Book contents
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
13 - Proposed treatments for melancholia
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of patient vignettes
- Preface
- Acknowledgments
- 1 Melancholia: a conceptual history
- 2 Melancholia defined
- 3 Defining melancholia by psychopathology
- 4 Defining melancholia: laboratory tests
- 5 Examination for melancholia
- 6 The differential diagnosis of melancholia
- 7 Suicide in melancholia
- 8 Electroconvulsive therapy for melancholia
- 9 Achieving effective ECT
- 10 The validity of the pharmacotherapy literature in melancholia
- 11 Basic pharmacotherapy for melancholic patients
- 12 Pharmacotherapy for melancholic patients in complicating circumstances
- 13 Proposed treatments for melancholia
- 14 The pathophysiology of melancholia
- 15 Future directions
- References
- Index
Summary
There is a woman in this town who had lost three of four foetuses from epileptic attacks immediately after birth … It is clear that those foetuses died from a taint in the blood transmitted to the brain … In dealing with her next three children, immediately at birth, we had a fontanelle inserted in the neck and leeches applied behind the ears in order to drain off the impurities from the brain; they completely escaped epilepsy and still do to this day.
It is fair to say that most treatments prescribed today have little evidence to support their efficacy
Novel treatments for depression have been proposed. Some derive from observations of the neurobiology of mood disorders (e.g., light therapy (LT)) while others are opportunistic applications of new technologies (e.g., transcranial magnetic stimulation (TMS)). None has proven efficacy. Commonly promoted alternatives to standard treatments are discussed here.
Light therapy
Evidence for a seasonality in the incidence of mood disorders with higher incidence in the winter months encouraged thoughts that reductions in hours of sunlight affected brain neuroendocrine mechanisms and elicited mood disorders. The description of a seasonal affective disorder (SAD) (winter depression) and its inclusion in the psychiatric classification system encouraged extensive studies of LT. LT has also been assessed in patients with non-seasonally related depression.
This intervention presents high-intensity light from light boxes for varying lengths of time to subjects. Exposure time is 30–60 min daily for two weeks or more, typically between 6 and 9 a.m.
- Type
- Chapter
- Information
- MelancholiaThe Diagnosis, Pathophysiology and Treatment of Depressive Illness, pp. 284 - 297Publisher: Cambridge University PressPrint publication year: 2006