Note on Treatments for Mood Disorders

Treatments for Mood Disorders

Treatment of Unipolar Depressive Disorder

Psychodynamic Approach

Focus: Unconscious grief over real or imagined loss, leading to dependence.
Techniques:
- Free Association
- Dream Analysis
- Interpretation
Outcome: Aims to increase awareness and reduce dependency.
Effectiveness: Limited effectiveness.

Behavioral Approach

Reintroduce clients to enjoyable activities
Reinforce behaviors:
- Reward positive behaviors
- Ignore negative behaviors
Improve social skills

Effectiveness: Moderate but improved when combined with cognitive treatments.

Cognitive Approach

Phase 1: Increase activities to elevate mood.
Phase 2: Challenge automatic thoughts.
- Record and review negative self-critical thoughts with a therapist.
- Test the reality of these thoughts.
Phase 3: Identify cognitive biases.
Phase 4: Change primary attitudes by replacing negative thoughts with realistic alternatives.
Effectiveness: Strong for unipolar depression.

Multicultural Considerations

Important to consider race, creed, and ethnic background in treatment.

Family-Social Treatments

Interpersonal Psychotherapy:
1. Loss: Grieving the loss of a loved one.
2. Role Dispute: Differences in relationship expectations.
3. Role Transition: Adjustments to major life changes (e.g., divorce, job changes).
4. Deficits: Addressing extreme shyness and social awkwardness.
Couples Therapy: Moderately effective.

Biomedical Approaches

Electroconvulsive Therapy (ECT)

Indication: Used when antidepressants are ineffective or for severe cases.
Process:
- Electric shock (60 to 140 volts) for 0.5 seconds.
- Results in convulsions lasting 30-40 seconds.
- Followed by a brief coma (5-30 minutes).
Treatment Course: 6 to 12 sessions over 2 to 4 weeks.
Effectiveness: 60-80% show improvement, lasting up to 5 years.
Side Effects: Headaches, confusion, short-term memory loss.

Medications

Antidepressants: May take 4-6 weeks for full effect.
- Prevalence: 1 in 10 Americans are current users.
- Types:
  - Monoamine Oxidase Inhibitors (MAOIs): Prevent the breakdown of norepinephrine.
  - Tricyclic Antidepressants (TCAs): Block norepinephrine reuptake.
  - Selective Serotonin Reuptake Inhibitors (SSRIs): Block serotonin reuptake; includes Prozac, Paxil, Zoloft.
Mechanisms of Action:
- Boost neurotransmitter synthesis
- Block degradation
- Prevent reuptake
- Mimic neurotransmitters
Side Effects:
- MAOIs: Insomnia, dizziness, dietary restrictions (tyramine), which can cause serious reactions.
- TCAs: Drowsiness, insomnia, agitation, sexual dysfunction.
- SSRIs: Generally fewer side effects, concern over increased suicide risk in youth.
- 1/3 of unipolar patients do not respond to medications.

Other Biomedical Treatments

Vagus Nerve Stimulation:
- Stimulates vagus nerve; fewer side effects than ECT.
Transcranial Magnetic Stimulation:
- Electromagnetic coil stimulates the cortex; effectiveness is variable.
Deep Brain Stimulation:
- Involves electrodes in Brodmann Area 25; unclear effectiveness due to limited studies (only 6 subjects treated).

Treatment for Bipolar Disorder

Lithium:
- Response rates of 60-80% in classic bipolar.
- Decreases neurotransmitter levels by increasing norepinephrine reuptake.
- Side Effects: Gastrointestinal issues, tremors, muscle weakness, frequent urination.
- Serious Risks: Bladder control loss, seizures, heart rate abnormalities.
- Compliance Issues: Ongoing monitoring required.
Alternative Medications: Antiseizure medications like Tegretol and Depakote, and antipsychotics may also be used.

Bipolar Disorder is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Individuals with bipolar disorder may experience mood changes that can affect their energy, activity levels, sleep, behavior, and judgment. Specifically, the disorder is defined by the following characteristics:

Types of Bipolar Disorder

Bipolar I Disorder:
- Defined by manic episodes lasting at least 7 days or by manic symptoms that are so severe that immediate hospital care is needed. Manic episodes are typically preceded or followed by hypomanic or major depressive episodes.
Bipolar II Disorder:
- A milder form of bipolar disorder characterized by a pattern of depressive episodes and hypomanic episodes but not the full-blown manic episodes of Bipolar I Disorder.
Cyclothymic Disorder:
- Periods of hypomanic symptoms and periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a major depressive episode.

Symptoms

Mania and Hypomania Symptoms:
- Increased energy or activity
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or feeling pressure to keep talking
- Racing thoughts or flight of ideas
- Distractibility
- Increased goal-directed activities (e.g., social, work, sexual) or physical restlessness
- Engaging in risky behaviors (e.g., spending sprees, unprotected sex)
Depressive Symptoms:
- Feelings of sadness or hopelessness
- Loss of interest or pleasure in activities once enjoyed
- Significant weight loss or gain
- Insomnia or sleeping too much
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty thinking, concentrating, or making decisions
- Thoughts of death or suicide

Additional Characteristics

Episodes: Individuals can have periods of stability, but the cycles of mood changes can occur several times a year or even multiple times in a single year.
Duration: Episodes can last for days, weeks, or even months, with different durations for manic and depressive phases.
Triggers: Certain factors may trigger episodes, including stress, major life changes, or substance abuse.

Impacts of Bipolar Disorder

Social Relationships: The extreme mood changes can strain relationships with friends, family, and colleagues.
Occupational Performance: Mood swings can affect work performance and stability in employment.
Risk of Other Disorders: Individuals may be at a higher risk for anxiety disorders, substance abuse, and suicidal behavior.
Understanding bipolar disorder is crucial for seeking appropriate treatment and support, which can include medication, therapy, and lifestyle changes. Early intervention often leads to better outcomes.