Biotherapies

Biotherapies are the oldest of psychotherapies. They include psychosurgery, electroconvulsive therapy, and drug therapy. Psychosurgery, primarily in the form of prefrontal lobotomies, became very common in the early part of the 20th century. Because the effects of lobotomy were so variable, its use was discontinued. Today, very little surgery is done for psychotherapeutic reasons. Basically, the surgical means are yet too crude and the brain is simply too complex. Electroconvulsive therapy (ECT) followed a similar path, but ECT is still performed, especially in cases of severe depression. Drug therapy has flourished and become the main type of biotherapy. Four main classes of psychoactive drugs exist: antipsychotics, antidepressants, antianxiety drugs, and lithium.

The treatment of severe psychopathologies (i.e., those formerly called psychoses) was completely changed by the introduction of antipsychotic drugs. Before, those patients literally had to be tied down. After, the antipsychotic drugs made it possible to manage such patients safely. The most common antipsychotic drugs are the phenothiazines (i.e., Thorazine and Haldol). Both are dopamine blockers and are used on schizophrenics. Most respond but many have side effects such as dry mouth, tremors, and jerkiness of movement. The drugs must be used in conjunction with some other form of therapy.

Antidepressants increase serotin and norepinephrine. Older antidepressants are trycyclics and monoamine inhibitors. Prozac is a newer antidepressant. Because depressed patients are at risk of suicide, the use of such drugs is important. Fortunately, many patients respond positively to the antidepressants.

Drugs to reduce anxiety are among the largest category prescribed today. Formerly barbiturates were prescribed, but their addictiveness and toxicity led to their discontinued use. Today muscle relaxants (i.e., Miltown and Equanil) and benzodiazepines (i.e., Librium and Valium) are used instead. Both may be overprescribed and some find their use habit forming.

Lithium (lithium chloride, a salt) has been successful in treating bipolar disorder. Highly effective, its mode of action is unknown. But its effect is one of the main sources of evidence for the classification of bipolar disorder as distinct from unipolar depression.

Bipolar disorder is successfully treated with Lithium (a salt, lithium chloride). Its mode of action is a mystery still. Patients must monitor their lithium levels as high levels may be toxic.

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