Anti-depressants usually take a few weeks to have an effect and divided into three classes the first being Monoamine oxidase inhibitors (MAOIs) which include phenelzine (Nardil), the second are Tricyclics which include amitriptyline (Elavil) and have generally have fewer side effects than the monoamine oxidase inhibitors and the third class are Selective serotonin reuptake inhibitors (SSRIs) which are the newest class of antidepressants, include paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorders. Monoamine oxidase inhibitors and Tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain whilst Selective serotonin reuptake inhibitors increase the level of serotonin only. Whilst antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness.
Of the three classes of antidepressants, MAOIs generally have the most side effects, many people who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction and if they are discontinued abruptly, withdrawal symptoms occur.
Antipsychotic Drugs:
Antipsychotic drugs are mainly used to treat mental health conditions such as schizophrenia and other psychoses, agitation, severe anxiety, mania and violent or dangerously impulsive behaviour. They include chlorpromazine (Thorazine), thioridazine (Mellaril) and haloperidol (Haldol) and usually begin to take effect a few days after they are administered. Antipsychotic drugs reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions.
However, a new class of antipsychotic drugs, called atypical antipsychotic drugs also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs, however side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity and coordination problems. These side effects often make people stop taking the medications and this frequently results in a relapse of schizophrenia.
A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug as they assume they are now well and therefore do not need to take them.
Lithium:
One drug used in the treatment of bipolar disorders is lithium, it prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate. As with all drugs there are side effects, lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse. Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
Electroconvulsive Therapy (ECT):
ECT is a treatment for a small number of severe mental illnesses. It was originally developed in the 1930s and was used widely during the 1950s and 1960s for a variety of conditions. It is now clear that ECT should only be used in a smaller number of more serious conditions. ECT consists of passing an electrical current through the brain to produce an epileptic fit – hence the name, electro-convulsive. The idea developed from the observation that, in the days before there was any kind of effective medication, some people with depression or schizophrenia, and who also had epilepsy, seemed to feel better after having a fit. Research suggests that the effect is due to the fit rather than the electrical current. Electrodes are placed on the patient’s head over the temporal lobes of the brain.
Anaesthetics and muscle relaxants help minimize discomfort to the patient, while an electric current is delivered for about one second. The patient has a convulsive seizure and becomes unconscious, awakening after about an hour. The typical number of ECT sessions varies from six to twenty, and they are usually done while a patient is hospitalized. The National Institute of Health and Clinical Excellence (NICE) have looked in detail at the use of ECT and have recommended that it should be used only in depression, resistant mania or catatonia. They say ECT should be considered for acute treatment of severe depression that is life threatening and when a rapid response is required, or when other treatments have failed. It should not be used routinely in moderate depression, but should be considered for people with moderate depression if their depression has not responded to multiple drug treatments and psychological treatment.
Psychosurgery:
As a last resort when drugs and ECT have failed psychosurgery is an option, it basically involves either cutting out brain nerve fibres or burning parts of the nerves that are thought to be involved in the disorder while the patient is conscious. The most common form of psychosurgery is a prefrontal lobotomy. Unfortunately these operations have a nasty tendency to leave the patient vegetablised or ‘numb’ with a flat personality, shuffling movements etc. due to their inaccuracy. António Egas Moniz discovered the lobotomy in 1935 after successfully snatching out bits of chimpanzee’s brains.
It didn’t take long for him to get the message that his revolutionary treatment was not so perfect, in 1944 a rather dissatisfied patient called his name in the street and shot him in the spine, paralysing him for life. As a consolation he received the Nobel prize for his contribution to science in 1949.Surgery is used only as a last resort where the patient has failed to respond to other forms of treatment and their disorder is very severe. This is because all surgery is risky and the effects of neurosurgery can be unpredictable and there may be no benefit to the patient and the effects are irreversible.