How to Help Anxious Minds
A Harvard psychiatrist answers questions about mental illness.
The brain is the source of thought and emotion. When things go wrong, the results are devastating. Here, a Harvard psychiatrist answers your questions.
Los Angeles, Calif.: What is the role of noninvasive brain stimulation (such as electroconvulsive therapy and rTMS) in the treatment of psychiatric disorders?
Dr. Carl Salzman: Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (rTMS) are both effective treatments for serious depressive disorders; they may have uses for other psychiatric disorders, as well, but this is less clear. We do not fully understand how these treatments work, but we know they alter brain chemistry and restore normal balance among brain neurotransmitters. ECT is particularly helpful for the most severe depressions that do not respond to medications. Both treatments are modern and safe; the days of "[One Flew Over the] Cuckoo's Nest" type of treatment are long past, and ECT is not used as a punishment or to control behavior.
Sarasota, Fla.: What are the most promising drugs on the horizon for Alzheimer's disease? My grandmother is almost mentally and physically frozen. Can anything bring her back to life? Also, what are your thoughts on research showing that caffeine may help?
I wish I could be more positive in answering this question. Research into the causes of Alzheimer's disease has progressed more rapidly than the development of reliable and effective treatments. At the moment, a few drugs may slow the progression of the disease, but none cure it or reverse it. At best, we try to use medications sparingly to help the afflicted individual be more comfortable and socially active as long as possible. Families understandably hope for a new successful treatment and then find their hopes unfulfilled, leaving them angry and frustrated. We should all understand the terrible burden that this disease puts on families, loved ones as well as on the afflicted individual. We look forward to better treatments in the future. Regarding caffeine: be careful because it can cause increased agitation, restlessness and insomnia, all of which make the symptoms of Alzheimer's disease worse. Certain medicines can also worsen symptoms. If you think that may be happening with someone you love, check with his or her doctor. Also, make sure that the individual is not using excessive alcohol and is able to sleep. Lastly, in the final stages of the disease, singing songs from the person's childhood may help you maintain contact with them, at least for a few moments.
Pocatello, Idaho: What is the toll on the brain of taking psychoactive medications for 15 years or more? Can this contribute to permanent physical brain damage?
When psychiatric medications are taken as directed by a physician, there are no long-lasting harmful effects on the brain. In fact, it is clear that some medications, such as antidepressants, may actually be helpful for the parts of the brain that regulate emotions.
Meherrin, Va.: Do people diagnosed with bipolar disorder "outgrow" their illness as they age? If not, do their symptoms increase or change over time?
True bipolar disorder may persist throughout life, although its course and the severity of its symptoms can vary greatly over time. It is possible for symptoms to become less severe and be well controlled with appropriate treatment, which usually includes medications and psychotherapy. Keeping a simple daily mood chart (e.g., "today I was high, normal, low") will help determine whether the variations on mood are under good control. There is no reason why a person with bipolar disorder cannot live a full, productive and happy life.
Salzman is a professor of psychiatry at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston and author of the textbook "Clinical Geriatric Psychopharmacology."
© 2008
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Member Comments
Posted By: philroy59 @ 09/21/2008 1:34:55 AM
Comment: Dr. Salzman asserts: "When psychiatric medications are taken as directed by a physician, there are no long-lasting harmful effects on the brain." Can Dr. Salzman cite any scientific evidence whatsoever to support this claim? Perhaps Dr. Salzman has somehow simply overlooked all the growing evidence that these medications often do produce harmful effects, including those listed below.
I'm surprised that Newsweek would publish such a broad unsupported claim without basic fact-checking first, simply because it came from a Harvard "expert". Maybe it's time for Newsweek to write an in-depth article contrasting the latest findings and controversies about psychiatric medications against the long-running overhyped industry claims.
