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Biology 202, Spring 2005
Third Web Papers
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Pulling Teeth to Survive: A Discussion on Various Treatments for Depression


Samantha Thomson


A dark cloud hovers over, the walls close in and the room goes black to uncover the hidden depths of depression. It affects approximately 18.8 million Americans over the age of eighteen, yet those who suffer from depression never feel as if they are one of millions. Until the brain was better understood, discovering treatments for depression proved to be a challenge for psychiatrists, doctors and scientists alike. Reports of tooth removal, colon removal and even shaking therapies circulated through research circles as possible treatments for depressive disorders. Until the spike in pharmacological treatments, patients suffering from depression were provided few options to remedy their crippling disorders. Even today, in a world where an assortment of treatments is available to people suffering from depression, this disorder still haunts an overwhelming portion of the population. Kay Redfield Jamison expresses in her book on living with bi-polar syndrome, An Unquiet Mind, "Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But normal or manic I have run faster, thought faster, and loved faster than most I know." (1) With mentors like she for the millions suffering from the various types of depression, hope for an improved lifestyle for those affected seems attainable.

The most popular present-day medium of treatment for depression is through chemical intervention. The brain is made up of many neurotransmitters that serve as chemical messengers relaying signals between cells of the nervous system. Specific neurotransmitters, such as norepinephrine, dopamine and serotonin are closely related to depression; individuals that suffer from depression tend to experience high levels of one or all of these chemicals. Various drugs have been synthesized to target receptors and neurotransmitters in the brain in hopes of returning affect individuals to a less heightened state of depression (2).

The first type of drugs to go on the market, such as tricyclics or monoamine oxidase inhibitors, affected areas all over the brain. Individuals exposed to these particular types of drugs experienced many side effects and often treatments lasted for only small periods of time before individuals regressed back to highly depressed states; scientists learned that even though these particular drugs were in fact influencing the level of norepinephrine, dopamine and serotonin, they also were interfering with other receptor sites and neurotransmitters all over the brain not specifically involved with emotion (2).

Continued research led scientists to discover the integration of serotonin receptor sites in an overwhelming amount of areas in the brain that control emotion. As serotonin is passed from one nerve cell to the other some of the chemical attaches to the adjacent cell, while the rest is reabsorbed back into the pre-synaptic cell; this process of reabsorption is referred to as "reuptake" (3). A balance usually exists between the amount of reuptake and the amount of attachment to adjacent cells; however, individuals experiencing depression tend to have a higher amount of reuptake, thereby disrupting the chemical balance within their brains. Capitalizing on this feature of serotonin receptor sites, scientists created a type of drug called a "Selective Serotonin Reuptake Inhibitor" (SSRI), where by blocking the reuptake of serotonin into the pre-synaptic cell a chemical balance can be restored. Popular drugs such as Prozac and Zoloft are examples of SSRIs. These, along with many other SSRIs, have rapidly grown in popularity due to the highly selective nature of the drugs; since they only target specific areas of the brain, the patient experiences less undesirable side effects. Though chemical treatments are becoming more highly selective, still 30% of individuals seeking pharmacological treatment are unfortunately resistant to trial medications (4).

Other treatments for depression have been used both in the absence of and in conjunction with pharmacological remedies. One such method is referred to as "Electroconvulsive Therapy" (ECT). With this treatment patients are given an electrical shock, which targets a specific area of the brain triggering a minor seizure to occur within that portion of the brain (5). The seizure causes the brain to release chemicals within the brain, eventually targeting areas involved with controlling emotion. ECT treatments usually last about a month or less, as patients receive a total of six to twelve treatments at a frequency of approximately three times per week (6).

This type of treatment tends to be much more obtrusive than other alternative methods, however some individuals provide remarkable testimonies about its liberating effects. It is hypothesized that since ECT in conjunction with some psychotropic drugs has been discovered to stimulate neurogenesis, the physical change in the structure of the brain, with the creation of new cells, brings about some of the therapeutic effects. The neurogenesis involved specifically stimulates growth of the glial cells of the nervous system. Stephan Heckers and Dost Ongur state that, "since glial cells are essential for proper neuronal function, treatments that alter glial function would have significant effects on the brain." (7) Concerns remain, however, concerning the possible side effects of ECT. Since one is exposed to signals which trigger epileptic activity during treatment, there have been cases where seizures persist after exposure has subsided.

A similar type of treatment to ECT is "Transcranial Magnetic Stimulation" (TMS), where an electrical current is passed by way of a handheld port, through the scalp of the patient, then finally to the brain; the current stimulates nerve cells in the brain, however, with a much higher level of precision and lower level of force than that of the ECT (4). With his experiment involving 12 people receiving repetitive TMS (rTMS) psychiatrist Martin Szuba of the University of Pennsylvania determined that treatments lasted for about one month before the patient regressed back to a heightened level of depression (8).

