Biological Treatment for Depression - SSRIs

Question 1

What are SSRIs?

Answer 1

Form of antidepressants

Question 2

What are antidepressants?

Answer 2

A form of drug treatment

For moderate to severe depression

Question 3

How long do antidepressants need to be taken to get the full benefit for depression?

Answer 3

Need to be taken for six months to get the full benefit

Question 4

How long is it typical to be taking antidepressants?

Answer 4

Typical to be taking antidepressants for up to 24 months

Question 5

What is the most common SSRIs?

Answer 5

Fluoxetine (Prozac)

Question 6

What is SSRIs mode of action?

Answer 6

To raise serotonin levels by preventing reuptake

Question 7

How does serotonin work?

Answer 7

Sends signals between neurons in the brain and regulates mood, memory and sleep, and appetite

Question 8

How do SSRIs work?

Answer 8

Work by increasing levels of serotonin in the brain so that more messages can be sent

Question 9

How are SSRIs taken?

Answer 9

Taken in tablet form

Patient starts on the lowest dose possible required to improve their symptoms

Question 10

How do SSRIs raise serotonin levels?

Answer 10

SSRIs block reuptake of serotonin - serotonin won’t be reabsorbed by the presynaptic gap

If serotonin molecules aren’t reabsorbed, they stay in the synapse and can keep stimulating the receptors to send more messages

Question 11

What happens to other monoamines when serotonin levels are raised?

Answer 11

If serotonin levels are raised, the other monoamines (dopamine and norepinephrine) will also be higher

Question 12

What are antidepressants often prescribed in conjunction with?

Answer 12

Often prescribed in conjunction with psychological therapies

e.g. CBT (an eclectic approach to therapy)

Question 13

What is the supporting evidence/strengths of SSRIs as a biological treatment for depression?

Answer 13

Karp and Frank (1995)

Pinquart (2006)

Delgado (2000)

Drevets et al (1999)

Psychology in society

Question 14

What is the refuting evidence/weaknesses of SSRIs as a biological treatment for depression?

Answer 14

Smith (2012)

Hollon et al (2005)

Kirsch et al (2008)

Effectiveness

Side effects

Question 15

Why is Karp and Frank (1995) supporting evidence of SSRIs as a biological treatment for depression?

Answer 15

Karp and Frank found that drug therapy alone is just as effective for treating depression as combined therapy.

This is a strength because it provides evidence for the effectiveness of anti-depressants when used on their own as a treatment for depression.

However, it is worth noting that they are only effective with serious depression.

Question 16

Why is Pinquart (2006) supporting evidence of SSRIs as a biological treatment for depression?

Answer 16

Pinquart reviewed studies of anti-depressants and psychological therapies used to treat depression, found that whilst psychological therapies were more effective, drugs were cheaper and can be provided immediately whereas there is a waiting list for psychological therapies.

This is a strength because it means that patients with depression will start to benefit immediately from the anti-depressants therefore supporting the use of drugs to treat depression.

However, critics would argue that this decision is driven more by financial gains rather than what is best for the patient.

Question 17

Why is Delgado (2000) supporting evidence of SSRIs as a biological treatment for depression?

Answer 17

Delgado claims that the use of drugs such as SSRIs (which specifically work to increase serotonin levels) are effective, resulting in a reduction of symptoms.

This is a strength because it supports the effectiveness of SSRIs as demonstrated by a reduction in symptoms of depression.

Question 18

Why is Drevets et al (1999) supporting evidence of SSRIs as a biological treatment for depression?

Answer 18

Drevets et al found that serotonin levels were reduced in the raphe nuclei of unmedicated patients with depression compared to controls using PET scans.

This is a strength because it supports the idea that patients who have not taken their medication have reduced serotonin levels leading to depression demonstrating that SSRIs are effective when taken because they artificially raise serotonin levels.

Question 19

Why is psychology in society a strength of SSRIs as a biological treatment for depression?

Answer 19

Antidepressants may be seen as both a cheaper and more ethical way of treating patients with depression who may previously have been institutionalised or treated with electro-convulsive therapy.

This is a strength because it supports the usefulness of antidepressants as a treatment for depression, allowing the patient to remain living in the community whilst accessing other therapies such as CBT.

Question 20

Why is Smith (2012) refuting evidence of SSRIs as a biological treatment for depression?

Answer 20

Smith refers to ‘inappropriate prescribing’ of drugs such as SSRIs whereby using drug treatments seems to be the first choice but may not be the best choice. Drugs can be inexpensive for society and can control behaviours which society does not want.

This is a weakness because the patient may feel obligated to take the anti-depressants and this is viewed by some critics as a form of social control.

Furthermore, the patient may be sectioned, and sanctions enforced to make them accept the treatment, meaning they lose personal responsibility and free will.

Question 21

Why is Hollon et al (2005) refuting evidence of SSRIs as a biological treatment for depression?

Answer 21

Hollon et al. (2005) compared relapse rates for CBT and antidepressants and found that only 31% of CBT patients suffered a relapse compared to 76% of those treated with drugs.

This is a weakness because it shows that drug therapy is only palliative whereas cognitive therapy offers a better cure for depression.

Question 22

Why is Kirsch et al (2008) refuting evidence of SSRIs as a biological treatment for depression?

Answer 22

Kirsch et al reviewed 47 trials of patients with mild or severe depression who were prescribed SSRIs or a placebo and found that SSRIs weren’t any better than placebos when it came to mild depression.

This is a weakness because it shows that some of the effectiveness of these drugs is imagined (placebo effect)

Question 23

Why is effectiveness as weakness of SSRIs as a biological treatment for depression?

Answer 23

SSRIs do not actually cure depression they merely ease the symptoms (palliative).
Therefore, when a patient does stop taking the medication there is a strong possibility that they will relapse into depression.

This is weakness because it highlights the problems with using anti-depressants as a treatment on their own and suggests that some form of psychological therapy would also be necessary to try and tackle the root cause of the depression. (Eclectic approach)

Question 24

Why is side effects a weakness of SSRIs as a biological treatment for depression?

Answer 24

Side effects can be caused by the drugs, for example SSRIs can cause nausea, insomnia, anxiety, dizziness, weight gain, nervousness and even depression.
SSRIs can also lead to withdrawal symptoms such as insomnia, aches and pains.

This is a weakness because it highlights the problems with prolonged use of anti-depressants (withdrawal effects) and is likely to mean that patients are less likely to comply with their medication regime which may lead to a worsening of their depression.