (SSRIs), a second-generation antidepressant, are more commonly used due to their relatively fewer side effects. SSRIs work by inhibiting the reuptake of serotonin, which helps elevate mood. Despite having fewer side effects, SSRIs can still cause any typical medication side effects, so monitoring and adjusting treatment is essential for patient comfort and efficacy.

What is the mechanism of action for anti-anxiety medications?

Anti-anxiety medications, commonly known as benzodiazepines, work by enhancing the activity of gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter. By increasing GABA activity, these medications produce a calming and tranquilizing effect, helping to alleviate symptoms of anxiety such as racing thoughts, constant worry, and a rapid heartbeat. Benzodiazepines are designed for short-term use due to their potential for tolerance and dependence. Common side effects include drowsiness, sedation, disorientation, and confusion. It's important to use these medications under medical supervision, especially for individuals who operate heavy machinery or have responsibilities that require full cognitive function. Understanding the mechanism of action and potential side effects is crucial for safe and effective use.

How do mood stabilizers work in treating bipolar disorder?

Mood stabilizers, primarily lithium, are used to treat bipolar disorder by managing both depressive and manic episodes. The exact mechanism of action for lithium is not fully understood, but it is known to affect various neurotransmitter systems and cellular processes in the brain. Lithium helps stabilize mood swings, reducing the frequency and severity of manic and depressive episodes. However, it can have side effects, particularly involving the kidneys, such as excessive thirst, urination, and potential kidney dysfunction with long-term use. For patients who do not respond well to lithium or have pre-existing kidney conditions, anticonvulsant medications may be used as alternative mood stabilizers. Understanding the benefits and risks of mood stabilizers is essential for effective management of bipolar disorder.