Treating Abnormality: Biological Therapies Flashcards
When is ECT used?
Only in severe cases of depression which do not respond to drugs.
Explain the process of ECT and what happens.
ECT is usually given 3 times a week for up to 5 weeks. The patient is given, oxygen, a muscle relaxant and general anesthetic and then electrodes are placed on the head. A small electric current is passed through the brain. This causes a seizure within the brain lasting about 1 minute. The patient regains consciousness after 5-10 minutes.
What are the two types of ECT? Explain both of them.
Unilateral ECT - Only 1 side of the head is stimulated. Bilateral ECT - Both sides are stimulated.
What does ECT do to reduce depression?
It reduces overractive connections between areas of the brain that control mood, thinking and concentration.
What are the strengths of ECT?
- It is effective (in the short term). In Eranti et al’s research, 59% of ECT patients went into remission immediately after treatment and were still ok at their monthly check up, however, after 6 months, they were suffering from major depression again.
- It has saved the lives of those with severe depression who are on the brink of attempting/have attempted suicide. Also, for those who are so depressed that they have stopped eating and their organs are shutting down, ECT can provide instant relief, unlike antidepressants, which take weeks to kick in properly.
What are the limitations of ECT?
- There are possible side effects such as impaired memory (common with bilateral ECT), nausea and headaches. There have also been some reports of permanent psychological changes like permanent fear and anxiety. Although the process is always being improved and side effects are lessening, adolescents, children, the elderly and pregnant women are especially at risk of side effects.
- There are ethical issues. Its argued that people who are severely depressed are in no fit state to give truly informed consent for the procedure and to understand the possible side effects. A meta-analysis showed that roughly half of those who received ECT felt they weren’t properly informed. The Mental Health Act was ammended to try to deal with this, and now ECT has to have either the patient’s consent, or it has to be deemed necessary to save the patient’s life or to stop a serious deterioration in the patient’s condition.
How do monoamine oxidase inhibitiors (MAOIs) ease depression? Why is it not the first choice for antidepressants?
They affect neurotransmitters (chemical messengers) that communicate between brain cells. An enzyme called monoamine oxidase removes the neurotransmitters noradrenaline, serotonin and dopamine from the brain, but MAOIs prevent this from happening in order to make more of these brain chemicals available, ultimately increasing mood by improving brain cell communication.
It isn’t first choice, as it can react with certain foods or alcohol and cause high blood pressure.
How do selective serotonin re-uptake inhibitors (SSRIs) such as Prozac work?
They increase the amount of the neurotransmitter serotonin in the brain. After carrying a message, serotonin is usually reabsorbed by nerve cells (reuptake). SSRIs block reuptake (inhibition), meaning more serotonin is available to pass more messages.
SSRIs are effective and have fewer side effects than older antidepressants. They are commonly used for moderate to severe depression.
How do anti-psychotic drugs work and what are they used for?
Used mainly for disorders like schizophrenia. They help to deal with hallucinations and delusions.
They effect the action of several neurotransmitters, but mainly dopamine. If parts of the dopamine system become overractive, it plays a part in producing hallucinations and delusions. Anti-psychotic drugs block receptor sites for dopamine to reduce its activity.
What are the strengths of drug therapy?
- Anti-psychotic drugs shown to be very successful in cases of schizophrenia and reduce symptoms and suffering in patients considerably. However, symptoms such as feeling withdrawn from society do not get reduced by drug therapy.
- They are an easier course of treatment in terms of how much effort the patient has to put in, unlike talking therapies such as CBT, however doctors often recommend CBT alongside drug therapy. Drugs are also cheaper than long term therapy.
What are the limitations of drug therapy?
- It treats only the symptoms of abnormality rather than the problem itself. The treatments see abnormality in terms of physical problems only, so they are reductionist, as they ignore the possibility of situational and environmental factors. Psychological therapies have been shown to be more effective overall.
- They can have side effects such as tremors and slowing of the body and facial features. Anti-psychotic drugs can also damage the immune system. Anti-depressants can take 2 weeks to kick in, so some patients lose faith in them and stop taking them.
