Do Antidepressants Work?

   

Anti-depressants are chemicals designed to inhibit or accelerate neurotransmitter substances in our bodies. They stabilise these chemicals in order to alleviate symptoms of depression caused by an imbalance of certain substances.

   For example:

  • Low levels of serotonin mean the brain is not sufficiently stimulated leading to dampened moods.

  • Low levels of dopamine lead to a depletion of our innate ‘drive for pleasure’ which leads to depressive thoughts.

  • Low levels of norepinephrine mean that our bodies do not process and respond to stress effectively leading to anxiety.

   Here are some examples of drug therapies:

1) SSRIs – ‘selection serotonin reuptake inhibitors’ e.g. ‘Prozac’

   Seratonin is released into the synapse from one neuron in order to target receptor cells (receptor sites) on a receiving neuron after which they are reabsorbed by the initial neuron. SSRIs inhibit this reabsorption and thus increases serotonin levels in the synapses between neurons.

2) Tri-cyclics e.g. domipranine (‘Anafaril’)

   Block the transporter mechanism that reabsorbs serotonin and noradrenaline into the presynaptic cell after it has fired.

    A meta-analysis by The Royal College of Psychiatrists has supposedly confirmed the benefits of these (and similar) antidepressants against neurotransmitter imbalances. Data had been collected from 522 clinical trials of 116,477 people.

   The main researchers (inc. Dr Andrea Cipriani) found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills but also that there were huge differences in effectiveness between different drugs.

   This study has shown that drug therapies are a very acceptable option for anyone suffering from depression. It is important to reduce the stigma of taking medication for mental illness as the benefits are obvious. Antidepressants have been proven to reduce anxiety, improve moods, increase motivation and alertness.

   However, it is also important to realise that antidepressants are only part of recovery- there are many other forms of therapy available that are just as beneficial, such as psychotherapy, cognitive behavioural therapy etc. It is necessary that we are not too reductionist and realise that mental illness is the product of a myriad of things- including external/environmental factors that drugs cannot control. For this reason, it is important that we do not put all our faith in these drug treatments. There are proven side effects that may counteract the benefits. That being said, we must trust valid research and trust the professionals.

The most effective:

  • agomelatine

  • amitriptyline

  • escitalopram

  • mirtazapine

  • paroxetine

The least effective:

  • fluoxetine

  • fluvoxamine

  • reboxetine

  • trazodone

Female Doctors Paid More than Men in The NHS

 

A study by the BBC has found that there is a huge pay gap between men and women in top paying consultant positions. The top-earning male consultant in England earned £739,460 in 2016-17 whereas the best-paid woman only received £281,616 in comparison. This on top of there being a huge difference in the numbers of the highest paid men versus women in the NHS with a 20:1 ratio of men in the profession.

   The NHS defended the claim by saying that men were more likely to do overtime, but even after taking overtime and bonuses into consideration- there was still a substantial difference in pay (£1500). As well as that, why is it that the common perception of men is to do more overtime? Maybe because women are expected to “be with the children”? Maybe because men are “more hardworking”? Six-and-a-half times as many men as women in England and Wales get the top platinum award bonus worth £77,000 a year.    

We need to eradicate these misconceptions because as long as we still have people justifying inequality- there will still be inequality. This is so important as now, the majority of graduates are women- with an influx of female into the medical profession, it is essential that the pay-gap problem is tackled. 

   Following government consultation in 2017, it is now compulsory for employers to report the salaries of all their employers. However, this has not stopped the presence of a £14000 (on average) discrepancy between men and women in top consulting jobs in the NHS. This shows that women need more representation- we need more female doctors and we need more people supporting the equality of doctors pay.

Doctors save lives. Gender does not affect the quality of care or the quality of treatment and it shouldn’t affect their salaries either.

Measles in Europe

 

The number of cases of measles has increased dramatically in the last year, despite record lows in the previous annum. A suspected 400% increase is said to be the cause of people dismissing the all-important MMR (measles, Mumps, Rubella) vaccine.

   Often people choose to ignore vaccines for ethical and religious reasons however the main controversy is still the suspicion that the MMR vaccine could lead to autism though this has long since been discredited. However, the trust in the vaccine has been diminished considerably.

   Measles is a highly infectious viral illness that can be deadly. The MMR vaccine can prevent it but because of these preconceptions, there has been a decline in overall routine immunization. This has been proven by the 282 cases in the UK in 2017 alone with 35 deaths across Europe. Though this is nowhere near the chilling numbers faced in Romania (the worst affected country in Europe) with almost 6000 cases in 2017.

