Treatments for Mood Disorders

2. Treatments 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

3. Treatments for Unipolar Depression • Around half of persons depression 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

4. Treatments for Unipolar Depression • A variety of treatment approaches are currently in widespread use • These can be divided into psychological, sociocultural, and biological approaches

5. Psychological Approaches • Psychological treatments used most often to combat unipolar depression come from two 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

6. Psychological Approaches

7. 1. Why do you think behavioral therapy is effective for depression?

8. Psychological Approaches

9. 2. Give an example of a statement someone with depression might say for each of the three elements of the cognitive triad: 1. Self 2. World 3. Future

10. Psychological Approaches

11. Treatments for Unipolar Depression: Psychological Approaches

12. Sociocultural Approaches • Sociocultural theorists trace the causes of depression to the broader social structure in which people live and to the roles they are required to play

13. 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

14. 3. If you suffered from depression, which psychological treatment would you prefer: 1. behavioral 2. cognitive 3. sociocultural Why?

15. 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

16. Biological Approaches • https://www.youtube.com/watch?v=OTZvnAF7UsA • https://www.youtube.com/watch?v=twhvtzd6gXA 4. What message do these commercials give?

17. 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

19. 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

20. 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)

21. Biological Approaches • Antidepressant drugs: Tricyclics • In searching for medications for schizophrenia, researchers discovered that imipramine relieved depressive symptoms

22. 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 60%–65% of patients find symptom improvement

23. Biological Approaches • Potential side effects of tricyclics: • Dry mouth, blurred vision, constipation, urinary retention, drowsiness, increased appetite leading to weight gain, drop in blood pressure when moving from sitting to standing, which can cause lightheadedness, and increased sweating.

24. 5. Do the benefits outweigh the potential side effects?

25. Biological Approaches • Second-generation antidepressants • 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)

26. Biological Approaches • Second-generation antidepressant drugs • Sales of this type have skyrocketed recently due to a few reasons: • 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

27. 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

28. 6. What are the three classes of antidepressant drugs?

29. Treatments 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

30. Treatments 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

31. Vagus Nerve Stimulation

32. Treatments 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

33. Treatments 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

34. 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 highly successful • Unipolar depression seems to be an exception, responding to any of several approaches

35. How 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

36. How 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

37. How 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

38. How 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

39. Treatments 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

40. Treatments 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

41. Treatments 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

42. Treatments 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

43. Treatments 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

44. 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