Biological Therapies of depression
- Created by: Jessica
- Created on: 12-03-13 17:28
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- Biological Therapies
- Antidepressants
- Antidepressants work by reducing the reabsorbtion of the NT or blocking the enzyme which breaks them down
- Depression my be caused by an insufficient level of NTs such as serotonin and noradrenaline
- Both of these actions increase the level of NT to be passed to neighbouring cells
- Depression my be caused by an insufficient level of NTs such as serotonin and noradrenaline
- Tricyclis block the mechanism that reabsorbs the NTs leaving more in the synapse for 'uptake' in the next nerve ending
- Though effective in treating depression, they did cause a wide range of side effects, which were often unpleasant
- SSRIs quickly become widely used because they were as effective as the earlier drugs, but caused less troublesome side effects
- Work in much the same way as tricyclis but with a focus on serotonin
- Effectiveness
- Kirsch et al. reviewed clinical trials of SSRI antidepressants and concluded that only in cases of the most severe depression was there any significant advantage to using SSRIs
- Even the placebo appeared to benefit moderately depressed individuals presumably because it 'offered them hope'
- Turner et al. found evidence of publication bias towards studies which show a positive outcome of antidepressant treatment
- Found that, not only were positive results more likely to be published, but studies that were not positive were often published in a way that conveyed positive outcome
- Kirsch et al. reviewed clinical trials of SSRI antidepressants and concluded that only in cases of the most severe depression was there any significant advantage to using SSRIs
- Appropiateness
- Hammon - antidepressants appear less useful when given to children and adolescents
- Double-blind studies have consistently failed to demonstrate the superiority of antidepressant medications over placebo conditions
- Ryan suggests that this may well have something to do with developmental differences in brain neurochemistry
- Double-blind studies have consistently failed to demonstrate the superiority of antidepressant medications over placebo conditions
- Possibility that the use of SSRIs may increase suicidal thoughts
- Ferguson et al. found that those treated with SSRIs were twice as likely to attempt suicide
- Barbui et al. found that although the use of SSRIs increase the risk of suicide among adolescents, this was decreased among adults
- Ferguson et al. found that those treated with SSRIs were twice as likely to attempt suicide
- Hammon - antidepressants appear less useful when given to children and adolescents
- Antidepressants work by reducing the reabsorbtion of the NT or blocking the enzyme which breaks them down
- ECT
- Used in severe cases of depression where psychological and drug therapies have not proved effective. Also in cases where there is a risk of suicide
- Electrodes are placed above the temple. Patient is injected with anesthetic. Given a nerve blocking agent, paralyzing the muscles of the body. A small amount of electric current lasting half a second is passed through the brain. This leads to a seizure lasting up to a minute. ECT is given 3 times a week; patients have between 3 and 15 treatments
- Little definitive evidence as to why ECT works
- It is the seizure itself and not the electric current that relieves the symptoms
- It restores the brains ability to regulate mood
- Enhances the transmission of neurochemicals and blood flow in brain
- It is the seizure itself and not the electric current that relieves the symptoms
- Studies, such as that done by Gregory et al., that have compared ECT with 'sham' ECT have found a significant difference in outcome in favour of real ECT
- Folkers et al., - ECT have been found to be effective in cases of treatment- resistant depression
- Scott - a review of 18 studies with 144 patients comparing ECT with drug therapy showed that ECT is more effective than drug therapy in the short-term treatment of depression
- Dalto claim possible physical side effects include impaired memory, cardiovascular changes and headaches
- Rose et al., concluded that at least 1/3 of patients complained of persistent memory loss after ECT
- Department of Health report found that among those receiving ECT within the last 2 years, 30% reported that it had resulted in permanent fear and anxiety
- Way of minimisng cognitive problems is to use unilateral ECT rather than Bilateral ECT
- Studies have found that unilateral ECT is less likely to cause cognitive problems than bilateral ECT, yet may be just as effective
- The DOH report found that 700 patients who received ECT when sectioned under the Mental Health Act, 59% had not consented to treatment
- Where patients receive treatment voluntarily there remains the issue of being fully informed about side effects
- Antidepressants
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