PSYA4 Biological therapy

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  • Biological Therapies for Depression
    • A01
      • ECT
        • Electro convulsive therapy is generally used on severely depressed patients whom psycho-therapy and medication has proven ineffective.
          • An electrode is placed above the temple on the non-dominant side of the brain and another is placed in the middle of the forehead.
            • Firstly, the patient is given a shot of general anaesthetic so they are unconscious, also the patient is given a nerve-blocking agent then a small amount of electrical current (0.6 amps) lasting half a second passes through the brain.
        • How or why ECT works is not yet completely understood. But, what is clear is that it is the seizure rather than the electrical stimulus that generates improvements in depressive symptoms.
          • The seizure seems to restore the brains inability to regulate mood, it may do this by enhancing transmissions of neurochemicals or by improving blood in the brain.
      • Drugs
        • Antidepressants are used to relieve symptoms of depression and they are used to treat severe to moderate illness.
        • Depression is thought to be due to deficiency in the amounts of neurotransmitters like noradrenaline and serotonin.
        • In normal individuals, neurotransmitters are constantly being released stimulating neighbouring cells. But, in depressed individuals, the neurotransmitters are reabsorbed into nerve endings.
          • Thus, antidepressants reduce the rate of re-absorption or block the enzymes form breaking down the neurotransmitters.
        • The treatment of depression has three distinct phases the treatment of current symptoms take place during the acute phase of the treatment, once the symptoms have diminished, treatments enter the continuation phase for around 6 months. After, medication is gradually withdrawn in order to prevent relapse. A third phase is the maintenance and is recommended for individuals who have a history of recurrent depressive episodes.
    • A02
      • ECT
        • There is a lot of evidence to support the effectiveness of ECT.
          • Gregory compared ECT with a 'sham' ECT where patients were given a anaesthetic but no treatment. The results showed a high significant difference in favour of those whom received ECT.
        • A review of 18 studies compared ECT with drug therapy which showed that ECT is much more effective than drug therapy.
          • However, none of these trails compared ECT with a newer antidepressant such as SSRIs which are said to be very effective
        • Possible side effects include impaired vision and memory, cardiovascular changes and headaches. Rose concluded that at least 1/3 of patients complained of chronic memory loss following ECT.
          • But, a way of minimising side effects is to use unilateral ECT rather than bilateral ECT as it causes less damage but is still effective.
      • Drugs
        • It has been found that there is only a significant advantage to using SSRIs i the case of most severe depression but placebos are moderately effective as it offers patients hope.
          • However, for severely depressed individuals the expectations of anything working was less, therefore this rules out the placebo effect. This suggests that there is an apparent difference between treatment and control in depression
        • Despite the positive role of antidepressants they seem to be less effective in children.
          • In a double-blind study, they have consistently failed to demonstrate the superiority of antidepressants medications over placebo conditions.
            • However, the difference between antidepressants in children and adults may be due to developmental differences in brain neurochemicals
        • There may be some advantages of non-ssri depressants for those who fail to respond to SSRI treatments. However, a meta-analysis of studies comparing the effectiveness of SSRI and non-ssri treatments and found no significant difference
          • This suggests that drug treatments for depression may be more effective in some sufferers thus, implying there are individual differences.


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