Syftet med föreliggande uppsatsarbete är att beskriva erfarenheter av psykofarmaka och psykoterapi. Studien är kvalitativ till sin karaktär och utgår från intervjuer med fyra psykoterapeuter och en läkare. Uppsatsen tar utgångspunkt i ett fenomenologiskt perspektiv. Intervjuerna har analyserats så förutsättningslöst som möjligt utifrån EPP-metoden. Arbetet har haft sin grund utifrån fem övergripande frågeställningar; Hur uppfattar vi lidandets mening i relation till psykofarmaka? Påverkas en individs möjlighet att känna och tänka om denne regelbundet brukar psykofarmaka? Kan den som lider förvänta sig vägledning i de olika enskilda, respektive kombinationsbehandlingar som finns? Minskar det egna lidandet genom att sätta ord på sin ångest i psykoterapi? Hur resonerar läkemedelsindustrin i frågan kring individens psykiska lidande? Dessa frågeställningar har vilat mot en filosofisk fond som ställer frågan: Är medikaliseringen ett sätt att medicinera mot livet självt, att göra samhällets tillkorta-kommanden till ett individuellt problem? Resultaten presenteras i fem synopsis som visar på att; lidande kan ses som kraft till förändring. Antidepressiva läkemedel har en tendens att döva tankar och känslor. Patientens egen vilja är viktig. Mediciner tenderar att bli till substitut för mötet med människor och att relationen till läkemedelföretagen är problematiskt för behandlare då den också är en vinstmaskin. / The purpose of the study is to describe experiences gained from the use of psychotropic drugs and/or psychotherapy. The study is qualitative in nature and based on interviews with four psychotherapists and physicians. The study takes as its basis a phenomenological perspective. The interviews were analyzed as unprejudiced as possible using the EPP method. The work was based on five overreaching issues; How do we perceive suffering, meaning in relation to psychotropic drugs? Is an individual's ability to feel and think affected by regular use of psychotropic drugs? Can an individual who suffers expect guidance via individual treatment or via available combined treatments? Is an individuals suffering reduced by setting words to the anxiety in psychotherapy? How does the pharmaceutical industry discuss the issue of individual mental suffering? These issues have been tested against a philosophical background that asks the question: Is medicalisation a way of medicating against life itself, a way of making society's shortcomings the individual`s problem? The results are presented in five synopsis which say that suffering can be seen as force for change. Antidepressants have a tendency to numb thoughts and feelings. The patient's own will is important. Medication tends to be a substitute for meeting people and the relationship to pharmaceutical companies problematic for therapists as the industry is also a profit machine.

Certain electrophysiological markers hold promise in distinguishing individuals with major depressive disorder (MDD) and in predicting antidepressant response, thereby assisting with assessment and optimizing treatment, respectively. This thesis examined resting brain activity via electroencephalographic (EEG) recordings, as well as EEG-derived event-related potentials (ERPs) to auditory stimuli and facial expression presentations in individuals with MDD and controls. Additionally, the utility of resting EEG as well as auditory ERPs (AEPs), and the associated loudness-dependence of AEPs (LDAEP) slope, were assessed in predicating outcome to chronic treatment with one of three antidepressant regimens [escitalopram (ESC); bupropion (BUP); ESC+BUP]. Relative to controls, depressed adults had lower pretreatment cortical activity in regions implicated in approach motives/positive processing. Increased anterior cingulate cortex (ACC)-localized theta was observed, possibly reflecting emotion/cognitive regulation disturbances in the disorder. AEPs and LDAEPs, putative indices of serotonin activity (implicated in MDD etiology), were largely unaltered in MDD. Assessment of ERPs to facial expression processing indicated slightly blunted late preconscious perceptual processing of expressions, and prolonged processing of intensely sad faces in MDD. Faces were rated as sadder overall in MDD, indicating a negative processing bias. Treatment responders (vs. non-responders) exhibited baseline cortical hypoactivity; after a week of treatment, cortical arousal emerged in responders. Increased baseline left fronto-cortical activity and early shifts towards this profile were noted in responders (vs. non-responders). Responders exhibited a steep, and non-responders shallow, baseline N1 LDAEP derived from primary auditory cortex activity. P2 LDAEP slopes (primary auditory cortex-derived) increased after a week of treatment in responders and decreased in non-responders. Consistent with overall findings, ESC responders displayed baseline cortical hypoactivity and steep LDAEP-sLORETA slopes (vs. non-responders). BUP responders also exhibited steep baseline slopes and high ACC theta. These results indicate that specific resting brain activity profiles appear to distinguish depressed from non-depressed individuals. Subtle ERP modulations to simple auditory and emotive processing also existed in MDD. Resting alpha power, ACC theta activity and LDAEP slopes predicted antidepressant response in general, but were limited in predicting outcome to a particular treatment, which may be associated with limited sample sizes.

