Biological therapies for depression

Question 1

Antidepressants: how long are they used for?

Answer 1

4-6 months

Question 2

Antidepressants: what are the 3 stages?

Answer 2

current symptoms, continuation, maintenance

Question 3

Antidepressants: what do tricyclics do?

Answer 3

blocks the transporter mechanism that re-absorbs both serotonin and noradrenaline into the presynaptic cell. this prolongs their activity in the synapse making transmission easier

Question 4

Antidepressants: what do SRRIs do?

Answer 4

Blocks serotonin and so increases the quantity available to excite neighbouring cells. E.g. Prozac.

Question 5

Antidepressants: evaluation for the effectiveness of different severities of depression?

Answer 5

Kirsch et al reviewed clinical trials and found SSRIs were only effective with severe depression. There was also little difference between SSRIs and placebos.

Question 6

Antidepressants: evaluation for the effectiveness of non-SRRIs

Answer 6

Papakostas et al found no significant difference between SSRI and non-SSRI antidepressants.

Question 7

Antidepressants: evaluation for the appropriateness in children

Answer 7

Hammen found antidepressants were less useful when given to children. This could be due to their neuroanatomy development.

Question 8

Antidepressants: evaluation for the appropriateness with suicide?

Answer 8

Ferguson found those treated with SSRIs were twice as likely to commit suicide. However, for those over 65 years old, they had the opposite effect.

Question 9

Antidepressants: evaluation of age bias?

Answer 9

Benek-Higgens et al claim that elderly people’s symptoms of depression are often misread for old age. This therefore means that antidepressants often aren’t prescribed to them.

Question 10

Antidepressants: evaluation of publication bias?

Answer 10

it’s suggested that antidepressant studies are exaggerated and made to appear more beneficial than they actually are.

Question 11

ECT: when is ECT used?

Answer 11

severe cases, when other treatments haven’t been effective, those at risk of suicide

Question 12

ECT: what’s the difference between bilateral and unilateral ECT?

Answer 12

unilateral = one on forehead one on inactive temple
bilateral = one on each temple

Question 13

ECT: what effect does the seizure have?

Answer 13

restores the brains ability to regulate mood, and increases blood flow to the brain

Question 14

ECT: evaluation for effectiveness compared to sham ECT

Answer 14

Gregory et al (1985) found a significant difference in the effectiveness between ECT and sham ECT (patient is anaesthetised but not given the treatment). It has also been found useful in treatment-resistant depression.

Question 15

ECT: evaluation for the effectiveness against antidepressants

Answer 15

Scott, reviewed 18 studies with 1144 patients and found ECT is a more effective short-term treatment. However this didn’t compare ECT with newer SRRIs.

Question 16

ECT: evaluation for the appropriateness due to side effects?

Answer 16

possible side effects include impaired memory, cardiovascular changes, and headaches. Rose et al found that at least 1/3 of patients complained of persistent memory loss after ECT. It has also been linked to a slowing of cognitive, fear, and anxiety.

Question 17

ECT: evaluation for the appropriateness of unilateral VS bilateral?

Answer 17

studies have found unilateral ECT is less likely to cause cognitive side effects, however is just as effective (Sackeim).

Question 18

ECT: evaluation of ethical issues

Answer 18

around 700 patients who received ECT were sectioned under the mental health act (1999), 59% of these had not given consent. However it could be argued whether they were in a fit state to give consent?