Treatments for Mood Disorders

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Chapter 9
Slides Handouts by Karen Clay Rhines,
Ph.D. Seton Hall University

• Treatments for Mood Disorders

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Treatments for Mood Disorders

• Mood disorders as extraordinarily painful and
  disabling as they tend to be respond more
  successfully to more kinds of treatments than do
  most other forms of psychological dysfunction
• This diversity of successful treatments has
  affected individuals with depression in both
  positive and negative ways

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Treatments for Unipolar Depression Psychological
Approaches

• Psychological approaches to treating unipolar
  depression come from the three main models
• Psychodynamic Widely used despite no strong
  research evidence of its effectiveness
• Behavioral Primarily used for mild or moderate
  depression but practiced less than in past
  decades
• Cognitive Has performed so well in research
  that it has a large and growing clinical following

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Treatments for Unipolar Depression Psychological
Approaches

• Psychodynamic therapy
• Believing that unipolar depression results from
  unconscious grief over real or imagined losses,
  compounded by excessive dependence on other
  people, psychodynamic therapists seek to bring
  these issues into consciousness and work through
  them
• Psychodynamic therapists use the same basic
  procedures for all psychological disorders
• Free association
• Therapist interpretation

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Treatments for Unipolar Depression Psychological
Approaches

• Psychodynamic therapy
• Despite successful case reports, researchers have
  found that long-term psychodynamic therapy is
  only occasionally helpful in cases of unipolar
  depression
• Two features may be particularly limiting
• Depressed clients may be too passive or weary to
  fully participate in clinical discussions
• Depressed clients may become discouraged and end
  treatment too early when treatment doesnt
  provide fast relief
• Short-term approaches have performed better than
  traditional approaches

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Treatments for Unipolar Depression Psychological
Approaches

• Behavioral therapy
• Lewinsohn, whose theory tied a persons mood to
  his/her life rewards, developed a behavioral
  therapy for unipolar depression in the 1970s
• Reintroduce clients to pleasurable activities and
  events, often using a weekly schedule
• Appropriately reinforce their nondepressive
  behaviors
• Use a contingency management approach
• Help them improve their social skills

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Treatments for Unipolar Depression Psychological
Approaches

• Behavioral therapy
• The behavioral techniques seem to be of only
  limited help when just one of them is applied
• When treatment programs combine two or three of
  the techniques, as Lewinsohn had envisioned,
  depressive symptoms (especially mild symptoms)
  seem to be reduced

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Treatments for Unipolar Depression Psychological
Approaches

• Cognitive therapy
• Beck views unipolar depression as resulting from
  a pattern of negative thinking that may be
  triggered by current upsetting situations
• Maladaptive attitudes lead people to the
  cognitive triad
• Negatively viewing oneself, the world, and the
  future
• These biased views combine with illogical
  thinking to produce automatic thoughts

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Treatments for Unipolar Depression Psychological
Approaches

• Cognitive therapy
• Becks cognitive therapy the leading cognitive
  treatment for unipolar depression is designed
  to help clients recognize and change their
  negative cognitive processes
• This approach follows four phases and usually
  lasts fewer than 20 sessions
• Phases
• Increasing activities and elevate mood
• Challenging automatic thoughts
• Identifying negative thinking and biases
• Changing primary attitudes

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Treatments for Unipolar Depression Psychological
Approaches

• Cognitive therapy
• Over the past three decades, hundreds of studies
  have shown that cognitive therapy helps unipolar
  depression
• Around 5060 of clients show a near-total
  elimination of symptoms
• This treatment has also been used in a group
  therapy format

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Treatments for Unipolar Depression Sociocultural
Approaches

• Theorists trace the causes of unipolar depression
  to the broader social structure in which people
  live, and the roles they are required to play
• The most effective sociocultural approaches to
  treating unipolar depression are interpersonal
  psychotherapy and couple therapy
• The techniques used in these approaches borrow
  from other models

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Treatments for Unipolar Depression Sociocultural
Approaches

• Interpersonal therapy (IPT)
• This model holds that four interpersonal problems
  may lead to depression and must be addressed
• Interpersonal loss
• Interpersonal role dispute
• Interpersonal role transition
• Interpersonal deficits
• Studies suggest that IPT is as effective as
  cognitive therapy for treating depression

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Treatments for Unipolar Depression Biological
Approaches

• Biological treatments can bring great relief to
  people with unipolar depression
• Usually biological treatment means,
  antidepressant drugs, but for severely depressed
  persons who do not respond to other forms of
  treatment, it sometimes includes
  electroconvulsive therapy

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Treatments for Unipolar Depression Biological
Approaches

• Electroconvulsive therapy (ECT)
• The use of ECT was -- and is -- controversial
• It is now used frequently but only in severe
  cases
• The procedure consists of targeted electrical
  stimulation to cause a brain seizure
• The usual course of treatment is 6 to 12 sessions
  spaced over two to four weeks
• Treatment may be bilateral or unilateral

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Treatments for Unipolar Depression Biological
Approaches

• Electroconvulsive therapy (ECT)
• The discovery of the effectiveness of ECT was
  accidental and based on a fallacious link between
  psychosis and epilepsy
• The procedure has been modified in recent years
  to reduce some of the negative effects
• For example, patients are given muscle relaxants
  and anesthetics before and during the procedure
• Patients generally report some memory loss

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Treatments for Unipolar Depression Biological
Approaches

• Electroconvulsive therapy (ECT)
• ECT is clearly effective in treating unipolar
  depression
• Studies find improvement in 6070 of patients
• The procedure seems particularly effective in
  cases of severe depression with delusions, but it
  has been difficult to determine why ECT works so
  well
• Although effective, the use of ECT has declined
  since the 1950s, because of the memory loss
  caused by the procedure and the emergence of
  effective antidepressant drugs