Depression is a disabling mental disorder that has huge impacts on one’s life and is therefore considered a global health concern. Efforts to find the most effective treatments have led to the development of antidepressants and cognitive therapy treatments. However, exercise as a form of treatment for depression has been growing in popularity. Recently, Dance Movement Therapy has gained exposure as a possible form of exercise treatment. Therefore, in the current study, West African dance was studied in order to determine its effects on depression. It was hypothesized that West African dance would target and alleviate symptoms of depression as outlined on the Beck Depression Inventory. Participants were already enrolled in the dance class and the Beck Depression Inventory was administered to the participants. Results indicated that West African dance had a significant positive impact on depression by lowering overall depression scores and psychological depression scores. This study contributes to current literature by offering a unique form of dance with rhythmic drum beats that has not been studied before. Future research should be aimed at further establishing the efficacy of West African dance and the long-term effects it has on depression.

<p>Activation of monoaminergic receptors is essential to the mechanism by which psychostimulants and antidepressants induce changes in behavior. Although these drugs rapidly increase monoaminergic transmission, they need to be administered for several weeks or months in order to produce long-lasting alterations in behavior. This observation suggests that it is likely that molecular mechanisms downstream of receptor activation contribute to the effects of psychostimulants and antidepressants on behavior. </p><p>Recently, we and others have demonstrated that the methyl-CpG-binding protein 2 (MeCP2) contributes to both neural and behavioral adaptations induced by repeated psychostimulant exposure (Deng et al, 2010, Im et al, 2010). Psychostimulants induce rapid and robust phosphorylation of MeCP2 at Ser421 (pMeCP2), a site that is thought to modulate MeCP2-dependent chromatin regulation (Cohen et al, 2011), and this phosphorylation event is selectively induced in the GABAergic interneurons of the nucleus accumbens (NAc). In order to understand the signaling pathways that contribute to the pattern of pMeCP2 we observe, I characterized the monoaminergic signaling pathways that regulate pMeCP2. I found that activation of dopamine (DA) and serotonin (5-HT) transmission is sufficient to induce pMeCP2. The novel finding that drugs that activate serotonergic signaling induce pMeCP2 suggests that pMeCP2 may be involved in serotonergic mediated behaviors.</p><p>To determine the requirement of pMeCP2 in serotonergic mediated behaviors, I utilized mice that bear a knockin (KI) mutation that converts serine to alanine at 421 (S421A) (Cohen et al, 2011). After characterizing the behavioral phenotype of these mice, I conducted tests to assess anxiety- and depression-like behavior. I found that the KI mice do not display heightened anxiety in several assays. However, the KI mice exhibit depression-like behavior in the forced swim and tail suspension but show no differences compared to wild-type (WT) littermates in the sucrose preference test, suggesting that pMeCP2 may be implicated in the behavioral response to stressful stimuli. </p><p>Because we are interested in examining the role of pMeCP2 in the behavioral adaptations to chronic monoaminergic signaling, I then put the KI mice and their WT littermates through chronic social defeat stress, a behavioral paradigm in which repeated exposure to aggressive mice causes social avoidance that is reversed by chronic but not acute antidepressant treatment. Although the WT mice show an increase in social interaction following chronic imipramine treatment, the KI mice fail to show a behavioral response to chronic treatment. These data suggest that pMeCP2 may be implicated in the antidepressant action of chronic imipramine. Finally, investigation of the brain regions in which pMeCP2 may be contributing to the behavioral response to chronic imipramine treatment revealed that chronic but not acute imipramine treatment induces pMeCP2 in the lateral habenula (LHb), a brain region involved in the behavioral response to stress and reward. Together, these data implicate a novel role for pMeCP2 in depression-like behavior and the behavioral response to chronic antidepressant treatment.</p> / Dissertation

