A Deeper Look at Somatic Therapies for Depression
Somatic Therapies for Depression
Advocates of the biological model approach the treatment of unipolar depression,
particularly when it is severe, in two ways. The first is to treat the
patient with drugs like the tricyclics and the MAO inhibitors. The Second
approach is to administer electroconvulsive shock.
DRUG TREATMENT
Tricyclic antidepressants, you will recall, block the
reuptake of norepinephrine. As a result, less NE is absorbed, more NE is
available, and the patient becomes less depressed. In the United States, the
brand name of the most popular tricyclics are Tofranil (imipramine), Elavil
(amitriptyline), and Sinequan (doxepin). On the average, between 63 and 75
percent of depressed patients given tricyclics show significant clinical improvement (Beck, 1973). Further, maintaining a patient who is susceptible
to recurrent depressions on tricyclics between attacks reduces the probability
of recurrence (Gelenberg and Klerman, 1978).
The MAO inhibitors prevent the breakdown of norepinephrine by inhibiting
the enzyme MAO. With more NE available, the patient becomes less
depressed. But MAO inhibitors are now prescribed much less often than
tricyclic antidepressants, largely because the MAO inhibitors can have
lethal side effects. When combined with cheese, alcohol, pickled herring,
narcotics, or high blood-pressure-reducing drugs, MAO inhibitors can be
fatal. Most studies show MAO inhibitors to be superior to placebos in alleviating
depression, however, and if tricyclics fail, the MAO inhibitors
should be tried.
ELECTROCONVULSIVE SHOCK (ECT)
Electroconvulsive shock is, to the layman, the scariest of the antidepressant treatments.
In the two decades following ECT's discovery as a
psychotherapeutic treatment in 1938, enthusiasm was high,
and it was promiscuously prescribed for a very broad range of
disorders. The treatment, particularly in its less refined forms, can have very
serious side effects, however, and it has come to be regarded by the general
public as "barbaric" and "punitive." But strong evidence exists that ECT,
when given to severely depressed unipolar depressive patients, is a highly
effective antidepressant therapy. Modern techniques have greatly reduced
the common and severe side effects of yesteryear (Fink, 1979).
Typically, ECT is administered by a medical team consisting of a psychiatrist,
anesthesiologist, and a nurse. Metal electrodes are taped to either side
of the patient's forehead, and the patient is anesthetized. The patient is given
drugs to induce muscular relaxation in order to prevent the breaking of
bones during the convulsion. A high current is then passed through the
brain for approximately a half second. This is followed by convulsions that
last for almost one minute. As the anesthetic wears off, the patient wakens
and will not remember the period of treatment. Within twenty minutes, the
patient is functioning reasonably well and has little, if any, physical discomfort.
A course of ECT usually consists of a half dozen treatments, one
every other day (Schuyler, 1974). Electroconvulsive shock is today often administered
unilaterally, that is, to only half of the brain.
Producing the convulsion on the side of the brain that does not contain the speech centers (in
the non-dominant hemisphere, greatly reduces the possibility of the side effect of impaired
speech following ECT. Unilateral ECT is an effective antidepressant, but it probably is not as
effective as bilateral ECT (Scovern and Killman, 2003; Abrams, Taylor, Faber, Ts'o, Williams, and Almy, 1983).
How ECT works to break up depression is unclear. It probably increases
available norepinephrine and other biogenic amines, but it is such a gross
technique-shocking the entire brain-and has so many other effects, including
memory loss and motivational changes, that isolation of the effective
ingredient in ECT is quite difficult.
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
C-2007
For the new cutting edge Therapy I recommend click here:
The Liberator Method
Advocates of the biological model approach the treatment of unipolar depression,
particularly when it is severe, in two ways. The first is to treat the
patient with drugs like the tricyclics and the MAO inhibitors. The Second
approach is to administer electroconvulsive shock.
DRUG TREATMENT
Tricyclic antidepressants, you will recall, block the
reuptake of norepinephrine. As a result, less NE is absorbed, more NE is
available, and the patient becomes less depressed. In the United States, the
brand name of the most popular tricyclics are Tofranil (imipramine), Elavil
(amitriptyline), and Sinequan (doxepin). On the average, between 63 and 75
percent of depressed patients given tricyclics show significant clinical improvement (Beck, 1973). Further, maintaining a patient who is susceptible
to recurrent depressions on tricyclics between attacks reduces the probability
of recurrence (Gelenberg and Klerman, 1978).
The MAO inhibitors prevent the breakdown of norepinephrine by inhibiting
the enzyme MAO. With more NE available, the patient becomes less
depressed. But MAO inhibitors are now prescribed much less often than
tricyclic antidepressants, largely because the MAO inhibitors can have
lethal side effects. When combined with cheese, alcohol, pickled herring,
narcotics, or high blood-pressure-reducing drugs, MAO inhibitors can be
fatal. Most studies show MAO inhibitors to be superior to placebos in alleviating
depression, however, and if tricyclics fail, the MAO inhibitors
should be tried.
ELECTROCONVULSIVE SHOCK (ECT)
Electroconvulsive shock is, to the layman, the scariest of the antidepressant treatments.
In the two decades following ECT's discovery as a
psychotherapeutic treatment in 1938, enthusiasm was high,
and it was promiscuously prescribed for a very broad range of
disorders. The treatment, particularly in its less refined forms, can have very
serious side effects, however, and it has come to be regarded by the general
public as "barbaric" and "punitive." But strong evidence exists that ECT,
when given to severely depressed unipolar depressive patients, is a highly
effective antidepressant therapy. Modern techniques have greatly reduced
the common and severe side effects of yesteryear (Fink, 1979).
Typically, ECT is administered by a medical team consisting of a psychiatrist,
anesthesiologist, and a nurse. Metal electrodes are taped to either side
of the patient's forehead, and the patient is anesthetized. The patient is given
drugs to induce muscular relaxation in order to prevent the breaking of
bones during the convulsion. A high current is then passed through the
brain for approximately a half second. This is followed by convulsions that
last for almost one minute. As the anesthetic wears off, the patient wakens
and will not remember the period of treatment. Within twenty minutes, the
patient is functioning reasonably well and has little, if any, physical discomfort.
A course of ECT usually consists of a half dozen treatments, one
every other day (Schuyler, 1974). Electroconvulsive shock is today often administered
unilaterally, that is, to only half of the brain.
Producing the convulsion on the side of the brain that does not contain the speech centers (in
the non-dominant hemisphere, greatly reduces the possibility of the side effect of impaired
speech following ECT. Unilateral ECT is an effective antidepressant, but it probably is not as
effective as bilateral ECT (Scovern and Killman, 2003; Abrams, Taylor, Faber, Ts'o, Williams, and Almy, 1983).
How ECT works to break up depression is unclear. It probably increases
available norepinephrine and other biogenic amines, but it is such a gross
technique-shocking the entire brain-and has so many other effects, including
memory loss and motivational changes, that isolation of the effective
ingredient in ECT is quite difficult.
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
C-2007
For the new cutting edge Therapy I recommend click here:
The Liberator Method