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Labor Instability and Community Mental Health: The Work of Pharmaceuticals in Santiago, Chile

Clara Han

in When People Come First: Critical Studies in Global Health

This chapter explores how the local destiny of Chile's national program for depression was forged through pharmaceuticals. How and when women use antidepressants reflect both their practical ... More

This chapter explores how the local destiny of Chile's national program for depression was forged through pharmaceuticals. How and when women use antidepressants reflect both their practical knowledge of everyday afflictions and the shifting affective configurations of their domestic lives. In La Pincoya, psychopharmaceuticals distributed by the local primary care center in the framework of community mental health are absorbed into domestic relations. As material substrates, they can manifest care among neighbors and kin when shared in a variety of ways. They have entered a local formulary of medications informed by practical knowledges of the bodily symptoms and afflictions that are often reactions to labor instability, kinship relations, and economic indebtedness. The chapter examines how these knowledges work in relation to “health,” experienced locally, and how these knowledges—in tandem with institutional failures—can obscure rare disease processes.Less

Neuropsychiatry: The Breakthrough in Psychopharmacology

Gordon M. Shepherd

in Creating Modern Neuroscience: The Revolutionary 1950s

This chapter traces the development of neuropsychiatry. Before 1950 the means to ameliorate psychiatric disorders were limited to psychoanalysis, on the one hand, and extreme treatments such as ... More

This chapter traces the development of neuropsychiatry. Before 1950 the means to ameliorate psychiatric disorders were limited to psychoanalysis, on the one hand, and extreme treatments such as psychosurgery or electrical stimulation of the brain to produce convulsions, on the other. Mind was still conceived to be separate from body. This situation was radically changed by drug discoveries in the 1950s. For instance, the antischizophrenic drugs chlorpromazine, reserpine, and butyrophenones (haloperidol), caused dramatic quieting of schizophrenic patients, resulting in reduction or elimination of violent patients from hospital wards. Several classes of antidepression drugs (iproniazid, monoamine oxidase inhibitors, and tricyclics) were discovered, which gave the first relief from this debilitating mental and emotional disorder. The efficacy of lithium in the treatment of depression and bipolar disorder was also established.Less

The treatment of anxiety

Jeffrey A. Gray and Neil McNaughton

in The Neuropsychology of Anxiety: An enquiry into the function of the septo-hippocampal system

This chapter discusses behaviour therapy, drug therapy (antidepressants), cognitive-behavioural therapy for the treatment of disorders such as anxiety disorder and their possible interactions, in the ... More

This chapter discusses behaviour therapy, drug therapy (antidepressants), cognitive-behavioural therapy for the treatment of disorders such as anxiety disorder and their possible interactions, in the context of the theory.Less

Drugs Don't Talk: Do Medication and Biological Psychiatry Contribute to Silencing the Self?

Richard A. Gordon

in Silencing the Self Across Cultures: Depression and Gender in the Social World

This chapter examines the recent rise in the use of antidepressant medications as well as the growing emphasis on biomedical explanations for depression. The chapter presents the history of ... More

This chapter examines the recent rise in the use of antidepressant medications as well as the growing emphasis on biomedical explanations for depression. The chapter presents the history of antidepressant medications and changes in the Diagnostic and Statistical Manual as well as an analysis of the shift in the treatment of depression from psychotherapy to drugs. The author provides an overview of evidence for social factors in the origin of depression and argues that social models of depression have been marginalized by the dominance of biomedical discourse and practices. The chapter looks at the gaps in current scientific understanding of what constitutes effective treatment for depression. The chapter also discusses implications for depression treatment that considers the broader social environment and that acknowledges the effects of life stress and trauma.Less

Mental and behavioural disorders

Fabrizio Benedetti

in Placebo Effects: Understanding the mechanisms in health and disease

In depression, a fluoxetine treatment and a placebo treatment affect similar brain regions. In addition, covert (unexpected) administration of anti-anxiety drugs is less effective than overt ... More

