Title: Comer, Abnormal Psychology, 8th edition
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2Treatments for Mood Disorders
- Disorders of mood as 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 range of treatment options has been a source
of reassurance and hope for the millions of
people who desire to regain some measure of
control over their moods
3Treatments for Unipolar Depression
- Around half of persons with unipolar depression
(major depressive or dysthymic disorder) receive
treatment from a mental health professional each
year - In addition, many other people in therapy
experience depressed feelings as part of another
disorder thus, much of the therapy being done
today is for unipolar depression
4Treatments for Unipolar Depression
- A variety of treatment approaches are currently
in widespread use - These can be divided into psychological,
sociocultural, and biological approaches
5Treatments for Unipolar Depression Psychological
Approaches
- Psychological treatments used most often to
combat unipolar depression come from three main
schools of thought - 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
6Treatments for Unipolar Depression Psychological
Approaches
7Treatments for Unipolar Depression Psychological
Approaches
8Treatments for Unipolar Depression Psychological
Approaches
9Treatments for Unipolar Depression Psychological
Approaches
10Treatments for Unipolar Depression Psychological
Approaches
11Treatments for Unipolar Depression Psychological
Approaches
12Treatments for Unipolar Depression Psychological
Approaches
13Treatments for Unipolar Depression Sociocultural
Approaches
- Theorists trace the causes of unipolar depression
to the broader social structure in which people
live and to the roles they are required to play - Two groups of sociocultural treatments are now
widely applied multicultural approaches and
family-social approaches
14Treatments for Unipolar Depression Sociocultural
Approaches
- Multicultural treatments
- Culture-sensitive approaches increasingly are
being combined with traditional forms of
psychotherapy to help maximize the likelihood of
minority clients overcoming their disorders - It also appears that the medication needs of many
depressed minority clients are inadequately
addressed
15Treatments for Unipolar Depression Sociocultural
Approaches
- Family-Social Treatments
- 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
16Treatments for Unipolar Depression Sociocultural
Approaches
- Family-Social Treatments
- Couple therapy
- The main type of couple therapy is behavioral
marital therapy (BMT) - Focus is on developing specific communication and
problem-solving skills - If marriage is filled with conflict, BMT is as
effective as other therapies for reducing
depression
17Treatments 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 individuals who
do not respond to other forms of treatment, it
sometimes includes electroconvulsive therapy or
brain stimulation
18Treatments for Unipolar Depression Biological
Approaches
- Electroconvulsive therapy (ECT)
- One of the most controversial forms of treatment
- It is used frequently because it is an effective
and fast-acting intervention - The procedure consists of targeted electrical
stimulation to cause a brain seizure - The usual course of treatment is 6 to 12 sessions
spaced over 2 to 4 weeks - Treatment may be bilateral or unilateral
19Treatments 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
20Treatments for Unipolar Depression Biological
Approaches
- Electroconvulsive therapy (ECT)
- ECT is clearly effective in treating unipolar
depression - Studies find improvement in 6080 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, the frightening nature of the
procedure, and the emergence of effective
antidepressant drugs
21Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs
- In the 1950s, two kinds of drugs were found to
reduce the symptoms of depression - 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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23Treatments 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
body's 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 - Approximately half of patients who take these
drugs are helped by them
24Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs MAO inhibitors
- MAO inhibitors pose a potential danger
- People who take MAOIs experience a dangerous rise
in blood pressure if they eat foods containing
tyramine (cheese, bananas, wine) - In recent years, a new MAO inhibitor in the form
of a skin patch has become available - Dangerous food interactions do not appear to be
as common a problem with this kind of MAO
inhibitor
25Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs Tricyclics
- In searching for medications for schizophrenia,
researchers discovered that imipramine relieved
depressive symptoms - Imipramine and related drugs are known as
tricyclics because they share a three-ring
molecular structure
26Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs Tricyclics
- Hundreds of studies have found that depressed
patients taking tricyclics have improved much
more than similar patients taking placebos - Drugs must be taken for at least 10 days before
such improvement is seen - About 6065 of patients find symptom improvement
27Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs Tricyclics
- Most patients who immediately stop taking
tricyclics upon relief of symptoms relapse within
one year - Patients who take tricyclics for five additional
months (continuation therapy) have a
significantly decreased risk of relapse - Patients who take antidepressant drugs for three
or more years after initial improvement
(maintenance therapy) may reduce the risk of
relapse even more
28Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs Tricyclics
- Tricyclics are believed to reduce depression by
affecting neurotransmitter (NT) reuptake
mechanisms - To prevent an NT from remaining in the synapse
too long, a pumplike mechanism recaptures the NT
and draws it back into the presynaptic neuron - The reuptake process appears to be too efficient
in some people, drawing in too much of the NT
from the synapse - This reduction in NT activity in the synapse is
thought to result in clinical depression - Tricyclics block the reuptake process, thus
increasing NT activity in the synapse
29Reuptake and Antidepressants
30Treatments for Unipolar Depression Biological
Approaches
- Antidepressant drugs Tricyclics
- There is growing evidence that when tricyclics
are ingested, they initially slow down the
activity of the neurons that use norepinephrine
and serotonin - After a week or two, the neurons adapt to the
drugs and go back to releasing normal amounts of
the NTs, and the reuptake mechanism begins to
have the desired effect - Today, tricyclics are prescribed more often than
MAO inhibitors - They do not require dietary restrictions
