114 CHAPTER 4
2001). For short-term treatment of anxiety symptoms, psychiatrists may pre-
scribebenzodiazepines (commonly referred to as tranquilizers) such as Valium
or Xanax.Changing Brain Function Through Brain Stimulation
Medication changes brain functioning through a circuitous route: The medication
is generally swallowed, then absorbed into the bloodstream, and ultimately trans-
ported to the particular synapses. Two other biomedical techniques can change
patients’ brain functioning more directly: electroconvulsive therapy and transcranial
magnetic stimulation. The former has been in use for many years, and thus much
is known about who might or might not benefi t from it; the latter is relatively new,
and so guidelines about its use are only beginning to be formulated.Psychodynamic Therapy
Electroconvulsive therapy (ECT) is a procedure that causes a controlled brain
seizure in an effort to reduce or eliminate the symptoms of certain psychological
disorders. An electric current is passed through the head via electrodes that are
placed on the scalp. The current causes a seizure. Just before ECT treatment, the
patient receives a muscle relaxant, and the treatment occurs while the patient is
under anesthesia. Because of the risks associated with anesthesia, ECT is performed
in a hospital and may require a hospital stay. A typical course of ECT can involve
six to twelve sessions over several weeks, with about three sessions per week. Some
patients report memory loss for events that transpired before the ECT treatments
(Kho, Van Vreeswijk, & Murre, 2006).
Researchers do not yet understand why ECT is effective in treating depression.
In the 1940s and 1950s, ECT was a major neurological treatment, but was used less
often after effective medications were developed. ECT became politically unpopu-
lar when the public discovered that the procedure was sometimes used to make
troublesome patients docile. Moreover, some patients reported cognitive diffi cul-
ties as a result of ECT. Today, the cognitive impairments and other side effects of
ECT have been signifi cantly reduced, and laws prevent ECT from being used sim-
ply to calm unruly patients. Given these improvements, the use of ECT to alleviate
severe and treatment-resistant depression—the disorder for which this procedure
is most effective—has increased since the 1980s (Glass, 2001), and now is admin-
istered to about 12.5 per 100,000 people in the general U.S. population. ECT is
more commonly used for older adults than younger adults (Rapoport, Mamdani, &
Herrmann, 2006). It is also used more frequently for wealthy patients than for those
in publicly funded hospitals, perhaps in reaction to the fact that ECT was previously
overused in such hospitals (Sackeim, Devanand, & Nobler, 1995).Transcranial Magnetic Stimulation
In contrast to ECT, which transmits electrical impulses, transcranial magnetic
stimulation (TMS) sends sequences of short, strong magnetic pulses into the cerebral
cortex via a coil placed on the scalp. Each pulse lasts only 100–200 microseconds.
TMS has varying effects on the brain, depending on the exact location of the coil
and the frequency of the pulses, and researchers are still working to understand how
the magnetic fi eld affects brain chemistry and brain activity (George, Lisanby, &
Sackheim, 1999).
Studies indicate that TMS can be used effectively to treat depressed people for
whom medication has not helped (Bretlau et al., 2008), and it may work as well as
ECT (Avery et al., 2006; Dannon et al., 2002; Rosa et al., 2006). In 2008, the U.S.
Food and Drug Administration approved TMS as a treatment for depression that
should be used after traditional treatments have failed.
Other studies have suggested that TMS may reduce symptoms that arise in
a variety of disorders, not only in depression (Alonso et al., 2001; Grisaru et al.,Transcranial magnetic stimulation is a new
technique that might treat some kinds of
depression more effectively than ECT.AP Photo/Charles Krupa
Benzodiazepines
A class of medications commonly known as
tranquilizers.Electroconvulsive therapy (ECT)
A procedure that causes a controlled brain
seizure in an effort to reduce or eliminate the
symptoms of certain psychological disorders.Transcranial magnetic stimulation (TMS)
A procedure that sends sequences of short,
strong magnetic pulses into the cerebral
cortex via a coil placed on the scalp.