mood_lec3 - TREATMENTS FOR MOOD DISORDERS I BIOLOGICAL...

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TREATMENTS FOR MOOD DISORDERS I. BIOLOGICAL TREATMENTS FOR MOOD DISORDERS II. PSYCHOTHERAPY FOR MOOD DISORDERS I. BIOLOGICAL TREATMENTS FOR MOOD DISORDERS ECT (Electroconvulsive Therapy) * Overuse in the 1940's-mid 1960's * Today mostly for severe depression not responding to medication * Modern ECT is like a surgical procedure: - anesthesia and muscle relaxants - oxygen to reduce memory loss - heart monitor, EEG monitoring, etc. * Shock levels lower (12-65 volts vs. 150) and briefer (< ½ sec.) * Shocks sometimes applied unilaterally (although this doesn’t always work) * Convulsions last several minutes * At least 6-10 treatments * High relapse rate (60%) * Not understood why/how it works * Side effects: - Common: Severe headaches; memory loss for events surrounding ECT - Less common: Irretrievable loss of long-term memories TRANSCRANIAL MAGNETIC STIMULATION (TMS) * for treatment-resistant depression mostly; (also being researched for OCD patients) * electromagnetic coil is held against patient’s scalp that emits powerful magnetic pulses to alter brain activity VAGUS NERVE STIMULATION (VNS) * for treatment-resistant depression (FDA approved in 2005) * surgical implantation of a pulse generator in left upper chest; wires go from there into the neck and send mild pulses (every 5 minutes) to the neck’s left vagus nerve, and from there to brain areas involved in the regulation of mood, motivation, sleep, appetite, etc. * adverse effects: voice alteration or hoarseness LIGHT THERAPY * for SAD (Seasonal Affective Disorder) * light boxes, requiring at least 10,000 lux
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MEDICATIONS FOR MOOD DISORDERS 1. ANTIDEPRESSANTS 1.1 Tricyclics * Available since mid 1950's * E.g., Tofranil (Imipramine), Amitryptiline (Elavil) * They are mostly norepinephrine reuptake inhibitors * Side effects of Tricyclics - weight gain - sedation - constipation - dry mouth 1.2 SSRI’s ( S erotonin S elective R euptake I nhibitors ) * Available since 1989 in U.S., first one was Prozac * E.g.: Prozac, Zoloft, Paxil, Celexa, Lexapro * Work by blocking serotonin reuptake * Advantages of SSRI’s over Tricyclics: - generally fewer side effects, hence better compliance - less dangerous in overdose - less interaction with alcohol - faster action than tricyclics (2-3 weeks vs. 5-6 weeks) - more effective for OCD features - more effective for sensitivity to rejection *
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