Mood%20Disorders:%20Treatment

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Mood Disorders Treatment

• Chapter 6

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Exam I

• Grades 55-98, average grade 78
• 12 had 90-100
• 22 had 80-89
• 32 had 70-79
• 11 had 60-69
• 2 had less than 60

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Treatment for Mood Disorders

• Biological Approaches
• Drugs MAOIs, Tricyclics, SSRIs
• Electroconvulsive Therapy
• Lithium
• Psychosocial Approaches
• Cognitive therapy
• Behavioral activation therapy
• Interpersonal therapy

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Neurotransmission Review
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Monoamine Oxidase Inhibitors (MAOIs)

• Monoamine oxidase (MAO)
• Enzyme that breaks down serotonin/norepinephrine
• MAO inhibitors block monoamine oxidase
• MAO inhibitors are slightly more effective than
  tricyclics
• Must avoid foods containing tyramine (e.g., beer,
  red wine, cheese) and interactions with other
  common medication

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Tricyclic Antidepressants

• Widely used (e.g., Imipramine (Tofranil),
  Amitriptyline (Elavil))
• Block reuptake of norepinephrine, serotonin, and
  other neurotransmitters
• Takes 2 to 8 weeks for the effects to be observed
• Negative side effects are common
• May be lethal in excessive doses

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Selective Serotonergic Re-uptake Inhibitors
(SSRIs)

• Specifically block reuptake of serotonin
• Fluoxetine (Prozac) is the most popular SSRI
• Others include Sertraline (Zoloft) and Paroxetine
  (Paxil)
• SSRIs may increase risk of suicide in children
  and adolescents (current controversy)
• Side effects are relatively uncommon and
  generally dissipate in 1-2 weeks

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Hollon, S.D., Thase, M. E., Markowitz, J. C.
(2002). Treatment and prevention of depression.
Psychological Science in the Public Interest, 3,
39-77.
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Puzzles of Reuptake Blocking Antidepressants

• Serotonin reuptake is effectively blocked rapidly
  after first dose, yet clinical effects arent
  observed for 2-4 weeks
• Tricyclics and SSRIs have similar effectiveness
  even though they vary widely in their specific
  pharmacologic effects
• Recent data suggests adaptive changes in neurons
  that include increased sensitivity of
  post-synaptic receptors and down-regulation of
  pre-synaptic autoreceptors
• May enhance self-regulation systems of serotonin
  and noradrenergic systems

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Lithium

• Lithium is a common salt
• Primary drug of choice for bipolar disorders
• Effective at terminating manic episodes, and
  preventing them with maintenance dosing and
  regular administration
• Side effects may be severe
• Dosage must be carefully monitored
• Small window between effective lethal doses
• Why lithium works remains unclear

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Electroconvulsive Therapy (ECT)

• ECT
• Involves applying brief electrical current to the
  brain
• Results in temporary seizures
• Usually 6 to 10 treatments are required, two-day
  intervals over 2 to 4 weeks
• ECT is effective for cases of severe depression
• Side effects include short-term memory loss
• How ECT works remains unclear
• Relapse is common
• Still great controversy about ECT

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Psychological Treatment of Mood Disorders

• Cognitive Therapy
• Addresses cognitive errors in thinking
• Therapy involves three phases behavioral
  activation, challenging automatic thoughts, and
  changing schemas
• Best researched psychosocial treatment for
  depression
• Outcomes comparable to medications in effect size
  and in comparison studies

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Behavioral Activation

• Behavioral Activation
• Involves helping depressed persons make increased
  contact with reinforcing events
• Jacobson et al. (1996) study
• Randomized trial using additive design
• Compared BA alone to BAAT and BACT
• Comparable effects with BA alone

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Jacobson et al. (1996) Findings
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Interpersonal Psychotherapy

• Interpersonal Psychotherapy
• Focuses on problematic interpersonal
  relationships
• Four general types of relationship problems
• Interpersonal role disputes (marital discord)
• Loss of an important relationship
• Acquiring new relationships
• Deficits in social skills
• Comparable effectiveness to cognitive therapy,
  although less researched

17
Hollon, S.D., Thase, M. E., Markowitz, J. C.
(2002). Treatment and prevention of depression.
Psychological Science in the Public Interest, 3,
39-77.
18
Combined Treatments

• Drugs typically faster, psychotherapy effects
  longer-lasting (lower rates of relapse)
• Combination treatments may capitalize on
  strengths of both treatments to offset weakness
  of other
• Preliminary data is encouraging, especially for
  mild to moderate depression