BIOLOGICAL TREATMENTS FOR DEPRESSION. ELECTRO CONVULSIVE THERAPY (ECT)

BIOLOGICAL TREATMENTS FOR DEPRESSION


• ELECTRO CONVULSIVE THERAPY (ECT)


•ELECTRO-CONVULSIVE THERAPY

http://www.youtube.com/watch?v=EGZv2wbYV7U





• 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.



• 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.


•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



•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.



•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.



•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.



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.



•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.



•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.



•ECT is controversial…

http://news.bbc.co.uk/1/hi/health/medical_notes/1079436.stm




• ANTI-DEPRESSANT MEDICATION



• Tricyclics

• Monoamine Oxidase Inhibitors (MAOIs)

• 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.




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.




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.




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.




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.




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.




e.g., Prozac

Prozac has had some bad press…

http://news.bbc.co.uk/1/hi/health/758763.stm

http://news.bbc.co.uk/1/hi/health/758763.stm


• 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

BIOLOGICAL TREATMENTS FOR DEPRESSION. ELECTRO CONVULSIVE THERAPY (ECT)

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