Friday, 18 April 2014

Biological Therapies for Depression

 SSRIs are said to be the most commonly prescribed antidepressants. This can include drugs such as Sertraline and Citalopram.  Monamine Oxidase Inhibitors (MAOIs)  control the activity of certain neurotransmitters; chemicals in the brain which allow brain cells to communicate  with one another. The main neurotransmitters thought to be involved in depression are serotonin and noradrenaline.

 MAOIs are first-generation antidepressants which inhibit the production of monoamine oxidase, an enzyme which breaks down neurotransmitters. Through hindering the process it allows them to stay in the body longer, and thus increase the levels of serotonin and noradrenaline in the synapse. 

 Tricyclic drugs prevent the uptake of both serotonin and noradrenaline by the presynaptic neurone after it has been fired. This leaves more neurotransmitters in the synapse, in order for the next impulse to be made much easier. Cost effectiveness can also be taken into account with these antidepressants, as tricyclic drugs are just as effective as SSRIs, but less expensive, however SSRIs are said to be far more effective in very severe cases of depression.

 A concerning issue underlying the use of antidepressants is that they take a significantly long time to take effect (around 2-4 weeks), which weakens the effectiveness of the drug. Furthermore, they do not produce a cure for depression, as they only seem to treat the symptoms rather than the cause of the disorder. On the other hand, recent tests have shown 50-65% of patients given antidepressants showed signs of improvement, compared to a success rate of 25-30% for those in the same test given a placebo. Arguably these results highlight that antidepressants are in fact very effective, however they may force one to consider that due to placebo effects, the success of the drug may be psychological as well as pharmacological. 
 Additionally, antidepressants can cause a wide variety of side effects, ranging from dry mouth to suicidal thoughts, which may encourage the patient to stop taking the medication. MAOIs have proven to be very effective for many patients suffering from depression, however are problematic because out of all antidepressants they are said to have the most side effects. It is therefore debatable whether or not this is an appropriate drug to be prescribed to patients suffering from depression if the drug violates the 'protection from harm' ethical guideline. Speaking of which, there are ethical arguments that drug therapy is dehumanising and takes away the sense of personal responsibility and freedom. However, a short course of anti-depressants offer people a relief from depression and can allow them to regain the motivation to engage with other therapies to help overcome their disorder. 

 Electro Convulsive Therapy (ECT) may be advised if an individual has a very severe case of depression, however it should only be used if antidepressants have not worked.
 The modern technique involves putting the patient under a short-acting anaesthetic and muscle relaxant  before the shock is given, oxygen is also administered. A small amount of current around 6 amps is then passed through the brain, lasting around half a second, which results in a seizure roughly lasting a minute. This is usually given 3 times a week for up to 5 weeks.

 ECT appears to be highly successful for severe cases of depression. Psychologists have reviewed studies on ECT and have found it to be effective in over 60% of psychotic depressed patients, and researchers have also found that it seems to work where drugs don't. Psychologist Janicack found that around 80%of severely depressed patients responded positively to ECT, compared to 64% to drug therapy. 
 On the other hand, psychologists have found ECT to have a high relapse rate within a year of treatment, suggesting that it is only a temporary relief rather than a cure. Recent tests have found it to be very effective in the short-term, but smaller than the effect obtained by drugs.
 A primary disadvantage with ECT are the ethical issues surrounding its use and the extent to which the patient is protected from harm. Many patients dislike it as it is potentially dangerous, and their consent is problematic because they are forced to have the treatment. The Debt of Health checked 700 patients who had been sectioned and 59% of them had not been consented to treatment.
 Another issue igniting the debate on ECT's appropriateness is that doctors still have very little idea how it works. However, it is quick compared to drug therapy, and is sometimes the only option. 

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