Biological Therapies of depression

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  • 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
      • 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
      • 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
        • 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
    • 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
      • 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

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