Transcript Biological Treatments for depression

BIOLOGICAL TREATMENTS FOR DEPRESSION
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• ELECTRO CONVULSIVE THERAPY (ECT)
• ANTI-DEPRESSANT MEDICATION
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• visit
http://www.psychosurgery.org/aboutlobotomy/
Psychosurgery - about lobotomy
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• visit
http://www.youtube.com/watch?v=_0aNIL
W6ILk
Documentary on Walter Freeman.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY

is lobotomy all bad?...
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• visit http://www.psychosurgery.org/aboutlobotomy/ for one perspective on lobotomy…

is lobotomy all bad?...
 depression is
something to do with
the brain : SCIENCE
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• visit http://www.psychosurgery.org/aboutlobotomy/ for one perspective on lobotomy…

is lobotomy all bad?...
 depression is
something to do with
the brain : SCIENCE
 people with
depression are still
human !! ETHICS
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
http://www.npr.org/templates/story/st
ory.php?storyId=5014080
how do “we” feel NOW about surgery?
BIOLOGICAL TREATMENTS FOR DEPRESSION
• SURGERY
• child of its time
• pre-technology: where would we be without it ?
• scientific value = the BRAIN is important !
• ethical standards
• times are changing (!)
• scientific standards (peer review; rigour)
• complexity of the brain (and brain-body
interactions)
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ELECTRO CONVULSIVE THERAPY (ECT)
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
http://www.youtube.com/watch?v=EGZv2w
bYV7U
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
• ECT involves placing an electrical pulse to the patient's
head to cause a carefully controlled fit or seizure. The
treatment is performed under full general anaesthetic so
that the patient is unaware of the seizure.
• A muscle relaxant is also given to reduce the shaking
movements and prevent injury. The treatment is usually
given twice a week. A course of ECT usually comprises
between 6 and 12 treatments.
• Most people are hospitalised for the duration of
treatment, but it is possible to receive ECT as an outpatient.
However, this is relatively rare and the majority of patients
having ECT will have this treatment as part of their inpatient stay in a mental health hospital ward
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•ECT arose from many different observations, including
doctors realising that patients with epilepsy and depression
tended to be less depressed after having a fit or seizure.
•Depression is caused by a fall in some brain chemicals and
ECT appears to increase these brain chemicals.
•The precise way in which ECT works remains unknown,
but it is no less effective for this.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•ECT is considered the treatment of choice in severely
depressed patients when other forms of medication have
either not worked, caused side effects the patient cannot
cope with, or will not help the patient quickly enough (for
example if the person is not eating and drinking or is
severely suicidal.
•ECT is sometimes also an effective treatment for
schizophrenia and mania, but is only occasionally used for
these conditions.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•ECT is no more dangerous than minor surgery under
general anaesthetic, which has a death rate of approximately
1 in 10,000.
•It is performed under the care of an anaesthetic consultant
or specialist, who administers the general anaesthetic and
monitors the patient during the procedure.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
SIDE EFFECTS ?
•Many patients report patchy but persistent memory loss
just before and during ECT treatment. There is no good
evidence of long-term memory problems following ECT.
•Many people experience confusion on waking up from the
anaesthetic, but this clears within a few hours.
•The ability to learn new information is impaired for
several weeks after ECT treatment, but does return to
normal over time.
• Some people suffer from headaches and muscle aches
straight after treatment and these respond well to common
painkillers such as paracetamol.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•The amount of electricity applied to the scalp and the
lesser amount that reaches the brain is too small to cause
lasting brain damage.
• Researchers specifically looking for evidence of brain
damage have not found any.
•Furthermore, people who suffer from epilepsy and have
fits spontaneously (under much less carefully controlled
conditions) do not develop lasting brain damage unless the
fits are prolonged.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•A doctor cannot just decide to give a patient ECT. Any
patient who is well enough will have the procedure
explained to them and will be asked to give written consent
(permission) to treatment.
•This consent can be withdrawn at any time and the
treatment will be stopped.