In depression, a fluoxetine treatment and a placebo treatment affect similar brain regions. In addition, covert (unexpected) administration of anti-anxiety drugs is less effective than overt (expected) administration, which indicates the key role of expectation in anti-anxiety therapy. In dementia, the disruption of prefrontal executive control in Alzheimer's disease may decrease the magnitude of placebo responses, and expectations appear to be particularly important when associated to the effects of drugs of abuse. In general, placebo effects appear to be powerful in psychotherapy and, interestingly, the brain areas involved in the psychotherapeutic outcome are different from those involved in the placebo effect, which suggests different underlying mechanisms.Less

Anxiety Disorders

Jacqueline Corcoran

in Mental Health Treatment for Children and Adolescents

This chapter reviews the evidence basis for the treatment of anxiety disorders in children and adolescents. The most widely studied intervention for the anxiety disorders is CBT featuring exposure. ... More

This chapter reviews the evidence basis for the treatment of anxiety disorders in children and adolescents. The most widely studied intervention for the anxiety disorders is CBT featuring exposure. Antidepressant medication is also considered a viable intervention (indeed it is more effective for reducing anxiety than it is for helping with depression) although CBT is considered a first-line treatment. Combining psychosocial and pharmacological treatment may not be necessary to produce improvement. These interventions are evaluated against how well they address risk factors for the development of anxiety and adjustment for afflicted youth. Other recommendations for practice and research are explored.Less

Depressive Disorders

Jacqueline Corcoran

in Mental Health Treatment for Children and Adolescents

The prevalence of diagnosable depressive disorders in children is 2.8% and in adolescents is 5.7%. This chapter reviews the evidence basis for the treatment of depressive disorders in youth. ... More

The prevalence of diagnosable depressive disorders in children is 2.8% and in adolescents is 5.7%. This chapter reviews the evidence basis for the treatment of depressive disorders in youth. Cognitive-behavioral therapy has predominated in the research literature, with interpersonal therapy also receiving empirical support. In general, however, effects of intervention are small. Medication studies indicate that while antidepressants improve depression symptoms, they also increase suicidality in youth. Fluoxetine is the only SSRI with significant benefit for children, and sertaline and fluoxetine have significant benefits for adolescents. Large-scale studies on the differential efficacy of combining psychotherapy versus offering single treatments conflict in their findings. Interventions are evaluated against how well they address risk factors for the development of depression and adjustment for afflicted youth, and recommendations are advanced.Less

Anorexia Nervosa and Bulimia Nervosa

Jacqueline Corcoran

in Mental Health Treatment for Children and Adolescents

Rates of diagnosable anorexia nervosa (AN) and bulimia nervosa (BN) are low in youth because DSM criteria is not typically applicable to adolescents. Therefore, the majority of teens seeking ... More

Rates of diagnosable anorexia nervosa (AN) and bulimia nervosa (BN) are low in youth because DSM criteria is not typically applicable to adolescents. Therefore, the majority of teens seeking treatment qualify for Eating Disorder Not Otherwise Specified. This chapter reviews the evidence basis for the treatment of eating disorders. The vast majority of studies on eating disorders pertain to adults, and there is a lack of study on AN, in general. The Maudsley Model of family therapy has received attention for adolescent AN but there is not yet convincing evidence that it is more effective than supportive therapy. Considering the adult literature, CBT, interpersonal therapy, and antidepressants may be helpful for bulimia symptoms in adolescence. More treatment outcome studies on adolescent eating disorders are needed before such manifestations develop into full-blown disorders and entrenched patterns of dysfunctional attitudes and behaviors result.Less

Management of tinnitus

Jos J. Eggermont

in The Neuroscience of Tinnitus

It is clear that management of tinnitus requires alterations of neural activity in the CNS. The neural substrates of tinnitus suggest various approaches to modify neural processing and change the ... More

