PSYC496AV Lecture Notes - Monoamine Oxidase Inhibitor, Treatment-Resistant Depression, Suicidal Ideation

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12 Feb 2013
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BIOLOGICAL THERAPIES:
Electroconvulsive Therapy:
ECT is being used with increased frequency in Canada and elsewhere. One reason is that
when it works, it is faster than antidepressants and psychotherapy.
ECT entails the deliberate induction of a seizure and momentary unconsciousness by passing
a current between 70 and 130 volts through the patient’s brain.
Electrodes were formerly placed on each side of the forehead, allowing the current to pass
through both hemispheres, a method known as bilateral ECT.
Today, unilateral ECT, in which the current passes through the non-dominant (right)
cerebral hemisphere only is more commonly used.
The mechanism through which ECT works is unknown. It reduces metabolic activity and
blood circulation to the brain and may thus ingibit aberrant brain activity.
Although we don’t know why, ECT may be the optimal treatment for extremely severe
depression.
Risks: confusion and memory loss that can be prolonged. However, unilateral ECT to the non-
dominant hemisphere erases fewer memories than does bilateral ECT and no detectable
changes in brain structure result.
Clinicians typically resort to ECT only when the depression is unremitting and after less-
drastic treatments have been tried and found wanting.
Full informed consent is crucial, given that some patients have indeed had negative
experiences (full amnesia).
Rotman research institute in Toronto, reported on preliminary success in a small number of
patients with a deep brain electrical stimulation procedure for treatment-resistant
depression, a severely disabling disorder with no treatment options once ECT, medication
and psychotherapy have failed.
Mayberg et al concluded that disrupting focal pathological activity in limbic-cortical circuits
using electrical stimulation of the subgenual cingulate white matter can effectively reverse
symptoms in otherwise treatment resistant depression.
Drug Therapy:
Drugs are the most commonly used treatments biological or otherwise for mood
disorders.
There is evidence of a better response among people with higher levels of social support.
Specific Drug Therapies For Depression:
Three major categories of antidepressents:
(1) Tricyclics, such as imipramine (Tofranil) an amitriptyline (Elavil)
(2) Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and Sertraline
(Zoloft)
(3) Monoamine Oxidase (MAO) inhibitors, such as tranyl-cypromine (Parnate)
Since the MAO inhibitors have by far the most serious side effects, the other two classes of
drugs are more used.
The clinical effectiveness of all three types of drugs is similar. SSRIs have the advantage of
producing fewer side effects.
Antidepressent meds are often used in combination with some kind of psychotherapy.
Drug Therapy For Bipolar Disorder:
Carefully monitored dosages of the element lithium, taken in a salt form, lithium
corbonate, much more effective for bipolar patients than for unipolar patients.
Responsiveness or non-responsiveness to lithium treatment seems to be an inherited family
trait.
Discontinuation of lithium actually increases the risk of recurrence. Thus it is recommended
that lithium be used continuously.
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