Biological Therapies of Depression

Question 1

What are 2 different forms of biological therapies for depression?

Answer 1

1. Drug therapy (chemotherapy)

2. ECT

Question 2

What are the 3 main groups of antidepressants that proved to be successful when drugs were first developed?

Answer 2

1. Monoamine-oxidase inhibitors (MAOIs)
2. Tricyclic antidepressants
3. Selective serotonin reuptake inhibitors (SSRIs)

Question 3

What are the 3 phases of biological therapies?

Answer 3

1. Acute phase - treatment of current symptoms
2. Continuation phase - 4-6 months
3. Maintenance phase - for patients with a history of relapse.

Question 4

What do monoamine-oxidase inhibitors (MAOIs) do?

Answer 4

Block the action of the enzyme which breaks down noradrenaline and serotonin - increasing the availability of these in our nervous system to lift our mood.

Question 5

What are 2 negative effects of monoamine-oxidase inhibitors (MAOIs)?

Answer 5

1. Associated with potentially life threatening side effects e.g. a stroke - patients must be monitored closely.
2. Many foods such as cheese, bananas, some fish, containe tyramine which reacts adversely with MAOIs - patients must restrict their diet.

Question 6

What did Jarret find that supports monoamine-oxidase inhibitors (MAOIs)?

Answer 6

Found that they’re much more effecting in treating severe depression.

Question 7

What form of MAOI has been recently introduced and what did Julien find about it?

Answer 7

A MAOI in skin patch form has been introduced which allows slow continuous absorption of the drug into the nervous system.
Julien - found that it’s less likely to produce risky food interactions as it goes in through the skin which stops food and the drug from reacting with each other.

Question 8

What happens in a ‘normal’ brain?

Answer 8

In normal brains, serotonin and noradrenaline are released, stimulating the neighbouring cells, which are then reabsorbed into the nerve ending or broken down.

Question 9

How do tricylics work?

Answer 9

Tricylics block the transporter mechanism that reabsorbs both serotonin and noradlenaline int the pre-synaptic cell after it has fired = more neurotransmitters are left in the synapse, prolonging their activity = more noradrenaline and serotonin available.

Question 10

What are tricylics diagnosed for, how long do they take to work, how long are they usually taken for and what is their success rate?

Answer 10

Diagnosed for mild and severe depression, take 10-14 days to work, usually taken for 4-6 months and have a 60-65% success rate.

Question 11

What are 5 side effects of tricylics?

Answer 11

1. Constipation
2. Dry mouth
3. Sexual problems
4. Blurred vision
5. Potentially lethal in large doses

Question 12

How do selective serotonin reuptake inhibitors (SSRIs) work?

Answer 12

In a similar way to tricylics but instead of blocking the reuptake of many neurotransmitters, they block mainly the serotonin reuptake so there is more of it available.

Question 13

What are 5 general side effects of selective serotonin reuptake inhibitors (SSRIs)?

Answer 13

1. Nausea
2. Headaches
3. Sleeping difficulties
4. Dry mouth
5. Drowsiness

Question 14

What is one dangerous side effect of selecritve serotonin reuptake inhibitors (SSRIs)?

Answer 14

Some reports of extreme violence attributed to SSRIs, and 250,000 reported suicide attempts.

Question 15

What did Ferguson find relating to SSRIs and suicidal thoughts?

Answer 15

Those treated with SSRIs were more likely to commit suicide. However this is a correlation, cause and effect can’t be established and suicide is often linked with depression anyway.

Question 16

What dud Barbui et al find, relating to the appropriateness of SSRIs?

Answer 16

SSRIs may not be appropriate for adolescents as they are linked to suicidal thoughts most in this age group, but they protect adults 65+ from such thoughts so may be most appropriate for that age group.

Question 17

What did Kirsch et al find, relating to the effectiveness of SSRIs?

Answer 17

Reviewed clinical trials of SRRIs
Found - only the most severely depressed benefited from the treatment. In moderately depressed patients, even a placebo could be of benefit to them - suggesting that low levels of serotonin isn’t the main cause.of depression.

