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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
