WJEC A2 Psychology PY4 - Two Treatments of Unipolar

1. Biochemical Treatments

• MAOi - in 1952, first type of psychotropic drug used to treat depression developed, called monoamine oxidase inhibitors; work by preventing the enzyme, monoamine oxidase, from breaking down the serotonin and noradrenaline = level of these neurotransmitters in the brain increase
• TCAs: second type of antidepressant was tricyclics in 1958; worked by preventing the reuptake of noradrenaline and serotonin which led to an increase in the levels of the neurotransmitters in the brain
• SSRIs: third group of antidepressant drugs are selective serotonin reuptake inhibitors; work by selectively targeting serotonin and preventing reuptake occurring which results in an increase of serotoninin the brain; they were less sedative and toxic than TCAs
• antidepressants administered in a tablet form and only after being prescribed by a doctor
• amount and frequency of administration depends on the individual's unipolar and its severity

EVALUATION

(+) Effectiveness of Antidepressant Drugs

• have been found to be effective in reducing symptoms of depression in up to 65 -75% of cases, as opposed to 33% for placebos

(-) Hello/Goodbye Effect

• when a patient overestimates their symptoms at the onset of an illness (to elicit help) and underestimate their symptoms at the end of treatment (to show appreciation for being helped)
• distorts the effectiveness of antidepressants and people may feel more of an improvement than what it has actually done

(+) reduction in hospital admissions

• people can continue to live their normal lives by visiting their GP and self medicating without having to be sectioned

(-) Publication Bias

• Brown (2003) suggested 81% of studies which showed significant findings were published within a 5 year period, whereas only 68% of studies that showed non-significant findings were published
• could mean that results showing how ineffective some treatments are may not be as widely published
• eg Seroxat (an SSRI) marketed by GlaxoSmithKline were criticised for not publishing and actively suppressing results of studies which showed in some people (younger) the drug led to an increased risk of suicide and could be highly addictive

(-) Lag Times

• although antidepressants work quickly in increasing the levels of neurotransmitters, the symptoms are often very slow to disappear (3-6 weeks)
• because of this, patients may feel that the medication is not working and fail to continue taking the drug

(-) Side Effects

• TCAs - often result in a dry mouth or blurred vision
• MAOis - can react with certain foods such as cheese and red wine (rich in tyramine) which can increase blood pressure and the risk of heart failure
• SSRIs - anxiety, hand tremors, insomnia and an upset stomach
• however no addictive side effects of antidepressants
• but tolerances build up, so increasing levels of the drug needed for same effect

(-) Kirsch + Saperstein (1998)

• suggests that 25% of an antidepressant's effect is due to the active ingredient
• 50% is due to the placebo effect
• other 25% is due to non-specific factors

(?) Kirsch et al (2008)

• effect of antidepressants no more than a placebo effect (gives the patient hope) so treatment may be better combined with other methods

2. Electro Convulsive Shock Therapy (ECT) for Unipolar

• ECT - the passage of an electrical current (70-130 volts) through the brain which induces a convulsion or epileptic seizure; the convulsion is thought to affect neuro-chemical transmission so that a person's mood improves
• ECT primarily used to treat severe depression, bipolar disorders and certain OCD disorder, around 20,000 people in Britain undergo ECT a year; it has been found to be ineffective at reducing psychotic symptoms
• since 2007, patients sectioned under the mental health act may refuse consent to ECT if they have 'capacity', if it is perceived they don't, ECT may be administered without consent in an emergency/to prevent further deterioration
• consists of 6 - 10 treatments over 6 weeks for a lasting effect of 1 - 2 years

ECT Procedure:

• physical test required as heart conditions, chest diseases and peptic ulcers can be worsened by treatment
• 45 minutes before: injection administered which prevents the heart's normal rhythm from being disturbed and inhibits mucus and saliva secretion

ECT Procedure continued

• patient lies with head supported and a short acting anaesthetic and muscle relaxant are administered
• oxygen given before and after, mouth gag is applied to prevent tongue or lips being bitten
• chin held still, 110 volts are passed from one electrode to another for around 0.5 - 4 secs
• because of muscle relaxants, only noticeable sign of seizure is slight twitching of facial muscles and toes
• convulsion lasts 30 secs - 2 mins, when complete the jaw is relaxed, oxygen given until breathing resumes unaided
• patient placed in recovery position and observed until muscle relaxant and anaesthetic have worn off = recovery is complete
• in bilateral ECT, electrodes are attached to each temple and electricity passes through the frontal lobes
• in unilateral ECT, two electrodes attached to the temple and mastoid region of the non-dominant cerebral hemisphere

EVALUATION

(+) Comer (1992)

• ECT highly effective in 60 - 70% of people with severe depression, especially useful with suicidal patients as effects are immediate (unlike antidepressants)

(+) Sacheim (1988)

• agrees with Comer (60 - 70% of depression sufferers improve with ECT)
• however large population became depressed the following year
• tends to be used if antidepressants aren't working; it is effective but has high relapse rates after a year

(-) Side Effects

• anterograde or retrograde amnesia, although unilateral ECT minimises memory disruption; some have short term memory loss before and after
• patients often wake with headache and feel disorientated

(-) Breggin (1996)

• argues that brain damage can occur in some patients
• early treatments (w/o muscle relaxants) may have resulted in fractured bones or bitten lips/tongue due to violent movement from seizures

(?) NICE

• recommend ECT for unipolar only when other treatments have been unsuccessful
• discourages use of maintenance ECT for depression: regular sessions once a month - 6 months after initial 6 - 12 sessions
• discouraging may deprive someone of living and functioning safely in community, limits choice after failed treatments esp. if not wanting relapse

(?) Ethics

• unknown why beneficial effects, produces greater biochemical changes?
• early uses of treatment as punishments = negative image
• but always been successful at treatment when others have failed, saved lives