Title from title page of PDF (University of Missouri--St. Louis, viewed Mar. 3, 2010). Includes bibliographical references (p. 113-127).

Thesis (M.S.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains vi, 147 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 128-139).

Depression is a nebulous term that is used in a variety of ways to account for a range of experiences usually characterized by low mood, lethargy, diminished pleasure from activities, among others. One prevalent way of making sense of depression in North America is through a biomedical discourse that constructs depression as resulting from an imbalance of neurotransmitters in the brain. Such an explanatory discourse supports antidepressants as the treatment of choice for depression, despite controversy associated with this discourse and disputes about the effectiveness and appropriateness of antidepressants for the treatment of most presentations of depression. In spite of challenges Western physicians face in diagnosing and treating depression, its management overwhelmingly occurs in primary care. Models of primary care treatment decision-making range from those that frame physicians as the principal decision maker (paternalism) to those that feature patients as more autonomous deciders (patient-directed approaches). Existing in the centre of the treatment continuum is a range of joint approaches that feature a more equal relationship between physician and patient. Over the last several decades, paternalism as the traditional approach to treatment decision-making has given way to joint approaches that are heralded as the best ways to manage complex disorders that involve multiple treatment approaches with variable risks and benefits, as depression is often framed. Requests for antidepressants can be considered either patient-directed or joint approach actions, depending on how they are presented. Research on this topic typically focuses on statistical analyses of whether or not patient requests for antidepressants are granted, and whether they help or hinder treatment. Little research has focused on qualitative explorations of how patients and physicians construct accounts about requests themselves. For Study 1, Dr. McMullen and I interviewed 11 family physicians and asked them whether they experienced, and how they managed, patient requests for antidepressants. I used a discursive analytic approach in analyzing the data from the interviews and argue that (a) physicians framed patients as autonomous treatment decision-makers while defining limits on these decisions, and (b) they framed denials of what they characterized as inappropriate requests for antidepressants through patient-centered (and persuasive) approaches to refusal. For Study 2, I interviewed 11 patients about their experiences requesting antidepressants from their physicians. Using a discursive analytic approach, I argue that (a) patients provided accounts of employing what can be considered a soft sell approach in requesting antidepressants, while framing their physician’s contribution to decision-making as necessary and important, and that (b) unexpected outcomes which followed requests for antidepressants (i.e., not having their request endorsed by their physician or having their request fulfilled too readily by their physician) can be understood as discrepancies between the patients’ preferred level of involvement in the process of decision-making and what they encountered. The results of Studies 1 and 2 suggest that these interviewees enacted a physician+ joint approach to treatment decision-making by constructing accounts of requests for antidepressants in ways that largely favour the physician as the lead role within a broadly joint approach to decision-making. Despite attempts to avoid conceptualizations of being overly directive or uninvolved in the process of decision-making, physician and patient interviewees framed conflict as inevitable and offer hints as to how conflict might be avoided or mitigated. To the extent that both patients and physicians are attempting to get their respective needs met from one another within the primary care consultation, I frame their accounts as evidence of a mutual or reciprocal persuasion that is characteristic of more equal relationships. Finally, I bring together some of the controversies associated with treating depression with antidepressants in a primary care setting and raise broader questions about the role of the general practitioner in the management of depression.

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.

