Alright here we are coming to the end of Week 7 with one week to go. The week decided by you. I don't even know what we're going talk about next week right now but I look forward to talking about it. But what we're going to talk about today is biological approaches to treating mental disorders. So we've talked about you know, some of the other approaches including things like cognitive behavior therapy. but in this lecture we're going to focus on much more on drug therapies. and various other so called biological therapies that are used and that are in fact almost dominant. There's an interesting tendency going on now to kind of go to drug therapies as step one. Which might be okay in some cases, but I'm going to tell you a bit of a story about us being careful about that tendency as we move forward. So let's do it. Week 7, Lecture 8, Biological Treatments, I've got a little banner there. We've got a pill for that, you know that slogan, we've got an app for that. well sometimes it seems as though these pharmaceutical approaches, to mental disorders, and in fact, the health in general are really dominant. And we know that the pharmaceutical industry is very strong and that, and that they make a lot of money off of selling drugs. and that everywhere in their healthcare system, but it's a certainly there when it comes to mental disorders as well. So at any rate, let's ease into this story. I'm actually going to focus on sort of three different senses of biological treatments. All of which kind of assume that there's something about the brain or the brain chemistry that's off. And that's what causes various psychological problems. So we didn't in our brain section, didn't talk so much about neurotransmitters but I'm going to have to tell you a little bit more about those as well. Because a lot of drug systems. Work on, well they work by mimicking neurotransmitters or in some way affecting how useful they are in the brain. So let's hold off on that for a second. But that'll be part of the drug section. And then I'm going to talk a little about psychosurgery. Actually doing things to the brain, changing the brain. Used to be fairly common. Not so common any more, but there is something else that used to be common that still is used quite a bit and that's electroconvulsive shock therapy. Doesn't really change the brain in terms of you know, removing parts of it. But it certainly impacts the brain by sending electrical currents all thou. Well let's get out that story. So first of all I really want to convince you that the brain is a very complex and dynamic organism, especially when it comes to neurotransmitter. So what do we mean by neurotransmitters? I'm showing now here a few different, I'm highlighting a few different neurotransmitters. Let me step back, the brain I've talked about all the structures of the brain.But the communication from one structure to another happens largely through the release of neural transmitters. from one, axon, or set of axons, to others. Okay, so, these are drugs that the brain produces. And that's ultimately the way it communicates, because, the brain isn't wired like you know an, an amplifier for a guitar or something. Where a wire goes from point a to point b. It's like a bunch of little wires that send a little bit of electrical current via chemical. And then there is gaps and in those gaps neurotransmitters are released. And those neurotransmitters which are all positively or negatively charged chemicals then connect with another axon and keep the information flowing. So the whole flow of information through our brain. Is performed by these neurotransmitters and we have a lot. But there are three, Norepinephrine, Dopamine and Serotonin that are specially important when it comes to mental illnesses. And one of the points I want to make is that these, if we look at even just these three. What you'll see, so here's the norepinephrine system, and, and, again, norepinephrine as suggested here relates to our alertness, and our energy, sort of our vitality as you will. But look at this system, it goes through all the brain and it effects all different parts of the brain. So all of these different parts of the brain. If, if you well, let me say it this way. All different parts of the brain communicate by releasing norepinephrine, okay? from the, back here at the cerebellum, but you know, all the way through the mid-brain, all the way to the frontal cortex and, and back, almost, oops, sorry, almost to the occipital lobe. You know, through the parietal lobe. All through the brain there are parts of it that react to norepinephrine. Not quite as dramatic with dopamine. Dopamine relates to attention, motivation, pleasure. Okay, dopamine can make you sort of seek pleasure, and feel pleasure. so you know, that's a very important system. It tends to be more midbrain-ish, but you see it sneaks up into the frontal lobes as well. And if we look at serotonin, that's going to be a very critical thing especially when it comes to depression, obsession and compulsions, it talks about mood in general. And, like, all of these things affect mood, these two affect anxiety. Look at this system, again, all through the brain. Now why is this important? Well, because you, as you'll see, and I'll give you a couple examples. We sometimes use drugs to try to effect these. And that is for example, if we look at a depressed person you sometimes see that they don't seem to have as much seritone. As a non depressed person and if you do something to the brain that increases the amount of serotonin they feel better. So it actually helps the depression but here's the kicker it just doesn't effect the area that makes them feel better it effects all sorts of areas and that means you get side effects. You get the effects you want. And you get other effects that you didn't necessarily want. That's one of the problems with drug therapies. The other problem is that the brain is highly dynamic. It produces its own neurotransmitters. But if you start impacting those neurotransmitters by external sources then the brain changes how much neurotransmitter it releases. This is why drugs become addictive and why a person needs more and more and more of a certain drug to have the same effect. Because as they get an external source, the brain starts cutting back on internal production. So what that means is that sometimes a drug that helps right away even though it causes all of these side effects Stops working, unless you take a higher dose, and a higher dose. And as you raise the dose, you're