It is clear that management of tinnitus requires alterations of neural activity in the CNS. The neural substrates of tinnitus suggest various approaches to modify neural processing and change the properties of tinnitus and so obtain some alleviation of it. The interventions for tinnitus include compensation of missing activity in the output of the cochlea via specially tailored acoustic environments, and via amplification of environmental sounds in the hearing frequency range, i.e., by hearing aids. In deaf persons the missing sounds can be applied by a cochlear implant. A non-invasive method that may be useful to suppress tinnitus is based on trans cranial magnetic stimulation. Tinnitus Retraining Therapy and cognitive behavioral therapy are effective in reducing the annoyance and impact of tinnitus. Pharmacological approaches have so far produced disappointing results in humans and the somewhat more promising findings in animals.Less

Corporate Highs, Corporeal Lows

David Lenson

in Mind-Altering Drugs: The Science of Subjective Experience

This chapter narrates the author's personal experience with antidepressants. These include Prozac, Wellbutrin, and Effexor.

Drugs acting on reward and punishment systems

Heather Ashton

in Brain Function and Psychotropic Drugs

This chapter describes drugs that exert major actions on reward and punishment systems and are all drugs of dependence. Some have potent effects on pain systems and are of therapeutic importance ... More

This chapter describes drugs that exert major actions on reward and punishment systems and are all drugs of dependence. Some have potent effects on pain systems and are of therapeutic importance (narcotic analgesics), but all are also used as recreational agents because of their rewarding properties. Antidepressant drugs and drugs which induce depression also affect reward and punishment systems.Less

Drugs used in depression and mania

Heather Ashton

in Brain Function and Psychotropic Drugs

This chapter describes the main drugs used in affective disorders. Many drugs produce euphoria in normal subjects and some of these, at least temporarily, lighten mood in depressed patients. However, ... More

This chapter describes the main drugs used in affective disorders. Many drugs produce euphoria in normal subjects and some of these, at least temporarily, lighten mood in depressed patients. However, a characteristic of antidepressant drugs is that they have little effect on mood in normal subjects, yet restore normal mood in patients with clinical depression. Similarly, some drugs which are effective in mania (lithium, carbamazepine) have little effect on mood in normal subjects.Less

The inactive enantiomer of a noradrenaline uptake blocker reduces 5-HT synthesis

Peter C. Waldmeier and Laurent Maitre

in 5-Hydroxytryptamine in Psychiatry: A Spectrum of Ideas

The enantiomers of the tetracyclic antidepressant oxaprotiline differ in their ability to inhibit noradrenaline (NA) uptake. While (+)-oxaprotiline (CGP 12104 A) is extraordinarily potent in this ... More

The enantiomers of the tetracyclic antidepressant oxaprotiline differ in their ability to inhibit noradrenaline (NA) uptake. While (+)-oxaprotiline (CGP 12104 A) is extraordinarily potent in this respect, the (-)-enantiomer (CGP 12103 A, levoprotiline) is virtually inactive in vitro and in vivo. Levoprotiline was originally tested clinically in depressed patients as it is an ideal way to test the catecholamine hypothesis of affective disorders. Contrary to the prediction by this hypothesis, the compound clearly showed antidepressant effects in patients, which automatically raised the question of the mechanism of action. Levoprotiline has been found active in a number of behavioral tests for antidepressants: it was effective in the Porsolt swim test after chronic application; it enhanced the neurological syndrome induced by 5-hydroxytryptophan (5-HTP) and the stereotypies caused by apomorphine and after repeated treatment it also potentiated the effects of damphetamine and dopamine injected into the rat nucleus accumbens. Levoprotiline has little if any interaction with α2- and β-noradrenergic, cholinergic, serotonergic (5-HTx subtypes, 5-HT2), dopaminergic, GABAA, benzodiazepine, adenosine, and opiate receptors.Less

The acute effect of monoamine oxidase inhibitors on serotonin conversion to melatonin

