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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
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
TREATMENTS FOR UNIPOLAR
DEPRESSION
• A variety of treatment approaches are
currently in widespread use
• These can be divided into psychological,
sociocultural, and biological approaches
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
PSYCHOLOGICAL APPROACHES
Behavioral therapy
•Reintroduce clients to pleasurable
activities and events, often using a
weekly schedule
•Appropriately reinforce their
depressive and nondepressive
behaviors
•Help them improve their social skills
1. Why do you think behavioral therapy is effective for
depression?
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PSYCHOLOGICAL APPROACHES
Cognitive therapy
• Aaron Beck viewed 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”
• Repeatedly viewing oneself, the world,
and the future in negative ways
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
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PSYCHOLOGICAL APPROACHES
Cognitive therapy
• Beck's cognitive therapy is designed to help
clients recognize and change their negative
thoughts
• This approach follows four phases and usually
lasts fewer than 20 sessions
• Phases:
• Increasing activities and elevating mood
• Challenging automatic thoughts
• Identifying negative thinking and biases
• Changing primary attitudes
TREATMENTS FOR UNIPOLAR
DEPRESSION: PSYCHOLOGICAL
APPROACHES
Cognitive therapy
• Over the past several decades, hundreds of
studies have shown that cognitive therapy
helps unipolar depression
• Around 50%–60% of clients show a neartotal elimination of symptoms
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
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
3. If you suffered from depression, which
psychological treatment would you prefer:
1. behavioral
2. cognitive
3. sociocultural
Why?
14
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
BIOLOGICAL APPROACHES
• https://www.youtube.com/watch?v=OTZvnAF7UsA
• https://www.youtube.com/watch?v=twhvtzd6gXA
4. What message do these commercials give?
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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
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
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)
BIOLOGICAL APPROACHES
• Antidepressant drugs: Tricyclics
• In searching for medications for schizophrenia,
researchers discovered that imipramine relieved
depressive symptoms
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
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.
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• 5. Do the benefits outweigh the potential side
effects?
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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)
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
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
• 6. What are the three classes of antidepressant
drugs?
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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
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
VAGUS NERVE STIMULATION
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
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
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
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
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
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
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
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
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
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
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
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
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