increasing the side effects at the same time. So this is why drug therapy is not a panacea. You cannot just adjust a level and fix something, and have it remained fixed. The brain is complex and it's dynamic. Let's take that story now and do it in a few specific examples. Anti-depressants and anti-manic drugs. So, lot of words on this page. I, I apologize for that. but in some cases it kind of helps because it's complex. So, these are some of the, four of the most common drugs. They have been used to treat depression and mania. Let's start right at the beginning with Tricyclics, just to give you a sense of what they do, they slow the re-uptake of norepinephrine and serotonin. What does that mean? Well that means that parts of the brain release these neurotransmitters, and these drugs prevent them from being brought back into the releasing neuron. and so as a result, they hang around in that little gap longer. And it's as though the brain was releasing more of this. If you prevent it from coming up, in fact, most of these drugs will prevent reuptake especially of Seratonin. That seems to be critical for depression. this also prevent the re-uptake of norephinephrine. It does make people feel better, okay? It makes them feel more level, less depressed, less manic. but it results in weight gain, poor concentration. These are those side effects. In fact, a lot of the game of the pharmaceutical industry is trying to create drugs that produce the effects you want with fewer of the side effects. This is another big group, the Monamine Oxidase Inhibitors or MOI's. These ones work a little differently. There's these enzymes in our brain that if something is hanging around these enzymes kind of cleaned it up. They remove the excess neurotransmitters. But these MOIs prevent the enzymes from working, so there's norepinephrine and serotonin that would have been cleaned up and destroyed, is left around. which again makes for more serotonin, especially and makes people feel better. But high blood pressure, blurred vision, insomnia. That's the price of feeling a little better, I gained because of all these other areas of the brain that are also effected. Now, more common ones now that are used a little bit more often now are these so called Selective Serotonin Re-uptake Inhibitors, SSRIs. and really they do exactly what it says. They're very selective for serotonin as opposed to norepinephrine. So the idea is maybe the norepinephrine hanging around is causing some of these side effects. So if we can just prevent the serotonin from being rapt took, brought back into the cell, so we leave that around, maybe that will work better, and it seems to. So it seems like people do still feel better, and there are not as many side effects, which means you can have larger doses of this drug. Because you don't have these other side effects going on. And another one, finally lithium carbonate, the lithium carbonate is especially used for bipolar disorder. So when people have depression and mania, as we talked about. It seems to end manic episodes as soon as there's enough of this in the blood. So it can almost shut down a manic episode, you know, like that. and often when you shut down the mania, you seem to shut down the depression. So lithium carbonate is really you know, seemingly dramatically useful for manic depression, but in all these cases, here's the big point I want to make. When we say they're useful, we mean they're useful right away. But often, again, because the brain adjusts, we need larger and larger doses to remain effective and that causes more and more and more side effects. So a lot of people argue that drug therapies may be good as a beginning place. A place to get the patient in a position where they could say do cognitive behavior therapy, or, or engage in some other therapy. So that they're not so depressed anymore that they don't care and they don't want to do any therapy. We can get them to point where they can do therapy, but we eventually would want the therapy to take over and to pull back on the drugs. Not to just rely on these drugs, because that's a problematic root, because of the brains dynamic nature. So this fine inner play and a lot of people complain that too many therapist, to many psychiatrist especially see drugs as the answer. As oppose to a bridge to therapy. So that's a, a controversy that's now going on. Now in other cases, it, when it comes to depression for example, therapy may be able to it. You may be able to restructure the way people think about things and that may help them to succeed without drugs. But in other cases, let's say schizophrenia therapy is not going to do it. Okay, schizophrenia certainly seems like something biological is wrong. And it seems like the only thing that's effective for schizophrenia are, are anti-psychotic drugs. So for a schizophrenic drug therapy seem to be our only real option. And once they start they have to stay on the meds. They have to stay on the drugs for the rest of their life. If they don't, if the, symptoms come back. What are the drugs? Well, typically Chlorpromazine, goes by some other names, Thorazine etcetera. And specifically it seems to reduce the positive symptoms so the hallucinations and the delusions and the disordered thought. Okay, so somebodys who see's FBI spies everywhere and they're trying to get them and they feel perscuted or paranoid. You give them these drugs and those, impressions go away. And if they had voices in their head, the voices go away. Now again, this may sound like a great thing. people have, people are now normal, or more normalish. Now they're still not normal. Let me highlight that the negative effects that, you know, lack of proper emotion, that lack of energy, that lack of planning. you know, the whole kind of sitting on the couch behavior and doing nothing that remains. Okay, the patients still have that, but they're not hearing the voices and they're not feeling the paranoid delusions. But even that can be a problem because sometimes the patients feel like they have been dumped down. They feel like these drugs make them not as perceptive as they once were. They used to see all these connections now they don't and of course the drugs produce side effects. In fact, with a large enough dose which intuitively happens as their on these drugs. You have to keep upping the dose. Then we get this thing called tardive dyskinesia. it's characterized by lip smacking, a lot of that and drooling literally. so sometimes people have to have a cloth, and they literally have to wipe