Treatment of Mood Disorders

Antidepressants

* Selective serotonin reuptake inhibitors
* Tricyclic antidepressants
* Monoamine oxidase inhibitors
* Mixed reuptake inhibitors (e.g., serotonin/norepinephrine reuptake inhibitors)

The medications are approximately

equally effective

What percent of patients benefit from medications?

50%

What percent of patients that take medications achieve normal functioning?

25%

Selective Serotonin Reuptake Inhibitors are called

SSRIs

Selective Serotonin Reuptake Inhibitors

Specifically block reuptake of serotonin so more serotonin is available in the brain

What is the most popular SSRI?

Fluoxetine (Prozac)

SSRIs pose some risk of

suicide particularly in teenagers

Some evidence that SSRI use during pregnancy

lowered risk for birth complications

Tricyclic Antidepressants include

Tofranil, Elavil

Tricyclic Antidepressants

Block reuptake norepinephrine and other neurotransmitters

The mechanisms of Tricyclic Antidepressants are

not well understood

Tricyclic Antidepressants may be

lethal in excessive doses

Mixed Reuptake Inhibitors

Block reuptake of norepinephrine as well as serotonin

What is the best known mixed reuptake inhibitor?

venlafaxine (Effexor)

Mixed reuptake inhibitors have fewer side effects than

SSRIs

Monoamine Oxidase (MAO) Inhibitors

Block monoamine oxidase

This enzyme breaks down serotonin/norepinephrine

Monoamine Oxidase (MAO) Inhibitors as effective as

tricyclics, with fewer side effects

Monoamine Oxidase (MAO) Inhibitors is dangerous in combination with

certain foods: Beer, red wine, cheese cannot be consumed; patients dislike dietary restrictions

also cold medicine

Lithium carbonate =

a common salt

What is the treatment of choice for bipolar disorder?

lithium

Lithium is considered a mood stabilizer because

it treats depressive and manic symptoms

Lithium is toxic in

large amounts

Lithium is effective for

50% of patients

Why lithium works is

partially understood

Electroconvulsive Therapy (ECT) is effective for

medication-resistant depression

The nature of ECT

* Brief electrical current applied to the brain
* Results in temporary seizures
* Usually 6 to 10 outpatient treatments are required

Side effects of ECT:

* Short-term memory loss which is usually restored
* Some patients suffer long-term memory loss

Transcranial Magnetic Stimulation

Uses magnets to generate a precise localized electromagnetic pulse

Transcranial magnetic stimulation is less effective than

ECT for medication-resistant depression

Psychosocial Treatments for Depression: Cognitive-behavioral therapy

* Addresses cognitive errors in thinking
* Also includes behavioral components including behavioral activation (scheduling valued activities)

Psychosocial Treatments for Depression: Interpersonal psychotherapy

* Focus: Improving problematic relationships

Psychosocial Treatments for Depression have

longer-lasting effectiveness than medication