Treatments for Mood Disorders

Psychodynamic therapy for Unipolar Depression

- Look at free association, dream interpretation, and resistance and transference in therapy to interpret past events and feelings - Expect depressed clients will eventually gain awareness of losses in their lives, becoming less dependent on others, and cope with loss more effectively Limited effectiveness because depressed clients often feel too passive and weary to join into subtle therapy discussions. They may also be discouraged by long-term therapy required for progress.

Treatment for Mood Disorders (facts)

- People with mood disorders respond more successfully to treatment than do most other forms of psychological dysfunction - 1/3 of people with unipolar depression receive treatment Variety of treatment options: 1. Psychological approaches: Psychodynamic, Behavioral, and Cognitive therapies 2. Sociocultural approaches: interpersonal psychotherapy 3. Biological approaches: ECT, antidepressant drugs, brain stimulation Cognitive, Cognitive-Behavioral, Interpersonal, and Biological therapies are all highly effective treatments for unipolar depression. However, significant increases in prescription of antidepressant medications. ECT may be quick and effective for those who have not responded to antidepressant treatments, and brain stimulation for those who haven't had success with ECT.

Why are so many types of treatment relatively successful for unipolar depression?

1) There may be many factors that contribute to unipolar depression, and treatment of any of these might improve all areas of functioning. 2) There may be various kinds of unipolar depression, each of which responds to a different kind of therapy Right now, it seems like a combination of treatments relieves symptoms best. Still, 40% of patients do not improve with treatment.

Antidepressant Drugs as treatment for unipolar depression

3 main types of antidepressant drugs: 1) MAO Inhibitors: - MAO enzyme typically breaks down norepinephrine. By inhibiting the MAO enzyme, this drug helps approximately half of depressed patients. - Potential danger of rise of blood pressure if foods containing tyramine (cheese, bananas, wine) consumed 2) Tricyclics - Medications with a three-ringed molecular structure - Requires 10 days for improvements to take effect, and requires "continuation therapy" - Act by blocking the reuptake mechanism when neurotransmitters send a message, allowing them to stay longer and transfer more message to receiving neurons. - Don't require dietary restrictions; people taking them also show higher rates of improvement than those on MAO 3) Second-Generation Antidepressants - Selective Serotonin Reuptake Inhibitors that increase serotonin activity without inhibiting norepinephrine or ohter neurotransmitters. - Effectiveness and speed is about same as tricyclics, but these are preferred because it's harder to overdose on them, and they don't cause dry mouth, constipation, or dietary problems - Not as often distributed to minority groups

Brain Stimulation

3 promising biological approaches: (Doctors are striving for something less traumatic than ECT) 1) Vagus Nerve Stimulation: Treatment where an implanted pulse generator sends regular electrical signals to a person's vagus nerve; the nerve in turn stimulates the brain. Has brought significant relief to those who haven't responded to other treatments. Activates neurotransmitters all over the brain, but can't be sure why it works. FDA approved 2) Transcranial Magnetic Stimulation: Treatment in which electromagnetic coil is placed on head and sends current into the prefrontal cortex, increasing neuron activity in those regions. Just as effective as ECT, but not FDA approved because it can cause significant discomfort. 3) Deep Brain Stimulation: Treatment procedure in which pacemaker powers electrodes have been implanted in Broadmann Area 25 (considered a possible "depression switch") to stimulate that brain area. Promising findings, but in very early stages.

Cognitive therapy for Unipolar Depression

Aaron Beck's Congitive Therapy helps people identify and change their maladaptive assumptions and ways of thinking that cause their psychological disorders. Includes Behavioral components. 4 phases: 1) Increasing activities and elevating mood 2) Challenging automatic thoughts 3) Identifying negative thinking and biases 4) Changing primary attitudes 50-60% of patients who receive this treatment show almost complete elimination of symptoms - Some Cognitive therapists encourage Acceptance and Commitment Therapy (ACT), guiding depressed clients to accept negative cognitions as guides, rather than making patients fully discard them.

Electroconvlusive Therapy (ECT)

ECT is a highly controversial, but effective, fast-acting intervention for unipolar depression 65-140 volts of electricity through brain leading to brain seizure. 6-12 treatmetns over 2-4 weeks Originated from misguided idea that people with epilepsy somehow didn't become psychotic 60-80% of patients improve. Not too commonly used because it is frightening, can cause memory loss, and antidepressant drugs are another option

Black Box Problem

FDA is unsure whether to include suicide warnings on antidepressant medication boxes for children. - Does this keep people who should be taking antidepressants from doing so? How might the risk of danger compare?

Treatments for Bipolar Disorder

Lithium is an FDA-approved mood stabilizer for bipolar disorder - Discovered by John Cade, who thought uric acid was the cause of mania, but found the lithium he added helped make subjects lethargic. - 1/3 of patients with bipolar disorder seek treatment each year. 60% improve on medication. - Lithium is often given in combination with antidepressant drugs. - Mood stabilizers aren't completely understood, but it's suspected that they change synaptic activity in neurons by affecting the activity of second messenger systems. These influence key proteins or chemicals in neurons throughout the brain, or the activity of sodium and other ions Adjunctive Psychotherapy can help with social aspects of treatment.

Biological Treatments for Unipolar Depression

Most commonly takes the form of antidepressant drugs, but may also be ECT or brain stimulation

Second messengers

Neurotransmitter itself is considered the first messenger. The second messenger is the chemical changes within a neuron just after the neuron receives a neurotransmitter message and just before it responds. Lithium affects this particular messenger system

File Drawer Problem

Pharmaceutical companies test and present data on their own products. Is this a conflict of interest? Do we always know the risks accurately, or is some information not presented?

Psychological Approaches toward Unipolar Depression

Psychodynamic, Behavioral, and Cognitive schools of thought most often used in unipolar depression treatment Psychodynamic has not offered strong effectiveness Behavioral therapy is practiced less often Cognitive and Cog-behavioral is most common and successful

Behavioral therapy for Unipolar Depression

Theory and therapy guided by Peter Lewinsohn, whose theories of depression tie mood to the rewards in a person's life. 1) Therapists reintroduce depressed clients to pleasurable events 2) Reinforce depressive and non-depressive behaviors appropriately (may use a contingency management system) 3) Help clients improve their social skills Evidence suggests need 2+ behavioral techniques combined for behavioral treatment to improve depression (can esp. be combined for Cognitive-Behavioral treatment)

Sociocultural Approach to Unipolar Depression

Traces the causes of unipolar depression to the broader structure in which people live and the roles they are required to play. Two main treatments: 1) Multicultural Treatments-- culture-sensitive focus to psychotherapy AND medication considerations 2) Family-Social Approaches: - Interpersonal Therapy: Suggests loss of a loved one, role dispute, role transition, and interpersonal deficits might be. Has been highly effective (symptoms disappear in 50-60% of clients) - Couple Therapy