Biological Therapies For Mood Disorders

Question 1

What do SSRIs do/how do they work?

Answer 1

PREVENT the REUPTAKE or SEROTONIN in the presumptive neuron and therefore INCREASE SEROTONIN levels in the synapses of nerve cells

Eg Fluoxetine (Prozac)

Question 2

Why are people more likely to continue taking SSRIs, compared to other drug treatments?

Answer 2

Fewer SIDE EFFECTS and are NOT FATAL in overdose

Improvement occurs RELATIVELY QUICKLY, usually within 2 WEEKS

Question 3

What are some of the side effects of SSRIs?

Answer 3

Nausea 
Insomnia
Agitation
Dry mouth
Headache
Sexual dysfunction

Question 4

Why are unipolar and bipolar treated differently?

Answer 4

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

Question 5

How does Lithium Carbonate work? BIPOLAR depression

Answer 5

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

Question 6

When is lithium carbonate effective as a treatment for BIPOLAR depression?

Answer 6

Effective during the DEPRESSED and MANIC phase of bipolar

But does NOT IMPROVE depression for UNIPOLAR PATIENTS

Question 7

What does the effectiveness of lithium carbonate tell use about the two types of depression?

Answer 7

This indicates the two mood disorders have DIFFERENT CAUSES

Question 8

Why must lithium carbonate be taken continuously?

Answer 8

Discontinuation INCREASES the RISK of MANIA

Question 9

What are the side effects of lithium carbonate?

Answer 9

Can be FATAL

Tremors

MUSCLE TWITCHING

Blurred vision

KIDNEY and LIVER DYSFUNCTION

Question 10

Drug therapies are very effective for some patients. Why is this a strength?

Answer 10

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)

Question 11

What does SSRI stand for?

Answer 11

Selective Serotonin Reuptake Inhibitors

Question 12

Research evidence supports the benefits of antidepressants. Why is this a strength of drug therapies?

Answer 12

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)

Question 13

Antidepressants are not fully understood. Why is his a weakness of drug treatments for mood disorders?

Answer 13

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

Question 14

There are side effects of antidepressants. Why is this a limitation of drug treatments?

Answer 14

Because of the side effects of antidepressants, coupled with the fairly long period before they ‘kick in’, patients OFTEN DISCONTINUE before the antidepressant effect

Question 15

There is evidence for links between SSRI’s and suicide. Why is this a weakness of drug treatments?

Answer 15

There have been reports that SSRI’s (eg Prozac) are associated with divided urges (Cole, 1990)

Mixed evidence

Question 16

Antidepressants control the symptoms of mood disorders, not the cause. Why is this a limitation of this treatment?

Answer 16

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

Question 17

There is an issue with cause and effect for antidepressants. Why is this a limitation?

Answer 17

Does depression cause the neurotransmitter imbalance or vice versa

INCOMPLETE

Question 18

Antidepressants are not effective for some. Why is this a limitation of the treatment?

Answer 18

A small no. of depressed individuals do not respond to antidepressants alone and they may require ADDITIONAL TREATMENT and possibly HOSPITALISATION

Question 19

There are ethical issues that arise with the use of antidepressants. Why is this a weakness of the treatment?

Answer 19

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

Question 20

What is the conclusion of antidepressants as a treatment for mood disorders?

Answer 20

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

Question 21

What does ECT stand for?

Answer 21

Electro convulsive therapy

Question 22

ECT is a highly controversial threat meant. When is it used?

Answer 22

Only used on individuals with SEVERE DEPRESSION who do NOT RESPOND TO ANTIDEPRESSANTS

Question 23

How does ECT work?

Answer 23

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

Question 24

How long would a typical course of ECT last?

Answer 24

2-3 weeks

6-9 sessions

Question 25

What did Nobler et al. (1994) find? ECT

Answer 25

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

Question 26

ECT is effective for some. Why is this a strength?

Answer 26

When all else fails, ECT can work for some patients, alleviating their symptoms and allowing them to get on withy everyday life

Question 27

What evidence did Fink (2001) find to support ECT as a treatment for mood disorders?

Answer 27

Found ECT to be effective at ALLEVIATING the SYMPTOMS of SEVERE DEPRESSION in around 50% of those treated

Question 28

What evidence did Weiner and Coffey (1988) find to support ECT as a treatment for mood disorders?

Answer 28

Found that ECT significantly DECREASES SEVERE DEPRESSION when COMPARED to PLACEBO STUDIES

Question 29

ECT can cause side effects. Why is this a limitation of ECT as a treatment for mood disorders?

Answer 29

Include CONFUSION, NAUSEA and headache immediately after the he procedure

Question 30

ECT can cause memory loss. Why is this a limitation of ECT as a treatment for mood disorders?

Answer 30

Affects SHORT-TERM MEMORY and is common to have NO RECALL of events IMMEDIATELY PRIOR to the ECT

Question 31

Many see ECT as unethical. Why is this a limitation of ECT as a treatment for mood disorders?

Answer 31

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

Question 32

Relapse rates are high for ECT. Why is this a limitation of ECT as a treatment for mood disorders?

Answer 32

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

Question 33

It is not known how ECT works. Why is this a limitation of ECT as a treatment for mood disorders?

Answer 33

Unsure what other EFFECTS ECT may have on the BRAIN