Interventions Flashcards
What are some examples of antidepressants?
SSRIs
Tricyclics
MAOIs
Others
What is the extent of use of antidepressants?
2019 - 7.4 million people prescribed antidepressants
930,000 continuously receiving 4/2015-3/2018
US- - 23% women in 40s/50s take antidepressants, women 2x more likely to take than men
NHS - £200+ million on antidepressants each year - $14 billion worldwide
2017-19 - 17% adult population on antidepressants each year
How did COVID-19 impact use?
April-June 2022 - 21.2 million drugs prescribed, 1.17% increase from previous quarter, 3.58% increase from same tame previous year
28 month period since lockdown, March 2020-June 2022 2.36 million more issued than expected
What are the effects of antidepressant?
Tricyclics - strongly sedative
SSRIs - weaker/ subtle
Emotional numbing, lethargy, reduced libido, agitation
What are the mechanisms of antidepressants?
Varied affects to NT system
Tricyclics - increase activity of serotonin & noradrenaline by blocking reuptake (may also block dopamine)
SSRIs increase serotonin by blocking reuptake (can’t measure directly)
What are the differences between disease centred and drug centred model?
Disease - drugs help corrected abnormal brain state and therapeutic effects derived from underlying disease process
Drug - drugs create abnormal brain state & therapeutic effects from impact of drug induced state on emotional/ behavioural difficulties
What is the serotonin hypothesis?
Depression result of abnormalities in brain chemicals, particularly 5HT
Potential links with widespread SSRI use (90s)
Limited evidence for antidepressants correcting chemical imbalance involving monoamines
What is the evidence pyramid?
Secondary at top (clinical guidelines, meta analyses)
Primary in middle (RCTs, observational studies)
No design (case report)
No humans at bottom (animal/ lab studies)
What are some critiques of meta-analyses?
Ppts classified into responders/ non-responders - inflate apparent effectiveness (Moncreiff, 2018)
<1% low risk of bias, 28% high risk
Some trial ppts withdrawn from other antidepressants before trial
Average effect = small (not meaningful)
78% funded by pharmaceutical companies
Response measured at 8 weeks - not real life
Effects bigger sooner after release of drug
If >20% ppts classified as treatment resistant, study excluded
What are some unwanted/ long-term effects?
36% on for 5+yrs, 26% expected for life
Unwanted effects may vary
Cascade et al (2008) 38% report side effects
Effects in teenagers can include agitation, aggression & suicidality
Younger age & longer use = more adverse effects
What are withdrawal effects?
2019 - NICE stated usually mild and self-limiting over 1 week, can be severe
Davies & Read (2019) - average 56% experience withdrawal, majority say moderate/ severe
Tapering important
What are marketing & profits in antidepressants?
Global market approx $14bn/ year
Big pharma - one of highest profit margins
Illegal in UK to market directly to consumer
Vested interest affect trial results & induce bias
What are some antidepressant lawsuits?
Pfizer - largest fine paid for healthcare fraud lawsuit - $2.3bn in fines, penalties & settlement for illegal marketing claims
Questionable ethics
What is CBT?
Focused on here & now; structured & goal directed
Identifies (un)helpful patterns of behaviour, thoughts & emotions
Break unhelpful patterns
What is the psychodynamic approach?
Drawn on Freud, Klein, Jung
Centres on unconscious
Identifies defences as developing intrapsychic structures
Early childhood important
Insight critically important for success
