Chapter 7 Bipolar Disorders CLASS NOTES

Treatments for Unipolar Depression 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 

• Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) reuptake mechanisms 

  • To prevent an NT from remaining in the synapse too long, a pump-like mechanism recaptures the NT and draws it back into the presynaptic neuron 

  • The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse

  • This reduction in NT activity in the synapse is thought to 

• Second Generation antidepressant drugs 

  • A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics 

    • Most of the drugs in this group are labeled as selective serotonin reuptake inhibitors (SSRIs)

• These drugs act only on serotonin (no others NTs are affected) 

  • This class include fluoxetine (Prozac) and sertraline (zoloft) 

    • Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available

  • The effectiveness and speed of action of these drugs is on par with the tricyclics, yet their sales have skyrocketed 

    • 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 may have fewer side effects than the tricyclics 

  • Ketamine based-drugs 

    • Increase activity of glutamate in brain; may aid in new neural pathway development 

    • OFten alleviates depression quickly,combines well with other drugs 

    • Short-term impact 

    • “Special K”/ party drug; esketamine/spavato

• Brain stimulation 

  • For treatment-resistant clients, clinical investigators continue to search for alternative approaches. Biological approaches include: 

    • ECT 

    • Deep brain stimulation 

    • Vagus nerve stimulation 

    • Transcranial magnetic stimulation  

What causes Unipolar Depression? The psychological views 

• Foundational Perspectives 

  • Psychodynamic 

  • Limited research support

  • Cognitive-Behavioral

    • Modest to considerable research support 

• Link between depression and grief 

  • Actual loss or “symbolic” ( or imagined) loss 

  • People’s relationship leave them feeling unsafe and insecure (object relations theorists) 

  • Strengths 

    • Research evidence exists that early losses can increase risk for later depression-but see “limitations” next slide 

    • Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss

    • Model is hard to test 

Cognitive Behavioral View 

• Depression results from problematic behaviors and dysfunctional thinking 

  • Behavioral dimension 

  • Negative Thinking 

  • Complex cognitive and behavioral factor interplay 

Behavioral Dimension View (Lewinsohn and others) 

• Depression results from decreased rewards and increased punishments people receive in their lives 

• People perform fewer and fewer constructive behaviors, and they spiral towards depression

• Social rewards are especially important