Question 18

What study did Holland et al carry out into the effectiveness of SSRIs? (Method, findings, what does this suggest, 1 criticism).

Answer 18

Treated depressed p’s for 2 weeks with either an SSRI or cognitive therapy.
Found - around 60% of p’s from each group reported improvements in their symptoms, but the relapse rate for SSRIs was much higher (76%) than CBT (31%).
Suggests - SSRIs treat symptoms not cause.
1. IDG - individual differences - low int val.

Question 19

What age group may drug treatment be the least appropriate and effective for, and what has shown this?

Answer 19

Double blind procedure studies on children and adolescents have shown no differences in improvement when taking drugs or a placebo. Suggested to be due to the developmental differences in brain biochemistry in young people and adults.

Question 20

What are ethical issues that make studying the appropriateness and effectiveness of drug therapies problematic?

Answer 20

Placebo trials expose p’s to treatment which is inferior - this could be considered unethical and potentially put their lives at risk, make their situation deteriorate and have long term effects.
It’s also be argued that p’s are not in right state of mind to give fully informed consent to take part in such trials.

Question 21

How does publication bias effect the evaluation of drug treatments?

Answer 21

Publications may exaggerate the effectiveness of some drugs, leading doctors into believing that they’re making the correct decision when they may actually be inappropriate.

Question 22

What is one problem with taking antidepressants over a period of time?

Answer 22

They can become less effective as time progresses. So p’s who are treated multiple times and keep relapsing are less likely to benefit from the medication. May be because the drugs alter the brains biochemistry and the body can build up a tolerance to them.

Question 23

What does ECT stand for?

Answer 23

Electroconvulsive therapy

Question 24

What are the 5 stages of ECT?

Answer 24

1. Patient lies on bed.
2. Atropine given as pre-anesthetic, followed by anesthetic and muscle relaxant.
3. Electrodes placed on temples and 70-150 volt shock administered for 0.4 - 1 second.
4. Convulsions are produced.
5. Repeated 3 times a week, 3 - 15 treatments in total.

Question 25

How does ECT work?

Answer 25

An electrode is placed above the temple of the non-dominant side of the brain and the second in the middle of the forehead (unilateral ECT) OR above both temples (bilateral ECT).
The seizure restores the brains ability to regulate mood - maybe by enhancing neurochemicals or improving blood flow.

Question 26

What did Gregory find, relating to the effectiveness of ECT?

Answer 26

A significant diffrenrece between ECT and sham ECT - no much difference was found by other researchers between drugs and placebos.

Question 27

What did Pagin carry out and find, relating to the effectiveness of ECT?

Answer 27

Carried out a meta-analysis.

Found - ECT was more effective in the treatment of depression than drugs.

Question 28

What did a review of 1144 patients comparing ECT with drug therapy show?

Answer 28

ECT was more effective than drug therapy - but they didn’t compare with new drug therapies e.g. SSRIs so results may be unreliable.

Question 29

What are 2 general short term side effects of ECT?

Answer 29

1. Memory loss

2. Headaches

Question 30

What did the department of health report in 2007 find about side effects of ECT?

Answer 30

30% of patients receiving ECT said it caused permanent anxiety and fear.

Question 31

What did Rose et al find, relating to the side effects of ECT?

Answer 31

Memory loss affected at least one third of patients.

Question 32

What is one age group that ECT is particularly effective in?

Answer 32

The elderly - a meta-analysis found an improvement in 83% of patients.

Question 33

What is a major ethical issue with ECT?

Answer 33

Consent - it’s been found that out of 700 p’s that received ECT under the Mental Health Act, 59% had not consented to treatment. Even those who had had not always been fully informed of the procedure and possible side effects.

Question 34

What are 3 overall criticisms of biological treatments?

Answer 34

1. They treat symptoms and not the cause.
2. Side effects.
3. Ethical issues such as informed consent.