In cases of severe disorder it may be desirable to directly influence brain activity through electrical activation of the brain or through brain surgery.Electroconvulsive therapy (ECT) is a medical procedure designed to alleviate psychological disorder in which electric currents are passed through the brain, deliberately triggering a brief seizure (Figure 13.3). ECT has been used since the 1930s to treat severe depression.
When it was first developed, the procedure involved strapping the patient to a table before the electricity was administered. The patient was knocked out by the shock, went into severe convulsions, and awoke later, usually without any memory of what had happened. Today ECT is used only in the most severe cases when all other treatments have failed, and the practice is more humane. The patient is first given muscle relaxants and a general anesthesia, and precisely calculated electrical currents are used to achieve the most benefit with the fewest possible risks.
ECT is very effective; about 80% of people who undergo three sessions of ECT report dramatic relief from their depression. ECT reduces suicidal thoughts and is assumed to have prevented many suicides (Kellner et al., 2005). 1 On the other hand, the positive effects of ECT do not always last; over one-half of patients who undergo ECT experience relapse within one year, although antidepressant medication can help reduce this outcome (Sackheim et al., 2001). 2 ECT may also cause short-term memory loss or cognitive impairment (Abrams, 1997; Sackheim et al., 2007). 3
Today’s ECT uses precisely calculated electrical currents to achieve the most benefit with the fewest possible risks.
Although ECT continues to be used, newer approaches to treating chronic depression are also being developed. A newer and gentler method of brain stimulation is transcranial magnetic stimulation (TMS), a medical procedure designed to reduce psychological disorder that uses a pulsing magnetic coil to electrically stimulate the brain (Figure 13.4). TMS seems to work by activating neural circuits in the prefrontal cortex, which is less active in people with depression, causing an elevation of mood. TMS can be performed without sedation, does not cause seizures or memory loss, and may be a s effective as ECT (Loo, Schweitzer, & Pratt, 2006; Rado, Dowd, & Janicak, 2008). 4 TMS has also been used in the treatment of Parkinson’s disease and schizophrenia.
Still other biomedical therapies are being developed for people with severe depression that persists over years. One approach involves implanting a device in the chest that stimulates the vagus nerve, a major nerve that descends from the brain stem toward the heart (Corcoran, Thomas, Phillips, & O’Keane, 2006; Nemeroff et al., 2006). 5 When the vagus nerve is stimulated by the device, it activates brain structures that are less active in severely depressed people.
Psychosurgery, that is, surgerythat removes or destroys brain tissuein thehopeof improving disorder, is reserved for the most severe cases. The most well-known psychosurgery is the prefrontal lobotomy. Developed in 1935 by Nobel Prize winner Egas Moniz to treat severe phobias and anxiety, the procedure destroys the connections between the prefrontal cortex and the rest of the brain. Lobotomies were performed on thousands of patients. The procedure— which was never validated scientifically—left many patients in worse condition than before, subjecting the already suffering patients and their families to further heartbreak (Valenstein, 1986). 6 Perhaps the most notable failure was the lobotomy performed on Rosemary Kennedy, the sister of President John F. Kennedy, which left her severely incapacitated.
There are very few centers that still conduct psychosurgery today, and when such surgeries are performed they are much more limited in nature and calledcingulotomy(Dougherty et al., 2002). 7 The ability to more accurately image and localize brain structures using modern neuroimaging techniques suggests that new, more accurate, and more beneficial developments in psychosurgery may soon be available (Sachdev & Chen, 2009). 8
- Psychostimulants are commonly prescribed to reduce the symptoms of ADHD.
- Antipsychotic drugs play a crucial role in the treatment of schizophrenia. They do not cure schizophrenia, but they help reduce the positive, negative, and cognitive symptoms, making it easier to live with the disease.
- Antidepressant drugs are used in the treatment of depression, anxiety, phobias, and obsessive-compulsive disorder. They gradually elevate mood by working to balance neurotransmitters in the CNS. The most commonly prescribed antidepressants are the SSRIs.
- Antianxiety drugs (tranquilizers) relieve apprehension, tension, and nervousness and are prescribed for people with diagnoses of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and panic disorder. The drugs are effective but have severe side effects including dependence and withdrawal symptoms.
- Electroconvulsive therapy (ECT) is a controversial procedure used to treat severe depression, in which electric currents are passed through the brain, deliberately triggering a brief seizure.
- A newer method of brain stimulation is transcranial magnetic stimulation (TMS), a noninvasive procedure that employs a pulsing magnetic coil to electrically stimulate the brain.
EXERCISES AND CRITICAL THINKING
- What are your opinions about taking drugs to improve psychological disorders? Would you take an antidepressant or antianxiety medication if you were feeling depressed or anxious? Do you think children with ADHD should be given stimulants? Why or why not?
- Based on what you have just read, would you be willing to undergo ECT or TMS if you were chronically depressed and drug therapy had failed? Why or why not?