biological treatment Flashcards
Issue with biological treatment
WHen treating w biological treatments, we often assume that depression is due to chemical imbalances in the brain. As such, if we restore the balance of neurotransmitters, we could reduce the symptoms of depression
Issue/Problem is the controversial nature of recent evidence into the effectiveness and negative effect and yet it is an essential treatment for many so important to critically evaluate
Whether side effects are worth the ssuccess ratesr
To see if its effective for every patient]
Evaluate and appropriately give it out
To treat ppl in the most obvious way
Neurotransmission
THEORY- Neurotransmission
Nervous system made up of neurons, which are compirsed of the body, dendrites and axon
Dendrites: receive signals from other neurons
Axon : transmit signals further
Synaptic gap: space between dendrites of one dendrite and azon of another
Action potential travels along axon and at the synaptic gap, becomes chemical neurotransmitter.
Neurotransmitter released from axon terminal into synaptic gap
Neurotransmitters are chemical messages. When realeased, they stay in gap for a while and then are either metabolised or pulled back into axon terminal through reuptake
SSRIS
They block reuptake of neurotransmitter serotonin from synpatic gap. Increases concentration of serotonin in the synapse
Elkin
To be included in the study, patients had to meet the diagnosis of major depressive disorder with symptoms present at least in the two weeks previous to the study.
After obtaining informed consent, participants were randomly assigned to treatment conditions at each site.
Patients were assessed on: symptoms, life functioning, and functioning related to particular treatment approaches. They asked for info from client, therapist, an independent clinical evaluator blind to the treatment condition, as well as a significant other from the patient’s life if possible.
Study where approx 30 clinicians worked w 250 patients randomly assigned to one to four 16 week treatment conditions of
psychotherapy
CBT
Antidepressants
placebo
Results
Patients in all treatment groups showed reduction of symptoms
Placebo worst, medication best. Cbt and psychotherapy only slightly less effective than medication
By the end of the 16 weeks of therapy, psychotherapy and CBT had caught up with the drug.
Meds were fastest in reducing depressive symptoms
When severity of illness taken into account, all 3 treatment groups idnt differ signifcantly for moderate/ mild depression, but clear advantage for meds in severe depression
Patients of both cbt and psychotherapy reported greater effectson their capacity to establish and maintain interpersonal relationships, and recognize the source of their depression
Suggest maybe diff treatments for diff severity of depression
Conclusion
Drugs shown to be superior to placebo and more effective for severe depression
Evaluation
They excluded ppt because of compounding factrs like alcoholism, personality disorders, or suicidal tendencies, but this would make it less representative of the actual pop. of depressed ppl. Not generalisable
Problems w comparing diff treatments, bc they have diff goals (not just to cure patient). Some focus more on the process than
Geddes
carried out a systematic review of 31 randomized trials with 4410 patients
The aim of this systematic review was to identify all randomised trials, published or unpublished, available for review by August, 2000, in which continued antidepressant drug therapy was compared with placebo in patients who had responded to acute treatment with antidepressants
Findings
Continuing treatment with antideppresants reduced relapse rates by 70%
Average rate of relapse on the placebo was 40%, compared to 18% on active treament
Treatment effects persisted for up to 36 months
Significantly more ppt allocated to antidepressants withdrew from trials as opposed to those on placebo
Conclusion
antidepressant drugs are an effective way to treat depression and prevent relapse. Drugs have been effective in reducing the number of hospital in-patients who are being treated for psychological disorders.
Treatment benefit for patients depends on their absolute risk of relapse with greater abolute benefits in those at higher risk
Interesting as drugs are known to lead to relapses and make u rely on them, so the fact that they prevent relapsing is itneresting
EVAL
randomized control trials. Reduces chances of bias/ extraneous variables)
THey had a good way of finding studies, in depth search
They had good inclusion criteria
Had good standards abt what research they select
This finding is a clinically important simplification because current approaches to the treatment of depression try to distinguish between several stages in the recovery from depression and hypothesise different effects of treatment in each stage.
The trials were mainly done in secondary care settings, with patients at a high risk of relapse. This is an important patient group contributing substantially to the prevalence of depression.
^But, its unclear how results would apply to patients who were under-represented in the trials, particularly those with milder illnesses who might have a low underlying risk of relapse.
