Lecture 2.6: Treating Mood Disorders

What is the medication used to treat Depression?

Selective Serotonin Reuptake Inhibitor (SSRIs)

• Increase the levels of serotonin between neurons

• Better for severe depression

• Side effects: weight gain, loss of seggual drive, nausea

What is the medication used to treat Bipolar?

Lithium

• Stabilizes mood shifts

• Toxic in high doses—must be taken as prescribed

Cognitive Behavioral Therapy (CBT)

• Focuses on restructuring maladaptive thought patterns through critical reflection

• Works for both depression and bipolar disorder

Goal: to restructure negative thinking and internal attributional style.

• First phase: recognize and identify automatic thoughts

• Second phase: challenge cognitive distortions

  • Multiple techniques—examples include:

    • Critically examining the evidence for and against thoughts

    • Overcoming dichotomous (i.e., all-or-nothing) thinking and acknowledging “shades of gray”

• Third phase: challenge deeper beliefs about the self and the world.

Interpersonal Therapy (an offshoot of CBT)

• Focuses on interpersonal factors in current relationships that cause and maintain mood disorder symptoms

• For depression, goal is to improve social communication and problem-solving skills

• For bipolar disorder, goal is to establish a sense of consistency in daily activities

Focuses on:

• Interpersonal factors in current relationships that cause and maintain depression

• Building communication and social problem-solving skills

• Four areas of emphasis:

  • Grief

  • Role dispute

  • Role transition

  • Interpersonal deficits

Interpersonal Triad

Effectiveness of psychotherapy vs. antidepressants

• Interpersonal therapy, cognitive therapy, and an antidepressant were all superior to placebo plus clinical management condition for a 16-week treatment.

• Therapy was just as effective as medication.

  • Drug treatment led to a more rapid improvement initially, although effects were equivalent over the 16 weeks.

  • Type of improvement was independent of type of treatment (e.g., medication changed cognitions just as much as cognitive therapy).

Depression Treatment outcomes

• Average age of onset is 32.

• Seventy-five percent of people who have major depression will have at least 2 depressive episodes.

• Half recover within 6 months; 40% of people who recover relapse within a year.

Bipolar Treatment outcomes

• Onset is usually between ages 18-22.

• Length of time between episodes varies and is difficult to predict.

• Forty to fifty percent of patients are able to achieve a sustained recovery; rapid cycling patients have a worse prognosis