How effective are Anti D's

Electroconvulsive Therapy ECT
1. electrically induced seizure
2. originated to help epilsepy and schizo with induced convulsions of insulin
  1. insulin shock is dreadful experience and hard to control
  2. proved not effective and was found to work with depression
3. when drugs introduced ECT less popular
  1. used when people don't respond to drugs
    1. given muscle relaxants and anaesthetics to minimise discomfort
4. common side effect is memory loss but limiting shock to right hemisphere reduces memory loss
  1. memory impairment lasts no more than a few months, not forever
    1. REISNER 2004
5. high risk of relapsing into another episode of depression within a few months
  1. RIDDLE & SCOTT 1995
6. increases proliferation of new neurons in the hippo
  1. alters expression of at least 120 genes in hippo and frontal cortex alone
7. repetitive transcranial magnetic stimulation
  1. intense magnetic field applied to scalp, stimulating axons near surface of brain
    1. moderately effective against depression although mechanism of behavioural effect is unknown
Altered Sleep Patterns
1. teenagers reported almost daily problems in falling asleep or staying asleep
  1. next 6-7 years developed depression
    1. ROANE & TAYLOR 2008
2. fall asleep but awaken early unable to get back to sleep, REM sleep within 45 min
  1. more than average number of eye movements per min during REM sleep
  2. relatives show same sleep patterns and more likely to become depressed themselves than relatives who sleep normally
    1. MODELL, ISING, HOLSBOER & LAUER 2005
3. lifelong trait of people who are predisposed to depression
4. night of sleep deprivation is quickest known method of relieving depression
  1. benefit is brief, dep returns after next nights sleep
5. practical solution is to alter sleep schedule - going to bed earlier than usual, still wake up early but will have more sleep
  1. REIMANN ET AL 1999
occurs in episodes so giving medication employs expectations enhancing probability of recovery
1. to test effectiveness of antidep need to compare effects to those of a placebo
  1. only for people with severe depression do the drugs work
    1. KRISCH ET AL 2008
2. Alt to antidep is psychotherapy
  1. drugs work better for dysthymia
    1. long term life long condition of happy mood
  2. antidep ineffective for patients suffered abuse or neglect during early childhood or patients with multiple psych disorders
    1. patients respond better to psychotherapy
  3. psychotherapy more likely to have long-term benefits, reducing likelihood of relapse months or years after end of treatment
  4. people improve more from both treatments than just one
  5. brain scans show antidep and psychotherapy increase metabolism in same brain areas
    1. BRODY ET AL 2001
Other Therapies
1. program of regular, non-strenuous exercise e..g. brisk walk for half an hour per day
2. active people less likely than sedentary people to become depressed
  1. most of these studies are correlational in nature not cause-and-effect
3. exercise increases blood flow to the brain and provides other benefits without costs or risks of other treatments
  1. HUNSBERGER ET AL 2007

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How effective are Anti D's

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