Biomedical Therapies
Beginning in the mid-20th century, new medical treatments (especially medications) transformed mental health care. Today, biomedical therapies are used to reduce symptoms by targeting brain and body processes involved in mood, thinking, attention, sleep, and arousal. Many people use biomedical therapies alongside psychotherapy, while others use them on their own—especially when symptoms are severe or urgent.
biomedical therapy
Biomedical therapies are treatments for psychological disorders that use medical approaches—most commonly prescription medications and brain-stimulation therapies (such as ECT or TMS). These approaches are often used when symptoms significantly impair daily functioning, when safety is a concern, or when psychotherapy alone is not enough.
Psychotropic Medications
Psychotropic medications are prescription drugs that affect brain chemistry and are used to treat symptoms of psychological disorders. They are prescribed by medical clinicians (including psychiatrists and other physicians, and in some settings nurse practitioners or physician assistants). The field focused on medication treatment for mental health is often called psychopharmacology.
Medications usually manage symptoms rather than “cure” a disorder. Some are used short-term; others are used long-term to reduce relapse risk and improve daily functioning. Medication decisions typically involve trial-and-adjustment, ongoing monitoring, and shared decision-making around benefits, side effects, and goals.
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Table 1. Commonly Prescribed Psychotropic Medications |
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|---|---|---|---|---|
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Medication class |
Often used for |
Examples (brand/generic) |
General mechanism (simplified) |
Key considerations / common risks |
|
Antipsychotics (first-generation) |
Psychosis (e.g., schizophrenia), acute mania |
haloperidol (Haldol) |
primarily reduces dopamine signaling |
higher risk of movement-related side effects, including tardive dyskinesia |
|
Antipsychotics (second-generation/“atypical”) |
Psychosis; sometimes bipolar disorder; sometimes adjunct for depression |
risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa), clozapine (Clozaril) |
dopamine + serotonin pathways |
higher risk of weight gain/metabolic effects (varies by medication); clozapine requires careful blood monitoring |
|
Antidepressants (SSRIs/SNRIs and others) |
Depression; many anxiety disorders |
sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro); venlafaxine (Effexor) |
increases availability of serotonin and/or norepinephrine |
side effects can include GI upset, sleep changes, sexual side effects; tapering may be needed to avoid withdrawal-like symptoms |
|
Anti-anxiety medications (benzodiazepines) |
Short-term acute anxiety/panic; agitation; insomnia (select cases) |
lorazepam (Ativan), alprazolam (Xanax) |
increases GABA activity (calming effect) |
can cause sedation; dependence risk increases with longer use |
|
Anxiolytic (non-benzodiazepine) |
Generalized anxiety (select cases) |
buspirone (Buspar) |
affects serotonin receptors |
slower onset than benzodiazepines; typically not habit-forming |
|
Mood stabilizers |
Bipolar disorder (mania prevention; sometimes depression prevention) |
lithium; valproate (Depakote); lamotrigine (Lamictal) |
varies by medication |
requires monitoring (e.g., lithium levels); side effects vary widely by medication |
|
Stimulants |
ADHD |
methylphenidate (Ritalin), amphetamine salts (Adderall) |
increases dopamine/norepinephrine activity |
can reduce appetite and disrupt sleep; monitoring is important |
Brain-Stimulation and Rapid-Acting Biomedical Treatments
Some biomedical therapies use electricity, magnetic fields, implanted devices, or rapid-acting medications to change brain activity patterns.
electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT), uses a carefully controlled electrical stimulus to produce a brief seizure. Modern ECT is done with anesthesia and medical monitoring. It is most commonly used for severe depression, especially when symptoms are urgent or when other treatments have not helped. A major concern is memory side effects, especially around the time of treatment.
An alternative to ECT is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms. It does not require anesthesia and does not induce a seizure. It is used when other treatments have not worked (Mayo Clinic, 2012).
Deep brain stimulation (DBS)
DBS involves surgically implanted electrodes that deliver stimulation to specific brain circuits. In mental health, DBS has been used in very limited cases (typically severe, treatment-resistant conditions). The FDA has granted a Humanitarian Device Exemption (HDE) for a DBS system for refractory obsessive-compulsive disorder in adults (a narrow, specialized indication).
Vagus nerve stimulation (VNS)
VNS uses an implanted device to send stimulation through the vagus nerve. The treatment involves sending regular, mild pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck. This is achieved through a device that is surgically implanted under the skin in the chest, similar to a pacemaker. A wire (lead) connected to this device is wound around the vagus nerve in the neck. The electrical pulses are delivered to the nerve by the device periodically throughout the day. It has long been used for epilepsy and has also received FDA approval for treatment-resistant depression under specific conditions and monitoring requirements.
Ketamine-assisted therapy and intranasal esketamine
Ketamine-assisted therapy is rapid-acting treatment for people with treatment-resistant depression (and other conditions like PTSD, chronic pain, or substance-abused disorders). Low-dose ketamine, a type of anesthetic (often given as six IV infusions over 2–4 weeks, or as intranasal esketamine) works by boosting glutamate-driven synapse growth. Relief can appear within hours and is paired with follow-up therapy sessions to reinforce lasting change. Clinics screen for cardiovascular and psychosis risk, monitor patients for about two hours post-dose, and reserve ketamine for those who haven’t improved on standard medications.
In an effort to determine which treatment methodologies are evidenced-based, professional organizations such as the American Psychological Association (APA) have recommended that specific psychological treatments be used to treat certain psychological disorders (Chambless & Ollendick, 2001). According to the APA (2005), “Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (p. 1).
The foundational idea behind evidence-based treatment is that best practices are determined by research evidence that has been compiled by comparing various forms of treatment (Charman & Barkham, 2005). These treatments are then operationalized and placed in treatment manuals—trained therapists follow these manuals. The benefits are that evidence-based treatment can reduce variability between therapists to ensure that a specific approach is delivered with integrity (Charman & Barkham, 2005). Therefore, clients have a higher chance of receiving therapeutic interventions that are effective at treating their specific disorder. While EBPP is based on randomized control trials, critics of EBPP reject it stating that the results of trials cannot be applied to individuals and instead determinations regarding treatment should be based on a therapist’s judgment (Mullen & Streiner, 2004).