Gregory F. Oxenkrug

in 5-Hydroxytryptamine in Psychiatry: A Spectrum of Ideas

Monoamine oxidase (MAO) inhibitors were introduced as antidepressants about thirty years ago. The pharmacological mechanism of their antidepressant effect was related to the inhibition of MAO ... More

Monoamine oxidase (MAO) inhibitors were introduced as antidepressants about thirty years ago. The pharmacological mechanism of their antidepressant effect was related to the inhibition of MAO activity and limitation of the catabolism of the monoamines, serotonin (5-hydroxytryptamine, 5-HT) and noradrenaline. Both monoamines play an important role in the regulation of melatonin biosynthesis from serotonin. This process involves the N-acetylation of serotonin to form N-acetylserotonin (NAS), which is catalysed by N-acetyltransferase (NAT). The synthesis of NAS is triggered by noradrenaline stimulation of the pinealocyte adrenoceptors (mainly β  1 receptors). The next step is methylation of NAS to form melatonin, which is catalysed by hydroxyindole-O-methyltransferase. The inhibition of MAO by MAO inhibitors is acute: it occurs within hours of the administration of a single dose. Both tricyclic and heterocyclic antidepressants increase the levels of melatonin in human plasma after administration of a single dose. A single electroconvulsive shock almost doubled rat pineal TV-acetyltransferase activity and the concentrations of melatonin and serotonin. This chapter concentrates on studies of the acute effect of MAO inhibitors on melatonin biosynthesis.Less

Experimental tests of the 5-HT receptor imbalance theory of affective disturbance

J. F. W. Deakin, F. S. Guimaraes, M. Wang, and R. Hensman

in 5-Hydroxytryptamine in Psychiatry: A Spectrum of Ideas

Symptoms of anxiety and depression usually coexist. Scores on anxiety rating scales strongly predict scores on depression rating scales. Symptoms of anxiety predict symptoms of depression. Symptoms ... More

Symptoms of anxiety and depression usually coexist. Scores on anxiety rating scales strongly predict scores on depression rating scales. Symptoms of anxiety predict symptoms of depression. Symptoms of anxiety may ante-date and outlast depressive symptoms, and depression may be a higher level of affective disturbance than anxiety. However, there is no antithesis between the two sets of symptoms. The same treatments are effective in both and the most effective is treatment with 5-hydroxytryptamine (5-HT, serotonin) re-uptake-blocking antidepressants. It is therefore a very considerable paradox that excessive 5-HT neurotransmission has been associated with symptoms of anxiety whereas deficient 5-HT function has been associated with depressive illness.Less

Commentary on Part III Developmental Outcomes and Clinical Perspectives

Lynne Henderson and Philip G. Zimbardo

in Extreme Fear, Shyness, and Social Phobia

This chapter addresses the treatment of social phobia and compares and contrasts it with the treatment of panic disorder. It also reports the most current methods for treating shyness and ... More

This chapter addresses the treatment of social phobia and compares and contrasts it with the treatment of panic disorder. It also reports the most current methods for treating shyness and anxiety-related problems in children and adults. Although most studies so far have not determined corticotropin-releasing factor (CRF) and hypothalamic-pituitary-adrenocortical (HPA) axis abnormalities in social phobia, results from animal studies and from human studies of fear and behavioral inhibition indicate that more work is important to clarify the functioning of this system. In general, the data on treatment of social phobia and panic disorder indicates similarities and differences between the two disorders. Both social phobia and panic disorder have been shown to be responsive to several classes of medications. However tricyclic antidepressants are highly effective for panic but disappointing for social phobia.Less

Antidepressants

John R. Lipsey

in Psychiatric Aspects of Neurologic Diseases: Practical approaches to patient care

Antidepressant drug therapy is the cornerstone of treatment for major depression and is usually successful (Rosenbaum et al., 2005). Fifty percent of patients respond to the first antidepressant ... More

