Biological Therapies of Depression Flashcards

1
Q

What are 2 different forms of biological therapies for depression?

A
  1. Drug therapy (chemotherapy)

2. ECT

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2
Q

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

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

What are the 3 phases of biological therapies?

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

What do monoamine-oxidase inhibitors (MAOIs) do?

A

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.

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5
Q

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

A
  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.
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6
Q

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

A

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

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7
Q

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

A

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.

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8
Q

What happens in a ‘normal’ brain?

A

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

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9
Q

How do tricylics work?

A

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.

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10
Q

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?

A

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.

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11
Q

What are 5 side effects of tricylics?

A
  1. Constipation
  2. Dry mouth
  3. Sexual problems
  4. Blurred vision
  5. Potentially lethal in large doses
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12
Q

How do selective serotonin reuptake inhibitors (SSRIs) work?

A

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.

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13
Q

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

A
  1. Nausea
  2. Headaches
  3. Sleeping difficulties
  4. Dry mouth
  5. Drowsiness
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14
Q

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

A

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

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15
Q

What did Ferguson find relating to SSRIs and suicidal thoughts?

A

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.

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16
Q

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

A

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.

17
Q

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

A

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.

18
Q

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

A

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.

19
Q

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

A

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.

20
Q

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

A

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.

21
Q

How does publication bias effect the evaluation of drug treatments?

A

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.

22
Q

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

A

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.

23
Q

What does ECT stand for?

A

Electroconvulsive therapy

24
Q

What are the 5 stages of ECT?

A
  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.
25
Q

How does ECT work?

A

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.

26
Q

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

A

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

27
Q

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

A

Carried out a meta-analysis.

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

28
Q

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

A

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

29
Q

What are 2 general short term side effects of ECT?

A
  1. Memory loss

2. Headaches

30
Q

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

A

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

31
Q

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

A

Memory loss affected at least one third of patients.

32
Q

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

A

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

33
Q

What is a major ethical issue with ECT?

A

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.

34
Q

What are 3 overall criticisms of biological treatments?

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