their mouth in a regular basis because they will just drool. that's not very attractive. That doesn't make for good social interactions. You know, and so sometimes the biggest challenge with a schizophrenic patient. Is to keep them on their medication, they sometimes want to get off the medication. If you've seen the movie A Beautiful Mind you know, he is essentially a schizophrenic. And in that case there were it, side effects related to sexual behavior that neither he nor his wife were impressed by and so he stopped taking meds. so he could be sexually active again, but then all the problems come back. Okay, so that's the trick with schizophrenia, but literally in that case, this is the best we have at this point in time. We don't have a lot of good therapies, talk therapies, that seem to work. It seems like for schizophrenia It is a biological issue. So I wanted to draw that contrast between depression and Schizophrenia. Depression we might be able to reorder people's thinking and they might be fine. Schizophrenia not so much. Okay, so that's the drug therapy. I wanted to tell you about a couple of other things. First of all, psychosurgery. Psychosurgery, what that refers to is actually altering the brain. And we've talked some of these. We've talked about severing the corpus callosum, right? Like cutting it right down the middle, and that split brain syndrome that you get as a result? They did that again for a while, because it prevented epilepsy. well prevented the seizures at least. So, it worked that way, but of course it gave rise to all these other things and critically, it can't be undone. and so now we tend to rely more on drugs to prevent the seizures and we don't like to cut the brain up because it's not reversible. Now there was a point in time when frontal lobotomies were very commonly performed and I have a link to a video to explain that. but to give you a sense of that, you know, this was a time when your choice was sometimes as a, as a family member of a mentally ill patient. If you, if your brother, sister, whatever was very violent, an extremely violent patient, then at one point all they could do is restrain them. They kept him tied in a chair all the time. That was their only way of preventing the patient from being violent. But, they realized if they gave them a frontal lobotomy which literally means severing the frontal lobes then the patient became relaxed and mellow. Now, there are a bunch of other issues as well but, at least the patient wasn't trying to attack everybody. At least they didn't have to be restrained. They could be you know just left to play cards all day, which is kind of all they wanted to do. but in that case a lot of people saw lobotomy as a, as a positive change, as a improvement. and so they were pretty common for a while, we don't do them anymore. But I, I have a documentary for you to check out about that. And another thing that was common and that we still do is electro-convulsive shock therapy. And this is kind of interesting because, it started you know, sometimes in psychology, the therapies we come to where the theories we come to. We come almost by chance to some extent. And, and somebody noticed that people who had epileptic seizures Yes, it was very traumatic to have the seizure. You know, they'd wake up, they'd feel embarrassed or whatever, but emotionally, a lot of them reported they actually felt good after a seizure. They felt happier, they felt more positive. Why? We don't know. But people started saying, well if somebody feels depressed and especially if they feel suicidally depressed. They want to kill themselves, we can't talk to them, we can't get them to take any drugs, anything like that. what if we give them electro-convulsive shock therarpy? What is we essentially produce a seizure in the brain, pass an electric current through their brain to short circuit everything. So people started doing that and it worked. It made people feel better. It made them feel good enough, at least, so that maybe now you could go to a drug therapy and maybe eventually cognitive behavior therapy. So Electro-Convulsive Shock Therapy is still used in that way. For extremely depressed patients sometimes this is step one, and it, it can really help them. You know, there's a lot of research that suggests it works, it makes them feel better. Now, it's not without side effects, primarily memory there'll be memory loss that's associated with having these seizures. Usually for the stuff that happened just before the seizure. Sometimes the person generally feels a little bit more forgetful if they've gone through ECT, but they're not trying to kill themselves. So, you know, not a bad trade off. Alright, so that gives you, I think, a big picture and I think most therapists would argue. That if we took, for example, a case like depression, yeah, if it was really severe we might do ECT. And then we probably want to get them on, on some drugs, some Prozac or something Prozac by the way is an SSRI. so we might want to get them on Prozac or something to get their mood stabilized. And then we want to get them into cognitive behavior therapy, or something like that to try to teach them how to think differently. So that hopefully we can pull back the drugs, and this person can eventually live without you know any of that stuff. so that's you know a good example of the interplay between all these things. I got lots for you check up on because I know interesting stuff. A couple links just talking about drugs and therapy. This second one by the way is not really mental illness it's more general. but, it's a fasting it talks about the syndromes where now a lot of medical illness's is actually caused by all the drugs a person is taking. So a bit of a fascinating story there this is a documentary of frontal labotomies. So you can learn more about labotomies and here's one of electroconvulsive shock therapy so. Threw those int there so you can kind of get a visual. Some of these are on the creepy side so you've been warned. On this side a general reading about biological treatment, a short blog about what really causes mental illness. And another one talking about how effective biological treatments are or are not. So a little food for thought there. and that's what I got for you for week seven. And again, week eight will be a surprise to me, I look forward to it. I, I look forward to seeing what you want to hear more about. man our last week together, kind of weird. Alright, cool. Have a good time. I will see you next time, already. Bye bye.