- tardive dyskinesia and other movement disorders
http://www.ncbi.nlm.nih.gov/pubmed/16171976
http://www.ncbi.nlm.nih.gov/pubmed/18591121
- endocrine effects that lead to obesity and diabetes
http://www.ncbi.nlm.nih.gov/pubmed/16832314
http://www.ncbi.nlm.nih.gov/pubmed/16187768
- antipsychotic withdrawal induced psychosis
http://www.ncbi.nlm.nih.gov/pubmed/16774655
http://www.ncbi.nlm.nih.gov/pubmed/17650054
- agranulocytosis, a potentially fatal blood disorder
http://www.ncbi.nlm.nih.gov/pubmed/18681784
- drug-induced structural brain changes
http://www.ncbi.nlm.nih.gov/pubmed/15702141
http://www.ncbi.nlm.nih.gov/pubmed/16612194
- risk of suicide from antidepressants (blinded compared to placebo)
http://www.ncbi.nlm.nih.gov/pubmed/12601224
http://www.ncbi.nlm.nih.gov/pubmed/18690915
- antidepressant discontinuation syndrome
http://www.ncbi.nlm.nih.gov/pubmed/9219489
http://www.ncbi.nlm.nih.gov/pubmed/9269249
Using Imaging to Look at Changes in the Brain
http://www.nytimes.com/2008/09/16/health/research/16conv.html
Risks Found for Youths in New Antipsychotics
http://www.nytimes.com/2008/09/15/health/research/15drug.html
Judge to Unseal Documents on the Eli Lilly Drug Zyprexa
http://www.nytimes.com/2008/09/06/business/06lilly.html
Exposure to antipsychotics and risk of stroke
http://www.bmj.com/cgi/content/full/337/aug28_2/a1227
Several lawsuits target prescription drug Seroquel
http://www.post-gazette.com/pg/08241/907556-53.stm
Proof Is Scant on Psychiatric Drug Mix for Young
http://www.nytimes.com/2006/11/23/health/23kids.html
Psychiatric Group [APA] Faces Scrutiny Over Drug Industry Ties
http://www.nytimes.com/2008/07/12/washington/12psych.html
Stanford doctor's stock raises ethics concerns
http://www.mercurynews.com/lifeandstyleheadlines/ci_9689122
Grassley seeks FDA scrutiny of Paxil and suicide risk
http://finance.senate.gov/press/Gpress/2008/prg061208.pdf
Mental health journalism blog
http://www.furiousseasons.com/
Law Project for Psychiatric Rights
http://psychrights.org/Research/Digest/Researchbytopic.htm
MindFreedom International (UN-recognized NGO)
http://www.mindfreedom.org/kb/psychiatric-drugs/
"Mad in America" by Robert Whitaker
http://madinamerica.com/Mad%20In%
Posted By: 49er @ 09/17/2008 6:13:58 PM
Comment: Dr. Salzman's statement that psychotropic meds don't cause long term brain damage is simply not true. It is also outrageous that a news organization like Newsweek allowed a statement like this to go unchallenged.
My story:
I suffered many cognitive side effects and a hearing loss as the result of being on antidepressants which I am very slowly withdrawing from One of the cognitive side effects is very subtle but will occur in my writing. Even though I know which word to use, my fingers end up typing the wrong one. For example, in a post on a comments section, I meant to say ???enter??? and typed ???end???. It is like the drugs caused something in my brain to get crossed up as I never made these errors prior to being placed on meds.
My story aside, there are citations that challenge this view
1.http://www.ncbi.nlm.nih.gov/pubmed/17196056?dopt=AbstractPlus - A cross-sectional study of the prevalence of cognitive and physical symptoms during long-term antidepressant treatment.
2. http://www.annals-general-psychiatry.../1/7/abstract/ - Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a case-control study
Conclusion
Even though depression was improved in elderly patients receiving antidepressants, apathy appeared to be greater in patients who were treated with SSRI than that found in patients who were not. Frontal lobe dysfunction due to alteration of serotonin is considered to be one of the possibilities.
3. http://www.ncbi.nlm.nih.gov/pubmed/9640489
Selective serotonin-reuptake inhibitor-induced movement disorders.
4. not brain damage but still very serious ???
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum - Medication-induced mitochondrial damage and disease.
???All classes of psychotropic drugs have been documented to damage mitochondria,???
AA