Treatment of Mood Disorders

Medication

  • Antidepressants
    • Selective serotonin reuptake inhibitors
    • Tricyclic antidepressants
    • Monoamine oxidase inhibitors
    • Mixed reuptake inhibitors (e.g., serotonin/norepinephrine reuptake inhibitors)
  • Approximately equally effective
    • Only 50% of patients benefit
    • Only 25% achieve normal functioning

Selective Serotonin Reuptake Inhibitors

  • Called SSRIs
  • Specifically block reuptake of serotonin so more serotonin is available in the brain
    • Fluoxetine (Prozac) is the most popular SSRI
  • SSRIs pose some risk of suicide particularly in teenagers
  • Negative side effects are common
  • Some evidence that SSRI use during pregnancy lowered risk for birth complications

Tricyclic Antidepressants

  • Include Tofranil, Elavil
  • Mechanisms not well understood
    • Block reuptake norepinephrine and other neurotransmitters
  • Negative side effects are common (e.g., drowsiness, weight gain)
    • Discontinuation is common
  • May be lethal in excessive doses

Mixed Reuptake Inhibitors

  • Block reuptake of norepinephrine as well as serotonin
  • Best known is venlafaxine (Effexor)
  • Have fewer side effects than SSRIs

Monoamine Oxidase (MAO) Inhibitors

  • Block monoamine oxidase
  • This enzyme breaks down serotonin/norepinephrine
  • As effective as tricyclics, with fewer side effects
  • Dangerous in combination with certain foods
    • Beer, red wine, cheese cannot be consumed; patients dislike dietary restrictions
    • Also dangerous in combination with cold medicine

Lithium

  • Lithium carbonate = a common salt
  • Treatment of choice for bipolar disorder
  • Considered a mood stabilizer because it treats depressive and manic symptoms
  • Toxic in large amounts
    • Dose must be carefully monitored
  • Effective for 50% of patients
  • Why lithium works is partially understood

Electroconvulsive Therapy (ECT)

  • 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:
    • Short-term memory loss which is usually restored
    • Some patients suffer long-term memory loss
  • Mechanism is unclear

Transcranial Magnetic Stimulation

  • Uses magnets to generate a precise localized electromagnetic pulse
  • Few side effects; occasional headaches
  • Less effective than ECT for medication-resistant depression
  • May be combined with medication

Psychosocial Treatments for Depression

  • Cognitive-behavioral therapy
    • Addresses cognitive errors in thinking
    • Also includes behavioral components including behavioral activation (scheduling valued activities)
  • Interpersonal psychotherapy
    • Focus: Improving problematic relationships
  • Prevention
    • Preemptive psychosocial care for people at risk
  • Has longer-lasting effectiveness than medication

Preventing Relapse

  • Research on relapse prevention is relatively less common
  • Psychosocial and pharmacological treatments are both used
  • Psychosocial interventions generally more effective at preventing relapse

Psychosocial Treatments for Bipolar Disorder

  • Medication (usually Lithium) is still first line of defense
  • Psychotherapy helpful in managing the problems (e.g., interpersonal, occupational) that accompany bipolar disorder
  • Family therapy can be helpful