•Patients who are deemed too ill to give consent would still
have the procedure explained to them, but a specially
appointed independent doctor (who does not work with
the doctor who is treating the patient) would be asked to
give an opinion. If he considers ECT the most appropriate
treatment this second doctor would effectively give
consent on the patient's behalf.
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
•ECT is controversial…
http://news.bbc.co.uk/1/hi/health/med
ical_notes/1079436.stm
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
• Monoamine Oxidase Inhibitors (MAOIs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Elavil is usually prescribed as a treatment for depression. Some
doctors also prescribe Elavil to treat bulimia nervosa (an eating
disorder), to control chronic pain, to prevent migraine
headaches, and to treat a pathological weeping and laughing
syndrome associated with multiple sclerosis.
Elavil should be taken regularly for several weeks as it takes time
to become fully effective. Patients should not skip doses, as this
significantly decreases its effectiveness.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Elavil should be taken exactly as prescribed. Patients may
experience side effects, such as mild drowsiness, early on in
treatment for depression. However, these side effects usually
disappear after a few days. It may take as long as 30 days to
effectively treat depression.
Elavil may cause a dry mouth. Sucking on hard sweets, chewing
gum, or melting bits of ice in your mouth can provide relief.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Patients should not stop taking Elavil abruptly, especially if they
have been taking large doses for a long period of time. The
prescribing doctor will probably want to decrease the dosage
gradually. This will help prevent a possible relapse of depressive
symptoms, and will reduce the possibility of withdrawal
symptoms.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Elavil may make skin more sensitive to sunlight. Patients should
try to stay out of the sun, wear protective clothing, and apply a
sunblock. It may also cause drowsiness or loss of alertness;
patients, therefore, should not drive or operate dangerous
machinery or participate in any hazardous activity that requires
full mental alertness until they know how this drug effects them.
While taking this medication as a treatment for depression,
patients may feel dizzy or lightheaded, or actually faint when
getting up from a lying or sitting position. If getting up slowly
doesn’t help or if this problem continues, patients should notify
their doctor.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Patients should use Elavil with caution if they have ever had
seizures, urinary retention, glaucoma or other chronic eye
conditions, a heart or circulatory system disorder, or liver
problems. Caution should also be exercised if thyroid medication
is also being taken. Patients should discuss all of their medical
problems with their doctor before starting this depression
medication. Before having surgery, dental treatment, or any
diagnostic procedures, patients should tell the doctor that they
are taking Elavil. Certain drugs used during surgery, such as
anesthetics and muscle relaxants, and drugs used in certain
diagnostic procedures may react badly with this medication.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Older adults are especially vulnerable to certain Elavil side effects,
including rapid heartbeat, constipation, dry mouth, blurred
vision, sedation, and confusion, and are in much greater danger
of sustaining a fall.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
Elavil side effects may include: Abnormal movements, anxiety,
black tongue, blurred vision, breast development in males, breast
enlargement, coma, confusion, constipation, delusions, diarrhea,
difficult or frequent urination, difficulty in speech, dilation of
pupils, disorientation, disturbed concentration, dizziness in
getting up, dizziness or lightheadedness, drowsiness, dry mouth,
excessive or spontaneous flow of milk, excitement, fatigue, fluid
retention, hair loss, hallucinations, headache, heart attack,
hepatitis, high blood pressure, high fever, high or low blood
sugar, hives, impotence, inability to sleep, increased or decreased
sex drive…
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
e.g., Elavil
… increased perspiration, increased pressure within the eye,
inflammation of the mouth, intestinal obstruction, irregular
heartbeat, lack or loss of coordination, loss of appetite, low
blood pressure, nausea, nightmares, numbness, rapid and or fast,
fluttery heartbeat, rash, red or purple spots on the skin,
restlessness, ringing in the ears, seizures, sensitivity to light,
stomach upset, strange taste, stroke, swelling due to fluid
retention in the face and tongue, swelling of testicles, swollen
glands, tingling and pins and needles in the arms and legs,
tremors, vomiting, weakness, weight gain or loss, yellowed eyes