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Treatments for Unipolar Depression Biological
Approaches

• Antidepressant drugs
• In the 1950s, two kinds of drugs were found to be
  effective
• Monoamine oxidase inhibitors (MAO inhibitors)
• Tricyclics
• These drugs have been joined in recent years by a
  third group, the second-generation antidepressants

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Treatments for Unipolar Depression Biological
Approaches

• Antidepressant drugs MAO inhibitors
• Originally used to treat TB, doctors noticed that
  the medication seemed to make patients happier
• The drug works biochemically by slowing down the
  bodys production of MAO
• MAO breaks down norepinephrine
• MAO inhibitors stop this breakdown from occurring
• This leads to a rise in norepinephrine activity
  and a reduction in depressive symptoms
• About half of patients who take these drugs are
  helped by them

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Treatments for Unipolar Depression Biological
Approaches

• Antidepressant drugs Tricyclics
• In searching for medications for schizophrenia,
  researchers discovered that imipramine lessened
  depressive symptoms
• Imipramine and related drugs are known as
  tricyclics because they share a three-ring
  molecular structure

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Treatments for Unipolar Depression Biological
Approaches

• Second-generation antidepressant drugs
• A third group of effective antidepressant drugs
  is structurally different from the MAO inhibitors
  and tricyclics
• Most of the drugs in this group are labeled
  selective serotonin reuptake inhibitors (SSRIs)
• These drugs act only on serotonin (no other NTs
  are affected)
• This class includes fluoxetine (Prozac) and
  sertraline (Zoloft)
• Selective norepinephrine reuptake inhibitors and
  serotonin-norepinephrine reuptake inhibitors are
  also now available

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Treatments for Unipolar Depression Biological
Approaches

• Second-generation antidepressant drugs
• The effectiveness and speed of action of these
  drugs is on par with the tricyclics yet they
  boast enormous sales
• Clinicians often prefer these drugs because it is
  harder to overdose on them than on other kinds of
  antidepressants
• There are no dietary restrictions like there are
  with MAO inhibitors
• There have fewer side effects than the tricyclics
• These drugs may cause some undesired effects of
  their own, including a reduction in sex drive

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How Do the Treatments for Unipolar Depression
Compare?

• For most kinds of psychological disorders, no
  more than one or two treatments, if any, emerge
  as successful
• Unipolar depression seems to be the exception,
  responding to any of several approaches

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How Do the Treatments for Unipolar Depression
Compare?

• Findings from a number of research studies
  suggest that
• Cognitive, interpersonal, and biological
  therapies are all highly effective treatments for
  mild to severe unipolar depression
• Although cognitive and interpersonal therapies
  may lower the likelihood of relapse, they are
  hardly relapse-proof

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How Do the Treatments for Unipolar Depression
Compare?

• Findings from a number of research studies
  suggest that
• behavioral therapy have shown less effective than
  cognitive, interpersonal, or biological therapy

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How Do the Treatments for Unipolar Depression
Compare?

• Findings from a number of research studies
  suggest that
• Psychodynamic therapies are less effective than
  other therapies in depression
• A combination of psychotherapy and drug therapy
  is modestly more helpful to depressed people than
  either treatment alone

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How Do the Treatments for Unipolar Depression
Compare?

• Findings from a number of research studies
  suggest that
• Among biological treatments, antidepressant drugs
  and ECT appear to be equally effective for
  reducing depression, although ECT seems to act
  more quickly

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Treatments for Bipolar Disorders

• Until the latter part of the 20th century, people
  with bipolar disorders were destined to spend
  their lives on an emotional roller coaster
• Psychotherapists reported almost no success
• Antidepressant drugs were of limited help
• These drugs sometimes triggered manic episodes
• ECT only occasionally relieved either the
  depressive or the manic episodes of bipolar
  disorder

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Treatments for Bipolar Disorders Lithium Therapy

• The use of lithium, a metallic element occurring
  as mineral salt, has dramatically changed this
  picture
• It is extraordinarily effective in treating
  bipolar disorders and mania
• Determining the correct dosage for a given
  patient is a delicate process
• Too low no effect
• Too high lithium intoxication (poisoning)

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Treatments for Bipolar Disorder Lithium Therapy

• Lithium provides improvement for more than 60 of
  manic patients
• Most patients also experience fewer new episodes
  while on the drug
• Lithium also is a prophylactic drug, one that
  actually prevents symptoms from developing
• Lithium also helps those with bipolar disorder
  overcome their depressive episodes

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Treatments for Bipolar Disorder Lithium Therapy

• Researchers do not fully understand how lithium
  operates
• They suspect that it changes synaptic activity in
  neurons, but in a different way from that of
  antidepressant drugs
• Although antidepressant drugs affect a neurons
  initial reception on NTs, lithium seems to affect
  a neurons second messengers
• Another theory is that lithium corrects bipolar
  functioning by directly changing sodium and
  potassium ion activity in neurons

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Treatments for Bipolar Disorder Adjunctive
Psychotherapy

• Psychotherapy alone is rarely helpful for persons
  with bipolar disorder
• Lithium therapy alone is also not always
  sufficient, either
• 30 or more of patients dont respond, may not
  receive the correct dose, or may relapse while
  taking it
• As a result, clinicians often use psychotherapy
  as an adjunct to lithium (or other
  medication-based) therapy

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Treatments for Bipolar Disorder Adjunctive
Psychotherapy

• Therapy focuses on medication management, social
  skills, and relationship issues
• Few controlled studies have tested the
  effectiveness of such adjunctive therapy
• Growing research suggests that it helps reduce
  hospitalization, improves social functioning, and
  increases clients ability to obtain and hold a
  job