Biological therapies

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  • Biological therapies for depression
    • Anti-depressants
      • drugs that relive the symptoms of depression
        • depression thought t be caused by neurotransmitters working insufficiently
        • drugs work by blocking the enzyme which breaks down the neurotransmitter
        • reducing the rate of re-absorption of neurotransmitters
      • eg tricyclic anti- depressants
        • block the transporter mechanism which re-absorbs both serotonin and noradrenaline
        • leads to more neurotransmitters being left in the synapse
          • prolongs their activity
      • eg SSRI's
        • work similarly to tricylics but mainly on blocking serotonin
          • increase the quantity of serotonin available to excite neighbouring cells
        • eg Prozac
        • Kirsch et al
          • reviewed clinical trials of SSRI's
            • only provided advantages in the most sever forms of depression
              • however, they also found a placebo to be effective
                • psychological explanations
                • ethical issues involved with placebo as it involves deception
                  • participants are unaware  of their treatment
                  • prior general concent
      • three phases to treatment
        • acute phase
          • treating of symptoms
        • continuation phase
          • four to six months of taking drugs
          • drugs are gradually withdrawn
            • in order to prevent relapse
        • Maintenance phase
          • for individuals  who have a history of recurrent depressive episodes
          • monitoring of the patient
      • age bias
        • elderly are often misdiagnosed because  symptoms appears as due to their changes in lifestyle or natural changes
          • eg lack of sleep could be due to reduction in SWS sleep
        • also less likely to seek help due to the fear of the stigma attached and that they will loose their independence
      • children and adolescents
        • hammen foud that they were less useful in children and adolescents
        • Geller et al
          • double blind studies
          • meta-review
          • placebo effect in children
          • could be due to the behaviour approach
            • operant conditioning
        • less effective due to developmental differences in brain neurochemistry
      • Risk of suicide
        • fears that use of SSRI's may increase risks of suicidal thoughts
        • Ferguson et al
          • twice as more likely to commit suicide than with other conditions or a placebo
        • risk reduced for adults
      • publication bias
        • results that exaggerated the benefits of treatments were more likely to be published
      • type of chemotherapy
    • ECT
      • Electro-Convulsive Therapy
      • first used in 1938 to treat schizophrenia and widespread during the 1940s.
      • process
        • A weak current is passed across the temples for 0.5 - 4 seconds
        • The patient's body goes into convulsions that are reduced by muscle relaxants and anaesthetic (a mouth gag prevents the tongue being bitten)
          • believed that seizure restores the brains ability to regulate mood
            • eg by enhancing the transmission of neurochemicals or improving blood flow to the brain
              • Ethical issues
                • 59% had not consented to treatment
                • those who had consented were not in the best mind of frame to consent fully
        • Oxygen is given before and after treatment to aid recovery
        • usually involves 3-15 sessions
      • now only used in extreme cases such as extreme cases of depression
        • considered life threatening
        • other therapies have failed
      • case study
        • 37 year old woman
          • severely depressed after the separation from her husband
          • attempted to commit suicide four times
          • psychotherapy and anti-depressants had little effect
        • 8 sessions of ECT over 3 weeks
          • by the last session showed considerable improvements in her depressive symptoms
        • continued with further treatment of anti-depressants
          • four months later showed normal social and occupational functioning
      • effectiveness
        • Folkerts
          • effective when patients are resistant to other treatments
        • scott
          • compared 18 studies
          • ECT is more effective than drug therapy in the short term
          • however the studies didn't include new drugs such as SSRI's
      • Appropriateness
        • Datto
          • side effects include impaired memory, cardiovascular changes and headaches
        • Rose et al
          • third of patients suffered from persistent memory loss
        • The department of health report 2007
          • 30% of the people who received ECT in the last 2 years reported permanent fear and anxiety
          • Unilateral ECT has a smaller effect on cognitive impairment

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