16.2 Biological Treatments

Biological treatments for mental disorders include medications, electroconvulsive therapy, and transcranial magnetic stimulation. These interventions target brain chemistry and function to alleviate symptoms of conditions like depression, schizophrenia, and anxiety disorders.

Each treatment type has its own mechanisms, side effects, and effectiveness. Medications alter neurotransmitter levels, while ECT and TMS directly stimulate brain activity. Understanding these options helps in choosing appropriate treatments for different mental health conditions.

Types of Biological Treatments

Types of biological treatments

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• Psychopharmacology involves using psychiatric medications to treat mental disorders by altering neurotransmitter levels or activity in the brain
  • Main classes of psychiatric medications include antidepressants, antipsychotics, anxiolytics (anti-anxiety medications), and mood stabilizers (lithium, valproate)
• Electroconvulsive therapy (ECT) applies electrical currents to the brain to induce a seizure, typically used for severe or treatment-resistant depression, catatonia, and bipolar disorder, although its exact mechanism of action is not fully understood
• Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that uses magnetic fields to stimulate specific areas of the brain, approved for treatment-resistant depression and potentially used for anxiety disorders and schizophrenia

Mechanisms of psychiatric medications

• Antidepressants work by increasing levels of neurotransmitters in the brain
  • Selective serotonin reuptake inhibitors (SSRIs) increase serotonin levels by blocking its reuptake (fluoxetine, sertraline)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase both serotonin and norepinephrine levels by blocking their reuptake (venlafaxine, duloxetine)
  • Tricyclic antidepressants (TCAs) block the reuptake of serotonin and norepinephrine (amitriptyline, imipramine)
• Antipsychotics work by blocking dopamine and serotonin receptors in the brain
  • First-generation (typical) antipsychotics primarily block dopamine D2 receptors (haloperidol, chlorpromazine)
  • Second-generation (atypical) antipsychotics block both dopamine and serotonin receptors (risperidone, olanzapine, quetiapine)
• Anxiolytics work by enhancing the activity of inhibitory neurotransmitters or modulating serotonin receptors
  • Benzodiazepines enhance the activity of the neurotransmitter GABA (alprazolam, diazepam)
  • Buspirone is a partial agonist of serotonin 5-HT1A receptors and does not have the same sedative and addictive properties as benzodiazepines

Side effects of biological treatments

• Psychopharmacology can cause various side effects depending on the medication class
  • Antidepressants may cause nausea, weight gain, sexual dysfunction, and rarely, increased risk of suicidal thoughts in young adults
  • First-generation antipsychotics can cause extrapyramidal symptoms (EPS) and tardive dyskinesia, while second-generation antipsychotics may cause metabolic side effects (weight gain, diabetes) and sedation
  • Benzodiazepines can cause sedation, cognitive impairment, dependence, and withdrawal, while buspirone is generally well-tolerated but may cause dizziness or nausea
• Electroconvulsive therapy (ECT) can cause short-term side effects like confusion, memory loss, and headache, and rarely, persistent memory loss, in addition to risks associated with general anesthesia
• Transcranial magnetic stimulation (TMS) is generally well-tolerated but may cause headache, scalp discomfort, tingling sensations, and rarely, seizures

Effectiveness of biological interventions

• Depression can be effectively treated with antidepressants, ECT for severe or treatment-resistant cases, and TMS for treatment-resistant depression
• Schizophrenia is primarily treated with antipsychotic medications, both first-generation and second-generation antipsychotics are effective in reducing positive symptoms (hallucinations, delusions), while second-generation antipsychotics may be more effective for negative symptoms (apathy, social withdrawal)
• Anxiety disorders can be treated with benzodiazepines for short-term relief, SSRIs and SNRIs for long-term treatment, and buspirone as an alternative to benzodiazepines for generalized anxiety disorder