MODEL of chemotherapy and ECT (15 marks)

Chemotherapy is a form of biological therapy used to treat mental disorders. These

include anti-depressants, anti-anxiety drugs, anti-psychotic drugs, and stimulants.

Anti-depressants can help treat patients with depression (major and bipolar).
Monoamine Oxidase inhibitors (MAOI) such as Iproniazid produce euphoria and
increase serotonin levels.
Tricyclic drugs such as Tofranil also inhibit monoamine oxidase, but have fewer
side effects than MAOI drugs.
Selective re-uptake inhibitors (SSRI) increases serotonin levels and prevents its
uptake. Examples include Prozac and St John’s wort (herbal). Lithium carbonate is
especially useful for treating bipolar disorder.

Anti-anxiety drugs are tranquilisers that aim to reduce anxiety and depress the CNS
(central nervous system). They have sedative and calming effects. Examples include
benzodiazepines (BZ) such as Valium, were offered in the 1960s.
Barbiturates were offered in pre-1960 but were addictive and had many side
effects.
Buspirone is a newer drug that is as effective as BZs and has little side effects and
no addictive qualities. However, it can reduce vigilance, induce headaches and
dizziness.

Anti-psychotic drugs are neuroleptic drugs that can treat schizophrenia and other
psychotic disorders. The drugs sedate the person and reduce positive symptoms such
as delusions and hallucinations but have no effect on negative symptoms such as
withdrawal.
An example of an anti-psychotic drug is clozapine. Stimulant drugs such as
amphetamine increases alertness and elevates mood.

ECT (Electro-compulsive shock therapy) is a more severe treatment used to treat a

mental disorder and usually used as one of the last resorts.

- Benton stated that ECT could be used to extinguish negative and undesirable
behaviours as a form of aversion therapy (behavioural model).
- The memory loss induced can help restructure the patient’s view on life and
change their thinking (cognitive perspective) and lastly ECT can reduce the
metabolic activity and blood circulation to the brain and inhibits some brain
activity.
- Biochemical changes occur in the brain and it can stimulate the production of
neurotransmitters such as endorphins.
- The psychologists Cerletti & Bini decided that they would use electric shocks to
induce seizures. Strong electric currents would pass for 0.5 seconds between two
electrodes attached to each side of the forehead. The current of electricity was
between 70 – 130 volts and induced loss of consciousness and a convulsive
seizure.
- This was know as bilateral ECT as the current would pass through both
hemispheres of the brain, but nowadays unilateral ECT is used whereby the
electric current is passed to the non dominant hemisphere of the brain.
- To make the procedure more human compared to past methods, an anaesthetic
and muscle relaxants are give prior to treatment, patients are strapped to the
bed to ensure they do not break their bones during their spasms and a mouth gag
is placed on them to stop them from biting their tongue and lips.
- The convulsions themselves last for about 2 minutes and consist of usually 6 – 9
treatments (sessions) that might be given over a one month period.
- Many patients do not remember the treatment whey they wake up and they might
be confused for 40 minutes afterwards.

EVALUATION of chemotherapy and ECT (15 marks)

There have been many criticisms about the use of chemotherapy (drugs),
because it has been questioned whether the effectiveness of them outweighs the
negative side effects that they have on patients. There is also doubt as to the
appropriateness of when and why drugs are administered: are drugs given simply to
alleviate the symptoms or rather to sedate patients so that they are more compliant
and obedient.

PRIEN has shown that many anti-depressants are 70% effective in reducing
symptoms of severe depression, compared to only a 33% success rate of placebos.

ROSENHAN has also proved that these drugs are 80% effective with patients
suffering from manic depression; 15% of these patients committed suicide prior to the
drugs treatment, as they couldn’t function properly in daily life due to their extreme
mood swings. This means that these drugs were appropriate because they helped to
save many lives despite all the negative side effects.

However, JOHNSON stated that many patients do prefer to remain in a euphoric state
of manic depression, rather than take certain drugs – e.g. Lithium Carbonate – that
have toxic side effects, which can lead to gastrointestinal problems and even death.
Therefore, they may not be so appropriate after all, because severely depressed
patients would want to commit suicide, and if the drugs could cause death then in
reality how effective can they really be?

GERLENTER found that anti-anxiety drugs – e.g. BZ – are effective in reducing

symptoms of anxiety and panic, which are more effective than placebos for treating
social phobias.

However, FYER stated that there is a 90% relapse rate when BZ is stopped, because
they don’t treat the cause of the anxiety but simply the symptoms. Therefore, they are
not an appropriate form of anti-anxiety drugs; Buspirone is a newer drug with fewer
side effects and just as, if not more, effective as BZ, because they don’t have any
addictive qualities, but they can cause depression once the anxiety is treated.
Therefore, other types of anti-anxiety drugs are more appropriate in treating anxiety,
but can cause other problems so they are ineffective in this sense.

The use of ECT has also been greatly criticised about its appropriateness on patients,
because FINK stated that it doesn’t have a very high success rate so it is rarely used
nowadays.
However, it is 60% effective in treating severely depressed patients because it is better
than offering no treatment at all for patients who would commit suicide otherwise,
especially when drugs have failed to work in the past.

ECT is also appropriate when treating manic depression (80% effectiveness). On the
other hand, after the ECT treatment patients are confused for up to 40 minutes and
they tend to have no recollection of what has just happened, which is seen as
unethical because the patients are not protected from psychological/physical harm.
Therefore, it is inappropriate to use on patients who don’t have extreme forms of
mental disorders.

Epileptic fits are induced during ECT, which is unethical and viewed negatively by
the media. Therefore, is this form of treatment appropriate in treating mental disorders
if there is an unethical risk to the patients?

Many patients have expectations of the effectiveness of ECT, which may cause them
to work rather than the actual treatment itself. Therefore, the success rate of ECT can
be questioned in terms of the placebo effect.

BARLOW stated that there are imitations of ECT that are not as effective as real
ECT. Therefore, this is a breach of ethical guidelines because patients are denied
treatment. Even so, it does relate to Benton’s explanation of aversion therapy when
considering how ECT works.

JOHNSTONE provided evidence that states there are 9 deaths every 100 000
procedures, which he believes is relatively low. However, a dying treatment shouldn’t
be expected because for those select few patients where it is ineffective there is no
way to reverse the damage that has been caused, and so it is inappropriate to deem
ECT as a safe biological therapy of treating mental disorders; there are other less
severe forms (e.g. chemotherapy).

Even so, ECT is the only option left for desperate patients, because other forms of
therapy have failed and they are left with two choices in life: ECT or being driven
insane to commit suicide.

Overall there is clear evidence that ECT is appropriate, but it should only be used as a
last resort when other treatments have failed. For example, Trasncranial Magnetic
Stimulation (TMS) is an alternative to ECT, which is a painless method and can
target precise areas of the brain. It also has fewer side effects than ECT, and KLEIN
found it was 50% effective with depressed patients