and skin.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Monoamine Oxidase Inhibitors (MAOIs)
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Monoamine Oxidase Inhibitors (MAOIs)
The MAO inhibitors are a class of antidepressant drugs
which were actually accidentally discovered as a treatment
for depression. Physicians noticed that iproniazid, a drug
being tested on patients for tuberculosis, was found to have
an interesting effect in that it actually seem to make patients
happier. Later, it was also discovered to have the same effect
on depressed patients. This antidepressant drug and several
other chemically related medications, were found to slow
the body's production of the enzyme monoamine oxidase
(MAO), from which it received the name of MAO
inhibitors.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Monoamine Oxidase Inhibitors (MAOIs)
Usually, the brain supplies of the MAO enzyme break down
the neurotransmitter noradrenaline. MAO inhibitors block
this enzyme from carrying out this ”breaking down” process
and thereby stop the destruction of
noradrenaline. Ultimately this results in an increase in
noradrenaline activity, which in turn reduces symptoms of
depression. Approximately half of the depressed patients
who take this antidepressant drug are helped by it.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Monoamine Oxidase Inhibitors (MAOIs)
Clinicians have found that these drugs have the potential for
serious medical problems. Many of the foods consumed in a
normal diet such as cheeses, certain fish, bananas, and some
wines contain tyramine - a chemical that can raise blood
pressure dangerously if too much accumulates in the blood
system. Usually, MAO in the liver serves the beneficial role
of quickly breaking tyramine down into another chemical,
which helps keep blood pressure under control.
Unfortunately, when these antidepressant drugs are taken to
combat depression they also block the production of MAO
in the liver and intestines. This process allows tyramine to
accumulate and puts the person in great danger of high
blood pressure and has caused some patients to even die.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs increase the extracellular level of the neurotransmitter
serotonin by inhibiting it reuptake into the pre-synaptic cell,
thus increasing the level of serotonin available to the postsynaptic cell, increasing the level of serotonin available to
bind to the post-synaptic receptor.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
Prozac (Fluoxetine) is used to treat depression, obsessive
compulsive disorder, bulimia ( an eating disorder), and
severe symptoms of premenstrual syndrome. Prozac is
primarily prescribed for adolescents, adult men and women
and the elderly, but occasionally is also prescribed for
children.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
Prozac is usually taken about once a day, most commonly
in the morning, and may be taken either with food or
without. Dosage is usually established in relation to the
severity of the related illness along with the individual’s
response to the medication. Prozac is meant to be taken as
prescribed without modifications in a routine manner. It is
important to follow the doctor’s orders, and to continue
the medication as prescribed even after beginning to feel
better. It may take up to four weeks before the full benefits
of this drug are felt.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
The side effects of Prozac are much more limited than some
of the earlier generation antidepressants (tricyclics).
However, there are some side effects. The most common
side-effects include nausea, headache, trouble sleeping, dry
mouth, drowsiness and sweating.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
Some of the less common but more severe side-effects have
been noted to be: loss of appetite, unusual weight loss,
unusual or severe mental/mood changes, uncontrolled
movements (tremor), decreased interest in sex, and flu-like
symptoms. Much more unlikely but potentially very serious
side-effects associated with Prozac include vision changes,
trouble swallowing, swelling or white spots on the mouth
and/or tongue, changes in sexual ability, and painful and/or
prolonged erection.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
The most serious side-effects usually associated with Prozac
are fainting and an irregular/fast heartbeat. Allergic reactions
to Prozac are unlikely but include rash, itching, swelling,
dizziness and trouble breathing.
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)
e.g., Prozac
Prozac has had some bad press…
http://news.bbc.co.uk/1/hi/health/758763.stm
BIOLOGICAL TREATMENTS FOR DEPRESSION
• Rooted in the biological approach to mental ill-health
• alternative explanations may be more valid
• alternative treatments may be preferable
• alternative treatments may be more effective
• Who is in control ?
•
•
• Dependence
• psychological if not physiological