   The vaccine is given as two doses to very young children as part of the NHS childhood vaccination programme. One problem may be that parents of children often miss critical GP appointments, either because of external circumstances or because they don’t deem them necessary. This has been an issue faced by many practices across the UK – leading to an economic loss to the NHS.

   There should be an awareness that adults and older children can be vaccinated at any age if they haven’t been fully immunized before. Immunisation is very important to achieve herd immunity. Herd immunity is when a large enough proportion of the population is immune to a particular infection. This means there is a less of a chance of it being able to spread person to person. Herd immunity decreases the likelihood of widespread epidemic s – not unlike what we have seen with measles in the last year.

   Measles symptoms include a runny nose, sneezing and cough, sore, red eyes, a high temperature and, after a few days, a red-brown blotchy rash. It is a highly preventable disease but first, we must endeavour to reduce the stigma associated with vaccines because they bring more benefits to a population than harm.

A New Mechanism to Aid The Immune System

Most biologists and keen medics know that the main immunological response in the body consists of a series of processes carried out by white blood cells in the production of antitoxins and antibodies. When a foreign antigen is recognised by the body’s defence system, it stimulates Macrophages which engulf then display the antigen on their surface. Helper T-cells then prompt B-cells into the production of plasma cells which secrete antibodies specifically complementary to the foreign antigen. T- cytotoxic cells are also stimulated to give rise to more of  the same cells as well as immunological memory cells. These cells mean that the next time the same antigen is recognised by the body’s defence system, the response will be more immediate.

At Linköping University in Sweden, researchers are investigating the effect of another possible addition which aids the immunological system in the body. This is in the form of a warning system by mitochondria.

   Mitochondria usually act as a production of energy for body cells by respiration.They burn sugars and lipids to form water and carbon dioxide as well as energy in the form of ATP (adenine triphosphate releases energy when it breaks down into ADP- adenine diphosphate and an inorganic phosphate molecule).

It has been discovered there are DNA fibres that are secreted by the mitochondria of white blood cells. These are then released as a ‘web’ of mtDNA (mitochondrial DNA) which raises an alarm to the body’s immune system that the body has been exposed to a foreign antigen and is under attack. It also causes other white blood cells to release a signal  called “interferon type 1” which is a substance that helps the immune system to combat an infection.

From previous studies, we know that levels of mt DNA can be increased after the introduction of particular inflammatory diseases (e.g. rheumatoid arthritis, atherosclerosis, and hay fever) as well as after surgical trauma. I.e. mtDNA is one of the primary explanations for inflammation.

“…we will try to reduce the release of mtDNA, and in this way reduce the inflammation that it causes,” explains Björn Ingelsson, researcher and associate lecturer at the Department of Clinical and Experimental Medicine at Linköping University. He has conducted the research together with Professor Emeritus Anders Rosén and other co-workers.

There are a few ways in which mtDNA webs differ from other webs which makes it so fundamentaklt imprtant.

  1. mtDNA is activated at a mucg faster rate, of a few minutes, than other webs (e.g neutrophil-based meshes).

  2. mtDNA also has its characteristica ‘signal/warning’ function that others do not.

  3. mtDNA webs survive in the blood longer before being dissolved.

Significantly, it mustr be stated that mtDNA webs are a critical positive contribution to the body’s defense however:

“you can have too much of a good thing. If an unintentional secretion of mtDNA occurs, or if the secreted mtDNA is not removed from the blood, undesired inflammation may occur, and it is this side-effect we want to prevent,” says Björn Ingelsson.

   High levels of interferon type 1, the signal substance activated by the mtDNA webs, occur in several autoimmune diseases and several types of cancer. Researchers hope to quantify the secreted mtDNA molecules and to understand the warning signals, and therefore diseases including several autoimmune diseases and even cancer.

Cancer: Can Viruses Help?

 

 

 

 

 

 

Scientists have found a possible new treatment therapy for cancer patients called ‘reovirus therapy’ which they hope will aid traditional treatments like chemotherapy. It involves the virus being injected into the bloodstream.

The particular virus causes flu-like symptoms in the host. However it also crosses the blood-brain barrier and research has shown that the virus helps to encourage the body’s immune system to attack tumours more actively by making the cancer cells more visible to the body’s defence system.

10 patients have currently been treated using this method and experts at Leeds university are looking to treat more patients in the future.