Depression is commonly associated with abnormal sleep architecture. This thesis undertook to assess sleep architecture as a biological correlate of self and observer-rated depressive state, and consists of three studies. The first used a categorical approach to examine the association of sleep architecture with subjective mood in a community sample of 74 preoperative patients, and found no association between high depression scores and hypothesized sleep markers. The second followed 16 patients with Major Depression who were treated with the antidepressant mirtazapine in an 8 week longitudinal study during which they underwent polysomnography on 6 occasions. It was found that classes of sleep markers (REM latency or REM, arousal index, and slow wave sleep) tend to predict response when analyzed concurrently. The third study was methodological in nature, and found that commercially available software for automating eye movement counts did not show strong correspondence with visually scored polysomnographic data.

Darbo tikslas: Nustatyti kompensuojamųjų antidepresantų skyrimo pokyčius bei ypatumus ir savižudybių kitimo dinamiką Lietuvoje 2003 – 2005 metais bei įvertinti bendras antidepresantų suvartojimo ir savižudybių tendencijas. Metodas: Kompensuojamųjų antidepresantų suvartojimo 2003 – 2005 metais duomenys buvo gauti iš Valstybinės ligonių kasos. Vaistai suklasifikuoti pagal ATC sistemą, o jų suvartojimo standartizavimui ir kiekybiniam įvertinimui taikyta DDD metodika ir suvartojimas išreikštas DDD vienetais 1000 gyventojų. Savižudybių statistiniai duomenys gauti iš Statistikos departamento prie Lietuvos Respublikos Vyriausybės, suskaičiuotos kiekinės savižudybių išraiškos išreikštos savižudybėmis/1000 gyventojų. Rezultatai: Kompensuojamųjų antidepresantų suvartojimas Lietuvoje 2003 – 2005 metais padidėjo 35,42 %. Labiausiai šį augimą lėmė kitų antidepresantų suvartojimo augimas (išaugo 284,75 %) ir SSRI suvartojimo augimas (išaugo 20,66 %). TCA suvartojimas sumažėjo 4,6 %, o amitriptilino suvartojimo procentinė dalis nuo kitų antidepresantų suvartojimo sumažėjo nuo 14,44 % iki 11,8 %. Savižudybių skaičius, tenkantis tūkstančiui gyventojų, Lietuvoje 2003 – 2005 metais sumažėjo 13,51 %. Sumažėjo tiek vyrų, tiek moterų savižudybių dažnis. Tose pačiose vyrų ir moterų amžiaus grupėse, moterų kompensuojamųjų antidepresantų suvartojimas yra 3,5 ir daugiau karto didesnis, negu vyrų, o vyrų savižudybių dažnis yra 5 ir daugiau kartų didesnis, negu moterų. Išvados: Didėjantis... [toliau žr. visą tekstą] / Objective: To evaluate trends in the use of compensatory antidepressants and suicide rates in Lithuania in 2003 – 2005 period and to evaluate tendencies between consumption of compensatory antidepressants and suicide rates. Methods: Data about consumption of compensatory antidepressants in 2003 – 2005 years was obtained from the State patient fund under the Ministry of Health. All drugs were classified according to ATC system and DDD methodology was used for standardization of their consumption and quantitative evaluation. The results were expressed as DDDs/1000 inhabitants. Statistical data about suicide rates was obtained from Department of Statistics to the Government of the Republic of Lithuania, and quantity of suicides was expressed as suicides/1000 inhabitants. Results: The consumption of compensatory antidepressants in 2003 – 2005 period increased by 35,42 %. This growth of total consumption was determined by rapid increase in consumption of other antidepressants (ATC N06AX) (increased by 284,75 %) and SSRIs (increased by 20,66 %). The consumption of compensatory TCA decreased by 4,6 % and the proportion of consumption of amitryptiline with consumption of all antidepressants decreased from 14,44 % to 11,8 %. Suicide rate per 1000 inhabitants decreased by 13,51 % in Lithuania in 2003 – 2005. Decrease was in both male and female suicide rates. In the same groups of ages of males and females consumption of compensatory antidepressants within the females is 3,5 and more... [to full text]