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2006 Second Web Paper
Antidepressant medication as a treatment for depression approaches the workings of the brain from a chemical approach. Although neurotransmitters like serotonin regulate interactions between neurons and therefore play an important role in treating depression, it is clear that the workings of the brain are more complex since antidepressant medications do not always improve patients' depression. There is even evidence that medications like Prozac increase the chance of suicide in teens and children who take it (2).
Given the limitations of antidepressant medication, examining the brain from a different perspective is illuminating alternative possibilities for treatment. Instead of focusing on chemical interactions between neurons throughout the brain that are targeted by medications, scientists are seeking information about how neurons are organized into networks. Furthermore, moving beyond antidepressant medication requires increased awareness of the patient of the treatment process he or she is going through.
According to the Hamilton rating scale for depression, symptoms of depression include insomnia, guilt, inability to work or pursue hobbies, and anxiety (3). However, one of the most important symptoms is a feeling of helplessness. Even in the case of major depression, when a person is incapable of carrying on daily life or constantly thinking about death, the person very well may be confused about why he or she is in such a state and still feel completely helpless.
Some people who suffer from depression and are able to recognize that their problem is not only a temporary slump can find relief in a variety of ways. Psychotherapy involves engaging the patient in understanding the roots of the depression, whether they may be a difficult relationship or traumatic event. Talk therapy can help a patient change his or her behavior without physically or chemically altering the brain. Sometimes even regular exercise or even meditation is enough to lead a patient to recovery.
One patient described how meditation helped him overcome depression which plagued him for years (4). Even though it is impossible to know exactly what effect meditation has on the brain, it certainly involves becoming aware of one's mental state. In doing so, perhaps the person may be able to understand the way his or her brain reacts to situations and lessen the effects of depression. It is interesting to see how in some instances a person can use his or her own mind to fight against depression, even if medication or psychotherapy is still needed (5).
However, for some people, depression causes a feeling of utter hopelessness. Even though the patient may be aware that something is not normal, he or she is still stuck in depression and feels like there is no hope but to die. In cases of major depression in which there is a high risk of suicide, psychotherapy and antidepressant medications may not bring improvement.
The last resort treatment has been Electro-Convulsive Therapy (ECT). The treatment is controversial due to possible side effects of memory loss as well as frightening depictions in pop culture. Also, even though it is understood that ECT causes changes in serotonin receptors in the brain (6), little is known about how the procedure works and how long it is effective. Developments are being made however that use an electrical current to locally stimulate parts of the brain without the side effects of ECT.
An experimental procedure which electrically stimulates a specific area of the brain called Deep Brain Stimulation (DBS) has been effective in four of six patients (7). The procedure requires the patient to be conscious during surgery to talk about the effects of the electrical current so that doctors can find the correct are of the brain, called "area 25".One patient described the sensation of having this specific area on her brain stimulated as suddenly feeling connected to the surgeon. When the stimulation was turned off, the feeling went away. The patient understood that there was a difference in her state of mind when the brain was stimulated, but had trouble articulating it. Still, she had a desire to break free from her depressed state of being but she did not know how.
Tests show that another experimental procedure called "transcranial magnetic stimulation" (TMS) can enhance a person's ability to perform certain tasks like drawing, for example. In one experiment, the subject of TMS is told to read a common saying out loud and then again while the brain is stimulated. Under TMS the person noticed that an extra word had been placed into the phrase (8). When stimulated, the brain actually read the words instead of filling in what the person thought it saw.
Although TMS may be an exciting way to improve human skills in art or mathematics, it is also exciting to see how when different parts of the brain are active a person's outlook on the world can change dramatically. Certain parts of the brain must be active in order to react to stressful situations in life just as they must be active make mathematical deductions or translate an image inside one's head to a drawing (9). In some cases, the magnetic current actually temporarily weakens the frontal lobe of the brain in order to produce effects. When the subject realized that the card he was reading was not simply a common phrase, something happened to remove the instinct to simply recite the phrase. It is unclear exactly how either TMS or DBS work, except for the fact that they regulate the interaction of neurons in a complex network. However, there is evidence that the treatment causes at least temporary effects.
The procedures may still be experimental, but the implications of these studies are helpful to our understanding of the brain and therefore depression. If someone can consistently look over a word and then instantly notice it, it is easy to see how stimulation of a certain part of the brain could change the way a person feels about his or her life in a much broader sense. Also, after seeing the extra word, the subject came to a realization about how his brain interpreted the outside world. Perhaps after undergoing this therapy, patients with depression could understand the assumptions his or her brain made that caused life to seem so hopeless and find relief.
Commercials for antidepressant medications like Prozac and Zoloft are common and in many cases provide at least some relief for those suffering from depression. However, it is clear that though these treatments come in a convenient pill form, they are not effective for everyone. Moving beyond thinking about the brain in terms of neurotransmitters and trying to involving the patient more directly in treatment is allowing people to find relief when medication was not an effective option.
1) NIMH: Depression
2)NPR: FDA Study Links Antidepressants, Youth Suicide August 20, 2004
3) Hamilton rating scale for depression
4) NPR: Andrew Weil,NPR program about "integrative medicine" treatments for depression
5) Meditation and Depression
6) ECT and receptor function
7) Mayberg et al.
8) Savant for a Day,New York Times article on TMS
9) PubMed abstract
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