Transcript Biological Treatments for depression (PPH) 2011

BIOLOGICAL TREATMENTS FOR DEPRESSION
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ELECTRO CONVULSIVE THERAPY (ECT)
• ANTI-DEPRESSANT MEDICATION
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ELECTRO CONVULSIVE THERAPY (ECT)
BIOLOGICAL TREATMENTS FOR DEPRESSION
•ELECTRO-CONVULSIVE THERAPY
http://www.youtube.com/watch?v=EGZv2w
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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
•Selective Serotonin Reuptake Inhibitors (SSRIs)
BIOLOGICAL TREATMENTS FOR DEPRESSION
• ANTI-DEPRESSANT MEDICATION
• Tricyclics
•Block the transporter mechanism that reabsorbs
Noradrenaline and serotonin into the presynaptic
neuron.
•More neurotransmitter remains in the synapse,
making transmission easier
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
 Phases of Treatment
 Acute Phase
 Continuation Phase (4-6 months)
 Gradual reduction of dose
 Maintenance Phase – continuous for patients with
recurrent episodes
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