Antidepressant drug therapy is the cornerstone of treatment for major depression and is usually successful (Rosenbaum et al., 2005). Fifty percent of patients respond to the first antidepressant used, and 75% respond to one of the first three agents chosen if these agents represent different antidepressant classes. Insufficient dosage and duration of therapy are the most common causes of treatment failure. The required duration for a full therapeutic trial of any antidepressant is 6 to 8 weeks, but some patients require 10 to 12 weeks to achieve maximum benefit. Every patient being treated pharmacologically for depression should be educated about the course of recovery. Even if an antidepressant is ultimately successful, improvement in the first week or two may be minimal and involve primarily improved sleep or diminished anxiety. When more substantial improvements begin later, they may vary greatly on a day-to-day basis, and patients should be forewarned that the early course of recovery may be punctuated by unexpected brief dips in mood. Patients may also find that their energy, appetite, activity level, and social engagement improve before they notice a positive change in their moods. Thus, they look much improved to their friends and families before they feel better. Eventually, however, the full range of depressive symptoms resolves, and this improvement is sustained. During the course of antidepressant treatment, all patients must be asked about new or recurrent suicidal ideas, and their families should be told to report any evidence of self-harming actions or thoughts. Suicidal ideas, perhaps held in check by lack of energy to carry them out, may potentially develop into suicidal impulses or actions if a patient’s energy improves while severely depressed mood or hopelessness persist. Five classes of antidepressants will be described below: selective serotonin reuptake inhibitors (SSRIs), the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine, the alpha2-adrenergic antagonist mirtazapine, the norepinephrinedopamine reuptake inhibitor (NDRI) bupropion, and tricyclic antidepressants (TCAs). There is little evidence that any individual antidepressant (or antidepressant class) is generally superior to another, so the sequence of drug selection is determined primarily by tolerability and safety considerations. The SSRIs are commonly used in the initial treatment of major depression. Less

Bowels and Constipation

J. Eric Ahlskog

in Dementia with Lewy Body and Parkinson's Disease Patients: Patient, Family, and Clinician Working Together for Better Outcomes

Constipation is common among older adults, in general. However, it is very common among people with Lewy body disorders, and the reason is dysautonomia. Lewy body disorders tend to impair control ... More

Constipation is common among older adults, in general. However, it is very common among people with Lewy body disorders, and the reason is dysautonomia. Lewy body disorders tend to impair control of gut motility by the autonomic nervous system. At the stomach level, bloating may develop when the stomach fails to empty into the upper small intestine. At the other end, constipation is the consequence of Lewy processes affecting motility in the colon. Colon motility (peristalsis) is what moves the remnants of digested food (stool) to the rectum for expulsion. These regions are shown in Figure 15.1. Drugs that block the neurotransmitter acetylcholine are notorious for worsening constipation; these include medications used to treat urinary urgency (overactive bladder). All of the anticholinergic drugs for bladder overactivity that were listed in Table 12.1 cause constipation, as does another bladder drug, trospium (Sanctura). The tricyclic drugs for depression shown in Table 12.1 have variable anticholinergic properties and also tend to be constipating. One needs to balance benefits against the side effect of constipation if considering these medications. In the setting of DLB or PDD, constipation is typically due to autonomic nervous system dysfunction, often exacerbated by medication side effects. However, there are exceptions and the primary care clinician or internist should consider whether colonoscopy is appropriate. This procedure involves inserting a scope into the anus and then advancing the instrument to visualize the entire colon. In this way hidden colon cancers are detected before they become deadly. It is common knowledge that several natural remedies help prevent constipation: fruits, vegetables, fluids, and fiber. Individuals with constipation should make sure that their diet includes adequate fruits, which make a good snack. Meals should include vegetables, such as green beans, peas, and squash; catsup and potatoes do not count as vegetables. Intake of six to eight tall glasses of water, juice, or other fluids may help maintain moisture in the stool, making it easier to pass. Finally, fiber needs to be included in the diet in order to give the stool bulk. These strategies are often insufficient for persons with Lewy disorders, and additional measures are often necessary. Less