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