Biological Therapies For Mood Disorders Flashcards
What do SSRIs do/how do they work?
PREVENT the REUPTAKE or SEROTONIN in the presumptive neuron and therefore INCREASE SEROTONIN levels in the synapses of nerve cells
Eg Fluoxetine (Prozac)
Why are people more likely to continue taking SSRIs, compared to other drug treatments?
Fewer SIDE EFFECTS and are NOT FATAL in overdose
Improvement occurs RELATIVELY QUICKLY, usually within 2 WEEKS
What are some of the side effects of SSRIs?
Nausea Insomnia Agitation Dry mouth Headache Sexual dysfunction
Why are unipolar and bipolar treated differently?
Antidepressants can be effective in the treatment of UNIPOLAR depression caused by LOW levels or certain NEUROTRANSMITTERS
However, in BIPOLAR, it is likely that during the MANIC phase, the mood changes by an INCREASE in NEUROTRANSMITTERS
How does Lithium Carbonate work? BIPOLAR depression
CONTROLS the MOOD SWINGS of bipolar depression
It is still UNCLEAR HOW it specifically works, although it is thought to RETURN levels of SEROTONIN and DOPAMINE to NORMAL levels
When is lithium carbonate effective as a treatment for BIPOLAR depression?
Effective during the DEPRESSED and MANIC phase of bipolar
But does NOT IMPROVE depression for UNIPOLAR PATIENTS
What does the effectiveness of lithium carbonate tell use about the two types of depression?
This indicates the two mood disorders have DIFFERENT CAUSES
Why must lithium carbonate be taken continuously?
Discontinuation INCREASES the RISK of MANIA
What are the side effects of lithium carbonate?
Can be FATAL
Tremors
MUSCLE TWITCHING
Blurred vision
KIDNEY and LIVER DYSFUNCTION
Drug therapies are very effective for some patients. Why is this a strength?
Often produces dramatic results with significant LIFTING of MOOD so that people can GET ON WITH their LIVES
TCAs - 60%
MAOIs - 50%
SSRIs - 60%
(Comer 2008)
What does SSRI stand for?
Selective Serotonin Reuptake Inhibitors
Research evidence supports the benefits of antidepressants. Why is this a strength of drug therapies?
A review of studies comparing the antidepressant medications to placebos in controlled blind trials point to the effectiveness of the treatment
Acute depression was LIFTED in 50-70% of cases, which is about 40% HIGHER than PLACEBO groups (Thase and Kupfer, 1996)
Antidepressants are not fully understood. Why is his a weakness of drug treatments for mood disorders?
It is NOT CLEAR HOW they WORK or WHY they take SO LONG to take EFRCT
It is accepted that it is not as simple as increasing a particular neurotransmitter
If this was the case then the RESULTS should be RAPID and in fact noticeable effects CAN TAKE 3-5 weeks
There are side effects of antidepressants. Why is this a limitation of drug treatments?
Because of the side effects of antidepressants, coupled with the fairly long period before they ‘kick in’, patients OFTEN DISCONTINUE before the antidepressant effect
There is evidence for links between SSRI’s and suicide. Why is this a weakness of drug treatments?
There have been reports that SSRI’s (eg Prozac) are associated with divided urges (Cole, 1990)
Mixed evidence
Antidepressants control the symptoms of mood disorders, not the cause. Why is this a limitation of this treatment?
Most depressions arise in response to SIGNIFICANT LIFE EVENTS/DIFFICULTIES and although medications prove useful in reducing the depressive symptoms, they have LITTLE EFFECT on the ‘CIRCUMSTANCES’ or cause
Such individuals may require PSYCHOTHERAPEUTIC INTERVENTION to deal with their problems and stressors
There is an issue with cause and effect for antidepressants. Why is this a limitation?
Does depression cause the neurotransmitter imbalance or vice versa
INCOMPLETE
Antidepressants are not effective for some. Why is this a limitation of the treatment?
A small no. of depressed individuals do not respond to antidepressants alone and they may require ADDITIONAL TREATMENT and possibly HOSPITALISATION
There are ethical issues that arise with the use of antidepressants. Why is this a weakness of the treatment?
Involved in research using a PLACEBO CONDITION, where ppt’s in the placebo condition are LED to BELIEVE they are TAKING MEDICATION when in fact they are NOT
What is the conclusion of antidepressants as a treatment for mood disorders?
In spite of our LACK of UNDERSTANDING of how they work, antidepressants are the first point of call for treatment of mood disorders, providing SUSTAINED RELIEF for the sufferer and family members
They provide the ground for the patient to move to PSYCHOLOGICAL THERAPIES and COMBINATIONS of BIOLOGICAL and an APPROPRIATE PSYCHOLOGICAL THERAPY such as cognitive therapy or interpersonal therapy are VERY EFFECTIVE
What does ECT stand for?
Electro convulsive therapy
ECT is a highly controversial threat meant. When is it used?
Only used on individuals with SEVERE DEPRESSION who do NOT RESPOND TO ANTIDEPRESSANTS
How does ECT work?
ECT induces a BRAIN SEIZURE by passing 70-150 VOLTS of ELECTRICITY through the brain for UP TO a SECOND
A MUSCLE RELAXANT is given, and then ELECTRODES are placed on the head (bilaterally or unilaterally) and an electric shock given
Seizure usually lasts around ONE MIN
How long would a typical course of ECT last?
2-3 weeks
6-9 sessions
What did Nobler et al. (1994) find? ECT
That ECT reduces blood flow to the temporal regions of the brain, suggesting that it may be this which helps to alleviate the symptoms of depression
ECT is effective for some. Why is this a strength?
When all else fails, ECT can work for some patients, alleviating their symptoms and allowing them to get on withy everyday life
What evidence did Fink (2001) find to support ECT as a treatment for mood disorders?
Found ECT to be effective at ALLEVIATING the SYMPTOMS of SEVERE DEPRESSION in around 50% of those treated
What evidence did Weiner and Coffey (1988) find to support ECT as a treatment for mood disorders?
Found that ECT significantly DECREASES SEVERE DEPRESSION when COMPARED to PLACEBO STUDIES
ECT can cause side effects. Why is this a limitation of ECT as a treatment for mood disorders?
Include CONFUSION, NAUSEA and headache immediately after the he procedure
ECT can cause memory loss. Why is this a limitation of ECT as a treatment for mood disorders?
Affects SHORT-TERM MEMORY and is common to have NO RECALL of events IMMEDIATELY PRIOR to the ECT
Many see ECT as unethical. Why is this a limitation of ECT as a treatment for mood disorders?
Particularly in extreme cases where it may be ADMINISTERED AGAINST the WILL of the PATIENT
SIDE EFFECTS also induce FEAR of the procedure in the patient
Relapse rates are high for ECT. Why is this a limitation of ECT as a treatment for mood disorders?
80% relapse rate after the end of a course of EXT treatment and FURTHER TREATMENT is OFTEN REQUIRED - this suggests that it may NOT be EFFECTIVE in the LONG TERM as a treatment for depression
It is not known how ECT works. Why is this a limitation of ECT as a treatment for mood disorders?
Unsure what other EFFECTS ECT may have on the BRAIN