- Some patients show higher rates of improvement
31Treatments for Unipolar Depression Biological
Approaches
- Second-generation antidepressants
- 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 increase serotonin activity
specifically (no other NTs are affected) - This class includes fluoxetine (Prozac),
sertraline (Zoloft), and escitalopram (Lexapro) - Selective norepinephrine reuptake inhibitors and
serotonin-norepinephrine reuptake inhibitors are
also now available
32Treatments for Unipolar Depression Biological
Approaches
- Second-generation antidepressant drugs
- In effectiveness and speed of action of these
drugs are on a par with the tricyclics, yet their
sales have skyrocketed - 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 - They have fewer side effects than the tricyclics
- These drugs may cause some undesired effects of
their own, including a reduction in sex drive
33Treatments for Unipolar Depression Biological
Approaches
- As effective as antidepressant drugs are, it is
important to recognize that they do not work for
everyone - Even the most successful of them fails to help at
least 35 percent of clients with depression
34Treatments for Unipolar Depression Biological
Approaches
- Brain stimulation
- In recent years, three additional biological
approaches have been developed - Vagus nerve stimulation
- Transcranial magnetic stimulation
- Deep brain stimulation
35Treatments for Unipolar Depression Biological
Approaches
- Vagus nerve stimulation
- Depression researchers surmised they might be
able to stimulate the brain by electrically
stimulating the vagus nerve through the use of a
pulse generator implanted under the skin of the
chest - Research has found that the procedure brings
significant relief to as many as 40 of those
with treatment-resistant depression - As with ECT, researchers do not yet know
precisely why this technique reduces depression
36Vagus Nerve Stimulation
37Treatments for Unipolar Depression Biological
Approaches
- Transcranial magnetic stimulation
- Another technique designed to stimulate the brain
without the undesired effects of ECT, TMS has
been found to reduce depression when administered
daily for 2 to 4 weeks - Deep brain stimulation
- Theorizing a depression switch located deep
within the brain, researchers have successfully
experimented with electrode implantation in the
brain's Brodman Area 25
38Treatments for Unipolar Depression Biological
Approaches
- Brain stimulation
- While such positive initial findings have
produced considerable enthusiasm in the clinical
field, it is important to recognize and remember
that, in the past, certain promising
interventions (e.g., lobotomies) later proved
problematic and even dangerous upon closer
inspection
39How Do the Treatments for Unipolar Depression
Compare?
- For most kinds of psychological disorders, no
more than one or two treatments, if any, emerge
as highly successful - Unipolar depression seems to be an exception,
responding to any of several approaches
40How Do the Treatments for Unipolar Depression
Compare?
- Findings from a number of treatment outcome
studies suggest that - Cognitive, cognitive-behavioral, interpersonal,
and biological therapies are all highly effective
treatments for mild to severe unipolar depression - Although cognitive, cognitive-behavioral, and
interpersonal therapies may lower the likelihood
of relapse, they are hardly relapse-proof
41How Do the Treatments for Unipolar Depression
Compare?
- Findings from a number of treatment outcome
studies suggest that - When people with unipolar depression experience
significant marital discord, couple therapy tends
to be very helpful - Depressed people who receive strictly behavioral
therapy have shown less improvement than those
who receive cognitive, cognitive-behavioral,
interpersonal, or biological therapy
42How Do the Treatments for Unipolar Depression
Compare?
- Findings from a number of treatment outcome
studies suggest that - Traditional psychodynamic therapies are less
effective than other therapies in treating all
levels of unipolar depression - A combination of psychotherapy and drug therapy
is modestly more helpful to depressed people than
either treatment alone
43How Do the Treatments for Unipolar Depression
Compare?
- Findings from a number of treatment outcome
studies suggest that - These various trends do not always carry over to
the treatment of depressed children and
adolescents - Among biological treatments, ECT appears to be
somewhat more effective than antidepressant drugs
and ECT seems to act more quickly - In addition, the newly developed brain
stimulation treatments seem helpful for some
severely depressed individuals who have been
repeatedly unresponsive to drug therapy, ECT, or
psychotherapy
44Treatments for Bipolar Disorder
- 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
45Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
- The use of lithium (a metallic element naturally
occurring as mineral salt) and other
mood-stabilizers has dramatically changed this
picture - Lithium 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)
- Given the effectiveness, around one-third of all
persons with bipolar disorder seek treatment in a
given year another 15 are monitored by family
physicians
46Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
- All manner of research has attested to the
effectiveness of lithium and other mood
stabilizers in treating manic episodes - More than 60 of patients with mania improve on
these medications - Most individuals experience fewer new episodes
while on the drug - Findings suggest that the mood stabilizers are
also prophylactic drugs, ones that actually help
prevent symptoms from developing - Mood stabilizers also help those with bipolar
disorder overcome their depressive episodes to a
lesser degree
47Treatments for Bipolar Disorder Lithium and
Other Mood Stabilizers
- Researchers do not fully understand how mood
stabilizing drugs operate - They suspect that the drugs change synaptic
activity in neurons, but in a different way from
that of antidepressant drugs - Although antidepressant drugs affect a neuron's
initial reception on NTs, mood stabilizers seem
to affect a neuron's second messengers - These drugs also increase the production of
neuroprotective proteins, which may decrease
bipolar symptoms - Another theory is that mood stabilizers correct
bipolar functioning by directly changing sodium
and potassium ion activity in neurons
48Treatments for Bipolar Disorder Adjunctive
Psychotherapy
- Psychotherapy alone is rarely helpful for persons
with bipolar disorder - Mood stabilizing drugs alone are also not always
sufficient - 30 or more of patients don't respond, may not
receive the correct dose, and/or may relapse
while taking it - As a result, clinicians often use psychotherapy
as an adjunct to lithium (or other
medication-based) therapy
49Treatments 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