BIOLOGICAL TREATMENTS FOR DEPRESSION

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BIOLOGICAL TREATMENTS FOR DEPRESSION
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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• ELECTRO CONVULSIVE THERAPY (ECT)
• ANTI-DEPRESSANT MEDICATION

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• visit http//www.psychosurgery.org/about-lobotomy
  /
• Psychosurgery - about lobotomy

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• visit http//www.youtube.com/watch?v_0aNILW6ILk
• Documentary on Walter Freeman.

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• ? is lobotomy all bad?...

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• visit http//www.psychosurgery.org/about-lobotomy
  / for one perspective on lobotomy
• ? is lobotomy all bad?...

? depression is something to do with the brain
SCIENCE
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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• visit http//www.psychosurgery.org/about-lobotomy
  / 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
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BIOLOGICAL TREATMENTS FOR DEPRESSION

• SURGERY
• http//www.npr.org/templates/story/story.php?stor
  yId5014080
• how do we feel NOW about surgery?

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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)

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ELECTRO CONVULSIVE THERAPY (ECT)

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ELECTRO-CONVULSIVE THERAPY
• http//www.youtube.com/watch?vEGZv2wbYV7U

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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 in-patient stay
  in a mental health hospital ward

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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.

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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.

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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.

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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.

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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.

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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.

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ELECTRO-CONVULSIVE THERAPY
• ECT is controversial
• http//news.bbc.co.uk/1/hi/health/medical_notes/10
  79436.stm

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ANTI-DEPRESSANT MEDICATION

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ANTI-DEPRESSANT MEDICATION
• Tricyclics
• Monoamine Oxidase Inhibitors (MAOIs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ANTI-DEPRESSANT MEDICATION
• Tricyclics

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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.

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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.

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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.

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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 doesnt help or if this problem continues,
  patients should notify their doctor.

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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.

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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.

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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

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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.

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ANTI-DEPRESSANT MEDICATION
• Monoamine Oxidase Inhibitors (MAOIs)

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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.

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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. 

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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.

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BIOLOGICAL TREATMENTS FOR DEPRESSION

• ANTI-DEPRESSANT MEDICATION
• Selective Serotonin Reuptake Inhibitors (SSRIs)

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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 post- synaptic cell, increasing the level of
  serotonin available to bind to the post-synaptic
  receptor.

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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.

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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 individuals
  response to the medication. Prozac is meant to
  be taken as prescribed without modifications in
  a routine manner. It is important to follow the
  doctors 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.

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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.

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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.

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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.

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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

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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

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