Biological therapies

Created by: Hannah Jeffery
Created on: 27-04-15 10:16

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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      - drugs are gradually withdrawn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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Biological therapies

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