Extensive research continues on this experimental method of therapy due to its low risk of side effects coupled with high precision. As compared to ECT "consider instead how easily a magnet under a wooden tabletop can move a pin on the surface-magnetic fields move almost unaffected through insulators, including the skull." (9)

Preliminary experiments have been performed concerning the effectiveness of rTMS on people with moderate to severe depression; A. Hausmann and his colleagues performed a test where 41 patients were split into 4 groups, each of which received rTMS at different locations of the brain: the right dorsolateral prefrontal cortex, the left dorsolateral cortex and both. The scientists coupled the rTMS treatments with antidepressant medicine to determine if the patient experienced an accelerated rate of treatment with rTMS. They determined after processing the results of the experiment that "rTMS as an 'add on' does not exert an additional antidepressant effect." (10) At the Medical University of South Carolina, researchers are currently researching the effectiveness of rTMS as clinical therapy on patients experiencing depression. Furthermore they work to understand the cellular physiological consequences with animal studies, and utilize in vitro approaches to more clearly understand the interactions between rTMS and cortical activity (11).

Vagal Nerve Stimulation (VNS) is yet another treatment practiced for depression. With this type of therapy, a pacemaker is inserted into the vagal nerve located in the neck. Originally this procedure was performed with the intention that the pulses of the pacemaker would stop seizures, however, once inserted patients reported feelings of bliss as the pulses resonated through the nerve. Upon more research scientists determined that the pulses did indeed alter levels of serotonin and norepinephrine in the patient, thereby lowing the severity of depression experienced by that individual (4).

Studies have also been performed to test the effect of VNS on sleeping patterns. The test was performed 10-12 weeks after implantation and results showed that the overall sleep architecture was improved after implantation of the pacemaker. Overall patients demonstrated a decreased awake time, decreased duration of Stage 1 sleep and an increase in duration of Stage 2 sleep (12). Patients who experienced an increased quality of sleep also displayed lower levels of depression.

The FDA has recently approved VNS as an appropriate treatment for individuals eighteen years and older with major depressive episodes who have not responded well to at least four other antidepressant treatments (13).

Other highly affective methods for all types of depression are attained through alternative treatments. Such methods integrate mind, body and spirit to improve mood and release tension within oneself. From self-help groups, to yoga and other types of meditation, affected individuals find comfort within themselves while lending support and first-hand experience to others. Diet is another medium that people chose to help guide them toward recovery; it is even thought that milk and wheat can trigger depression in Autistic and Schizophrenic individuals. Animal assisted programs help affected individuals build trust with spirits other than themselves as they work to improve socialization skills in a seemingly dark world. Creative Arts, such as art, dance/sports and music tend to heighten self-awareness while one gains comfort with his or her body (4).

As we go through the day to day and commit ourselves to becoming a particular person, it is important to keep this disorder in mind. It grabs hold of you and seems only to let go long enough to ask for help before the walls close in again. During those moments of light, where the world seems clear again it is our responsibility as onlookers, suffers and survivors of depression to begin the search for an appropriate treatment. The days of pulling teeth are over.

References

1)Serendip Home Page, a resource from Bryn Mawr College

2)Web MD

3)Medicine Net, a pharmacological source.

4)healthyplace.com

5)familydoctor.org

6)American Psychiatric Association

7) Ongur, Dost; Heckers, Stephan. "A Role for Glia in the Action of Electroconvulsive
Therapy". Harvard Review of Psychiatry. Sept-Oct 2004. v12 i5 p253(10).

8) Williams, Stephen. "Can Magnets Ease Severe Depression?". Newsweek. Sept 21, 1998.
v132 n12 p107(1).

9)Medical University of South Carolina, research site.

10) Hausmann, A. et al. "No Benefit Derived From Repetitive Transcranial Magnetic
Stimulation in Depression: A Prospective, Single Centre, Randomized, Double Blind,
Sham Controlled "Add On" Trial". Journal of Neurology, Neurosurgery and Psychiatry.
Feb 2004. v75 i2 p320(3).

11)Medical University of South Carolina, research site 2.

12) Armitage, R. et al. "The Effects of Vagus Nerve Stimulation on Sleep EEG in Depression
A Preliminary Report". Journal of Psychosomatic Research. May 2003. v54 i5 p475(8).

13) "VNS is Approvable for Depression Use". The BBI Newsletter. March 2005. v28 i3 p35(1).


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