Depressive and Bipolar disorders - Treatment

Unipolar depression CBT treatments: Behavioral activation

THIS IS NOT EXPOSURE

Reintroduce to pleasurable activities, reinforce those activities, Improve social skills

Create a fun activities log with fun activities specified to that person and use a daily activity diary to track what activities they have done that day from the list

Unipolar depression CBT treatments: Beck’s restructuring cognitions (for maladaptive attitudes)

1. Increasing activities and elevating mood

2. challenging automatic thoughts

   1. Make a common way of thinking record. Looks at situation (what made me feel this way?), Automatic thoughts (what were thoughts I had in this situation?), mood (how did these thoughts affect how I was feeling), and common way of thinking (what thinking traps was I stuck in?)

3. Identifying negative thinking and biases

4. Changing primary attitudes: Change I can’t to I can

   1. Questions to asks to help create balanced thoughts: “Am I mistaking feelings for facts?” “Is this thought helpful to me?”

Unipolar depression CBT treatments: ACT (accept streams of thinking)

Let thoughts flow throughout your mind

We do not have to take bad thoughts and make meaning out of them

We do not have to force is away, we just need to not give it power

Unipolar depression sociocultural treatment: Culturally sensitive treatments

• Emphasize cultural values

  • Ex. family, spirituality, religion (adding things that are important to a person like these onto fun activities list)

• Address race, discrimination

• Assess illness beliefs, stigmatization (some cultures have beliefs/stigmas against mental illness that can make them reject treatment, and they need to be addressed)

• Hiring bilingual providers

• All materials written in the language of the person/group

All of these things lead to higher retention rates

Unipolar depression biological treatments: SSRIs

Increases availability of serotonin by stopping reuptake process

gives serotonin more time to bind to receptors and allows it to fire 

keeps natural serotonin for longer, does NOT make new serotonin 

Unipolar depression treatments: Biological: Brain stimulation; TMS

Transcranial magnetic stimulation

A coil sends a current that increases neuron activity in specific brain structures (parts of PFC)

Although it only affects specific parts of the brain, it improves functioning throughout the brain because of how it kicks into motion changes in the depression related brain circuits

Bipolar disorders treatments: Biological: Medication; Lithium

Great for mania, somewhat for depression

Treats current symptoms: patients with mania report 60% improvement

Prevents future symptoms

Can be toxic so need to make sure not to give too much

Very effective for bipolar disorders

How do mood stabilizing drugs work?

Scientist are not exactly sure, but they believe it acts on second messengers (antidepressants act on first messengers)

It increases production of neuroprotective protein (BDNF) which increases neuron health

Improve functioning between brain structures 

Changes sodium and potassium ion activity in neurons 

Bipolar disorder treatments: Adjunctive therapy

Teaches about the importance of meds; social skills and relationships; psychoeducation; solve impairment related problems; prevents suicide; learns patterns/recurrence triggers; learns early warning signs; learn coping strategies

Adjunctive

Something added to another thing, but not essential to it

Why do we need adjunctive therapy?

Psychotherapy or mood stabilizing alone is rarely helpful for persons with bipolar disorder

Individual, group or family therapy is often used as an adjunct to lithium or other medication based therapy

Early warning signs for mania

More talkative, colors look more bright

Early warning signs for a depressive episode

Sleeping too much, can’t get started