No clear diff between relapse reoccurence. Hard to tell diff between relapse and recurrence
Continuation therapy prevents relapse (so u dont suddenly get symptoms while getting treated)
Maintenence therapy (to maintain results once u are cured)
Ppl who were pulled out were pulled out for a reason (treatments werent working)
Bc theyre relying on other ppl’s data, this distorts findings as ppl were taken out, which may make it seem like theres less relapse than there is
some trials pulled out people whose meds werent working, may distort data - makes it seems theres less relapse than suppose
Diff between relapse and reoccurence
Relapse- Relapse is defined as a full return of depressive symptoms once remission has occurred - but before recovery has taken hold. Remissionis clinically defined as the experience of being symptom-free from illness.
Reoccurence phase
Recurrence refers to another depressive episode after recovery has been attained.
Kirsch
Effectiveness of meds might be due to placebo effect
Some drugs increase serotonin, some decrease it, others dont change level at all but they whoed the same effect
Found that any drugs help, not that there are specific drugs or chemicals
Specific nature doesnt matter, even placebos work
Enhanced placebo effect- bc many clinicians and pateints in clinical blind trials can sometimes work out what condiiton theyre in (shows experiment bias and demand characteristics)
Tretment may not be that effective
Only reason that they work is publication bias
Kirsch
Metaanalysis using clinical trials
Almost half of trials sponsored by companies werent published
Results
Found that 80% of effect of meds were duplicated by placebo
V little diff between effectiveness of drugs and placebo
Conclusion
When published and not published data is combined, they fail to demonstrate clinically significant effectiveness of drugs
Statistical and clinical signfiance:
Statistical significance may not necessarily mean clinical sig. E.g 500 ppl out of a million ppl getting better is statistically significant but theres still low chance of actually getting better,
Esp in meta analysis, even small effects might be statistically signidicant, but NOT clincially
statistically significant in large sample size show tiny effect sig, but may not be clinically significant
500 get better out of half million, may be stat sig but so many people not get better (0.1%) compare to effect size eg twice as likely to get better
EVAL
GOOD
Used data that was both published and unpublished
All data used HAM D depression rating scale, makes all studies directly comparable
BAD:
Metanalysis arrive at average esitmates across all studies
They are only as good as the research studies comprising them
Argument could be made abt how Kirsch’s crisiticm is dependnent on severity of MDD. Hollon argues most of kirsch’s studies were on less severe MDD
TADS
(treatment of adolescenets with depression study)
Multiclinial research study
Examined short term and long term effectiveness of drug treatments, psychotherapy or a combination of both in teens
13 clinics in the US used, around 400 ppt diagnosed w MDD
Study in 3 stages:
First 12 weeks- acute treatment: ppt assigned to 4 groups:
Medication
Placebo + clinical management (when clients and therapists meet and talk, but no specific psychotherapeutic technique used). So ppt couldnt work out they were in placebo group
CBT
CBT and medication
At the end of 12 weeks, ppt who were in placebo were told abt it. If they didnt improve, they were allowed to choose one of the other 3 treatments (but werent part of study anymore)
Consolidation treatment- ppt from 3 groups continued for 6 more weeks
Continuation treatment- ppt who improved were observed fro another 18 weeks
They checked effectiveness of treatment using:
Repsonse rate: needds to be 50% decrease in a standardised depression scale
Remission rate: few or no symptoms of depression
Relapse rate: recurrence of past conditons, e.g developing depressive symptoms after stopping treatment
Results
All 3 treatments outperformed placebo
Combo was the best in short term
Cbt catches up w meds and combo treatment
BUT, this doesnt mean we shouldnt use drugs, bc its good for if we need quick action, e.g someone is suicidal
Combo seems best for variety of situations
Cog treatment depends on how involved patient is/ motivation, which depressed patients might not have at the beginning
No therpay is effectie for ALL patients
Conc
Study suggests antidepressants (either alone or in combo) are effective for treatment in both short and longterm
Seems to support chemical imblanace theory (idea that deppresive symptoms are caused by neurotransmitter imbalances in brain, and restoring balance can reduce symptoms)
EVAL
Used respose rate such as HAM-D, standardised way of seeing what getting better means
