TREATMENT

• BEFORE LOBOTOMY, ECT (SHOCK), COMA - NOW DRUGS

• CHANGE NEUROCHEMISTRY OF BRAIN

• CHANGE WHAT RECEPTORS ABSORB SO ELEVATE OR LOWER LEVELS OF NEUROTRANSMITTERS IN SYNAPSES

TREATMENTS

• ANTI-PSYCHOTICS

• LITHIUM FOR BIPOLAR

• PHENOTHIAZINES AND CLOZAPINE FOR SCHIZOPHRENIA

• ILLNESS SPECIFIC

SSRI’S

• SELECTIVE SEROTONIN REUPTAKE INHIBITORS - PROZAC, PAXIL, XOLOFT (LATE 1980’S)

SSRI’S

• UNLIKE OLDER DRUGS, SPECIFICALLY DESIGNED TO PREVENT REUPTAKE OF SEROTONIN

• NOT ILLNESS SPECIFIC (NOT “ANTI-DEPRESSANTS”)

Psychotropic Prescribing in USA (IMS - S Units)

0100000020000003000000400000050000006000000700000080000009000000

10000000

1990 1992 1994 1996 1998 2000 2001

AntidepressantAntipsychotic

HUGE GROWTH

• 10% OF ADULT POPULATION NOW TAKING AN SSRI

• 3 OF 7 BEST SELLING PRESCRIPTION DRUGS OF ANY KIND ARE SSRI’s

• 300% INCREASE IN PAST 10 YEARS IN NUMBER OF CHILDREN AND ADOLESCENTS TAKING MEDICATION

ARE SSRI’S BETTER?

• NOT MORE EFFECTIVE THAN OLDER DRUGS

• FEWER NEGATIVE SIDE EFFECTS

• NOT ADDICTING

• LESS RISK OF OVERDOSE

? ABOUT SSRI’S

• NOT MUCH BETTER THAN PLACEBOS FOR LESS SEVERE CONDITIONS

• LONG-TERM EFFECTS?

• ONLY ELIMINATE SYMPTOMS, NOT UNDERLYING PROBLEM?

• BETTER ALTERNATIVES?

• NOT GOOD FOR UNDER AGE 18?

STRENGTHS OF BIOLOGY

• BEST FOR PSYCHOTIC DISORDERS

• MORE KNOWLEDGE ABOUT BRAIN

• ADVANCES IN DRUG TREATMENTS FOR MANY CONDITIONS

1. OVERSTATEMENTS

• MOST CONVINCING FOR PSYCHOSES

• LESS EVIDENCE FOR OTHERS

• ARE BRAIN STATES CAUSES OR EFFECTS OF M.I.?

• CAUSES CAN BE SOCIAL OR PSYCH AS WELL AS BIOLOGICAL

2. GENES NOT DESTINY

• ONLY A MINORITY OF PEOPLE WITH GENETIC SUSCEPTIBILITY DEVELOP DISORDER

• OFTEN NEED ENVIRONMENTAL PRECIPITANT

• ENVIRONMENT CAN SUPPRESS - MORMONS AND ALCOHOLISM

3. WHAT DOES A GENE DO?

• DIFFERENCE OF GENOTYPE AND PHENOTYPE (APPEARANCE)

• CULTURE CAN SHAPE PHENOTYPE

• E.G. ANOREXIA

• GENES MAY HAVE GENERAL, NOT SPECIFIC, EFFECTS

4. MOST M.I. NOT GENETIC

• MOST PEOPLE WHO GET A DISORDER DO NOT HAVE GENETIC PROPENSITY TO THE DISORDER

SCHIZ. IN DENMARK

• THOSE WITH 1ST DEGREE RELATIVES HAVE 10x RATE OF SCHIZ

• BUT 90% OF PEOPLE WHO DO GET SCHIZ DON’T HAVE SCHIZ RELATIVES

• FAR MORE PEOPLE HAVE NO FAMILY HISTORY OF SCHIZ SO DESPITE LOWER % PRODUCE MORE CASES

CONCLUSION

• GENES AND BRAINS ARE IMPORTANT

• BUT, FAR FROM THE ENTIRE STORY

• AT PRESENT, INFLUENCE IS OVERSTATED