lecture 28 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes drugs, electroconvulsive therapy

1. Biomedical Therapies
Brian J. Piper, Ph.D.

2. Goals
• Psychopharmacology
– Antipsychotics
– Antianxiety
– Antidepressants
• Brain Stimulation
– Transcranial Magnetic Stimulation
– Electroconvulsive Therapy
• Psychosurgery

3. Prevalence of Psychopharmacology
Decreases in child antidepressants
&
anti-anxiety meds in elderly
Overall: 22% increase
http://online.wsj.com/article/SB10001424052970203503204577040431792673066.html?mod=WSJ_WSJ_US_News_5

4. Psychopharmacology
• Most psychological drugs target
neurotransmitters
– Dopamine
– Norepinephrine
– 5-hydroxytryptamine (5-HT or serotonin)
– Gamma Aminobutyric Acid (GABA)
• It is not known if these mechanisms are
responsible for the therapeutic effects

5. History of Antipsychotics
(aka Neuroleptics/Major Tranquilizers)
• 1950s: Typical (D2 antagonist) antipsychotic
chlorpromazine developed as a anesthetic but
helps against hallucinations & delusions
• 1950s (late): tardive dyskinesia identified
• 1970s: Atypical (D2/5-HT2A antagonist)
clozapine antipsychotic introduced.
• 2000s: substantial weight gain recognized

6. Psychological Disorders &
Reduced Lifespan
(N = 5,036,662)!
Male Male Female Female
Life Expectancy Years Life Years Lost
Lost Expectancy
All (Psychiatric 76.5 NA 80.9 NA
History - )
Schizophrenia 57.8 18.7 64.6 16.3
Bipolar 62.9 13.6 68.8 12.1
.
Laursen (2011). Schizophrenia Research, 131, 101-104

7. Reduced Lifespan
Male Male Female Female
Life Expectancy Years Life Years Lost
Lost Expectancy
All (Psychiatric 76.5 NA 80.9 NA
History - )
Schizophrenia 57.8 18.7 64.6 16.3
Bipolar 62.9 13.6 68.8 12.1
Contributing Factors
suicide, accident, homicides,
self-care, metabolic (?)
.
Laursen (2011). Schizophrenia Research, 131, 101-104

8. Antidepressants
• Monoamine Oxidase (MAO) is an enzyme that
breaks down 5-HT, NE, & DA

9. MAO-Is
• Monoamine Oxidase (MAO) is an enzyme that
breaks down 5-HT, NE, & DA; peak use in
1970s
• Food Interactions: Tyramine rich foods (aged cheese,
beer, wine) + MAO-I results in increased blood
pressure & headaches (“cheese effect”)
• Moderate effectiveness but moderate side-
effects

10. Antidepressants: Serotonin Reuptake
Inhibitors
• Prozac (fluoxetine) was the original SRI
• Greater affinity for SERT than NET
• Not Selective (sigma receptors)
• Anorgasmia
• Low effectiveness but low side-effects

11. Cognitive Behavioral Therapy
• Short, evidence based, therapy
• Developed by Aaron T. Beck
• Instruction in how thoughts & feelings
influence behavior
1921-

12. CBT + Medication
• Patients randomized to receive Nefazodone (5-
HT2A/1 antagonist), CBT, or both for 3 months
Nef CBT Nef +CBT
Completers 69.5% 72.2% 76.5%
No Response
44% 48% 15%
Remission 22% 24% 42%
Keller et al (2000). New England J of
Medicine, 342, 1462-1470.

13. Electroconvulsive Therapy
• Brief seizure is induced
• Peak use in 1940s-1950s, resurgence
• Conditions: Major Depressive Disorder,
schizophrenia, bipolar
• Very effective for MDD but memory loss
1940s Present
Wave sinusoidal pulse
Anesthetic no yes
Consent ? yes

14. Biomedical Therapies &
Neurogenesis
• New neurons are produced in the
hippocampus in adults
ECS: electroconvulsive therapy; TCP: trancyclpromine (MAO-I), or Reboxetine (SNRI)
Mahlberg (2000). J Neurosciece, 20, 9104-9110.

15. Electroconvulsive Therapy Video
• Caitlin & Meghan Davies
• Season 1: Episode 2
– 1:05:00-1:08:00
– 1:29:30-1:50:00
Zofran (Ondansetron): 5-HT3 antagonist

16. Transcranial Magnetic Stimulation
• pulse of electromagnetic field
• very low risk of seizures & syncope
• Control condition?
• Repeated TMS shows moderate utility for
MDD
• Mechanism unknown

17. Psychosurgery
1874-1955
• 1949: Antonio Egas Moniz received Nobel
prize for frontal leucotomy
• 1940s-1967: Walter Freeman develops frontal
lobotomy (transorbital)
• Current: lesioning & deep brain stimulation is
a last resort

18. Who prescribes?
• Mostly MDs
– Psychiatrists
– Pediatricians
– General Practitioners
• Some clinical psychologists
– New Mexico (2002)
– Louisiana (2004)
Tanya Tompkins