Transcript Biological Therapies for depression: drugs

Biological Therapies for
depression:
By the end of the lesson you
should be able to......
• Outline a biological treatment of
depression (anti-depressants)
• Evaluate the biological treatment of
depression by focusing on their
effectiveness (do they work?) and
their appropriateness (should they
be used for depression?)
Biological therapies
• Biological therapies have arisen from the
biological approach that sees depression as a
biochemical imbalance.
• Antidepressants are designed to address this
imbalance
•Most widely used treatment for depression in NHS
BIOLOGICAL TREATMENTS FOR DEPRESSION
Their are 2 main Anti-Depressant
medications ………….
•Monoamine Oxidase Inhibitors (MAOIs)1950’s
• Selective Serotonin Reuptake Inhibitors
(SSRIs)- 1980’s “The wonder drug”
BIOLOGICAL TREATMENTS FOR DEPRESSION
Monoamine Oxidase Inhibitors (MAOIs)
•Used as a treatment for tuberculosis, but doctors
noticed it made patients happier.
•Monoamine oxidase is an enzyme which breaks down
monoamines (serotonin and noradrenalin)
•MAOI’s Block the action of this enzyme
•Thus, increasing the availability of these
monoamines in the nervous system
BIOLOGICAL TREATMENTS FOR DEPRESSION
•Selective Serotonin Reuptake Inhibitors
(SSRIs)
•E.g. Prozac
•Newer generation of drugs which
focus purely on serotonin.
•They block the re-uptake of
serotonin in the synapse, making
more available in the brain
Evaluation of antidepressants as
a treatment for depression
Effectiveness of antidepressants
• Gitlin (2002) carried out a clinical trial testing
SSRI and placebo’s.
• He found SSRI’s were effective in reducing
symptoms of depression in around 75% of
patients compared with 33% for placebos.
1. From these results what can we conclude
about the effectiveness of SSRI’s and placebos?
2. Is Gitlin’s clinical trial strong evidence for the
effectiveness of SSRI’s?
Effectiveness of antidepressants
• Read DeRubeis et al and Hollon’s et al (2005)
research on SSRI’s and answer the following
questions………..
1) What did DeRubeis find from his clinical
trail?
2) Why did Hollon carry out a follow up study
on DeRubesis’s participants?
3) What did Hollon (2005) find?
4) What does his finding suggest about using
drugs to treat depression?
Effectiveness of antidepressants
2 types of treatments…
• Curative treatments
• Palliative treatments
Many argue that drugs are just a palliative
treatment as they treat the symptoms and not the
cause of depression
-most people relapse once they stop taking the
drug.
Are dugs appropriate to use as they have side
effects?
•Monoamine Oxidase Inhibitors (MAOIs)
•Associated with potentially life threatening side
effects such as stroke!!
•Many of the foods consumed in a normal diet such
as cheeses, certain fish, bananas, and some wines
contain tyramine which reacts adversely with MAOI
•People prescribed With MAOI’s must restrict their
diet!!!
•Recently introduced a MAOI in the form of a skin
patch which allows slow continuous absorption of
the drug into the nervous system
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
•Hailed a wonder drug in the 1980’s- most
frequently prescribed, which has fewer side effects
(nausea or headaches) and believed to be less
dangerous in overdose
BUT...
Prozac has had some bad press…
Answer the following questions….
1. According to the article identify some
dangerous side effects of Prozac.
2. What evidence is there that supports the
idea that Prozac has serious side effects?
3. Are there any problems with this evidence?
4. Why is it a problem if drugs bring about side
effects?
5. Is there any evidence that suggests Prozac is
a safe drug with fewer side effects?
H.W- Write a burger paragraph on the
effectiveness of drugs or/and the
appropriateness of drugs (referring to
side effects)
• Outline the problem.
• Bring in evidence, what does the evidence
suggest?
• Why is this a problem-link back?
• Why does this matter?
Ethical issues
•Take away sense of
personal responsibility
or control
• people in severe
depressive states may
not be in a position to
give fully informed
consent
Treating the
symptoms not the
cause
Side effects
• Serious effects
on the body
• Prozac= suicide
Evaluation of
antidepressant
drugs
• Short term relief• Symptoms re-occur after drugs are no
longer taken
• maintenance therapy- continue taking
the drugs after improvement
•Dependency/addiction
Effective at
reducing symptoms
• Effective in treating symptoms 6575% of cases compared to only 33%
for placebo (Gitlin 2002)
Evaluation .....
• In order for therapy to be
most effective we must
combine drug therapy with
psychological treatment....
• Patients must gain an insight
into their disorder- in order for
treatment to be effective.