Chapter Eight: Treatments for Depressive and Bipolar Disorders
Disorders that feature severe changes in mood respond more successfully to more kinds of treatment than do most other forms of psychological dysfunction
Around half of those with unipolar depression receive treatment from a mental health professional each year
Many people in therapy experience depressed feelings as part of another disorder
Psychodynamic Therapy
Unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people
Encourage the depressed client to associate freely during therapy
Suggest interpretations of the client’s associations, dreams, and displays of resistance and transference
Help the person review past events and feelings
Therapists expect that in the course of treatment, depressed clients will eventually gain awareness of the losses in their lives, become less dependent on others, cope with losses more effectively, and make corresponding changes in their functioning
Long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
Depressed clients may be too passive and feel too weary to join fully in the subtle therapy discussions
They may become discouraged and end treatment too early when this long-term approach doesn’t provide the quick relief they seek
Psychodynamic therapy helps most in cases of depression that
are modest or moderate in severity
Involve a clear history of childhood loss or trauma
Involve a long-standing sense of emptiness, feelings of perfectionism, and extreme self-criticism
Short-term psychodynamic therapies have performed better than the longer-term approaches, especially when combined with psychotropic medications
Cognitive-Behavioral Therapy
Therapists combine behavioral and cognitive techniques to help clients suffering from depression
Behavioral Activation: Therapists work systematically to increase the number of constructive and pleasurable activities and events in a client’s life
Reintroduce depressed clients to pleasurable events and activities
Adding positive activities to a person’s life can lead to a better mood
Guide clients to monitor their negative behaviors and try new, more positive ones
Consistently reward nondepressive behaviors and withhold rewards for depressive behaviors
Contingency management approach
Help clients improve their social skills
Group therapy programs
Of limited help when its the sole feature of treatment
When combined with cognitive techniques, becomes quite helpful
Beck’s Cognitive Therapy
Cognitive Therapy: Helps people identify and change the maladaptive assumptions and ways of thinking that help cause their psychological disorders
Phase 1: Increasing activities and elevating mood
Encourage clients to become more active and confident
Prepare a detailed schedule of hourly activities for the coming week
As they become more active, their mood is expected to improve
Phase 2: Challenging automatic thoughts
Individuals recognize and record automatic thoughts as they occur and bring their lists to each session
Therapist and client test the reality behind the thoughts, often concluding that they’re groundless
Phase 3: Identifying negative thinking and biases
Therapists show clients how illogical thinking processes are contributing to these thoughts
Therapists guide clients to change their interpretation of events
Phase 4: Changing primary attitudes
Help clients change their maladaptive attitudes
New Wave Cognitive Behavioral Therapy: Use mindfulness training and other cognitive-behavioral techniques to help depressed clients recognize and accept their negative cognitions as streams of thinking and not as guides for behavior
Sociocultural theorists trace the causes of unipolar depression to the broader social structure in which people live and the roles they’re required to play
Culture-sensitive therapies are being combined with traditional forms of psychotherapy to help minority clients overcome their disorders
Family-Social Treatments
Help clients change how they deal with the close relationships in their lives
Interpersonal Psychotherapy
Any of four interpersonal problem areas may lead to depression and must be addressed
Interpersonal Loss: The loss of a loved one
Explore their relationship with the lost person
Express any feelings of anger they may discover
Develop new ways of remembering the lost person
Look for new relationships
Interpersonal Role Dispute: Two people have different expectations of their relationship and the role each should play
Help clients examine and resolve their role disputes
Interpersonal Role Transition: Feeling overwhelmed by the role changes brought about by major life changes
Therapists help them develop the social supports and skills the new roles require
Interpersonal deficits
ex: extreme shyness or social awkwardness
Prevents the client from having intimate relationships
Therapists help clients recognize their deficits
Teach social skills and assertiveness in order to improve their social effectiveness
Couple Therapy: The approach in which a therapist works with two people who share a long-term relationship
Integrative Behavioral Couples Therapy: Combine cognitive-behavioral and sociocultural techniques to teach couples specific communication and problem-solving skills, guide them to recognize their problematic interactions, and steer them to become more acceptive and supportive of each other
Depressed clients who receive couple therapy are more likely than those in individual
Antidepressant Drugs
MAO Inhibitors: Drugs that slow the body’s production of the enzyme MAO
Stop the destruction of serotonin and norepinephrine, which causes a reduction in depressive symptoms
Ppl who take MAO inhibitors can't eat foods containing the chemical tyramine
Causes their blood pressure to rise dangerously
Tricyclics
Reduce depression by acting on the neurotransmitter “reuptake” mechanisms of key neurons
Block the overly vigorous reuptake process
Allows serotonin and norepinephrine to remain in their synapses longer
Increases their stimulation of receiving neurons
Once the reuptake processes are corrected, serotonin and norepinephrine activity becomes smoother and more appropriate throughout their depression-related brain circuit
Structures and interconnections across that circuit become much more functional
Depression subsides for many patients
Don’t require dietary restrictions
Side effects: very dry mouth, constipation, blurred vision
Second-Generation Antidepressants
SSRIS: Increase serotonin activity specifically, without affecting norepinephrine or other neurotransmitters
Selective Norepinephrine Re-uptake Inhibitors: Increase norepinephrine activity only
Serotonin-norepinephrine Reuptake Inhibitors: Increase both serotonin and norepinephrine activity
Brain Stimulation: Interventions that directly or indirectly stimulate certain areas of the brain
Electroconvulsive Therapy: A treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion
Bilateral ECT: One electrode is applied to each side of the forehead, and a current passes through both sides of the brain
Unilateral ECT: The electrodes are placed so that the current passes through only one side
Practitioners give patients strong muscle relaxants to minimize convulsions
Give patients anesthetics to put patients to sleep during the procedure, reducing their terror
50-80% of ECT patients improve
Vagus Nerve Stimulation: A treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve, which then stimulates the brain
Vagus Nerve: The longest nerve in the human body
Can bring significant relief
Transcranial Magnetic Stimulation: A treatment in which an electromagnetic coil, which is placed on or above a patient’s head, sends a current into the individual’s brain
Deep Brain Stimulation: A treatment for depression in which a pacemaker powers electrodes that have been implanted in subgenual cingulate, thus stimulating that brain area
Unipolar depression may respond to any of several approaches
Depression treated by cbt is less likely to recur than depression treated by antidepressant drugs
Traditional psychodynamic therapies are less effective than other therapies for treating all levels of unipolar depression
Combination of psychotherapy and drug therapy is more helpful than either alone
These trends don’t always carry over to the treatment of depressed children and adolescents
Lithium: A metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders
Too low a dose will have little/no effect on the bipolar mood swings
Too high a dose can result in lithium intoxication
Mood Stabilizing / Antibipolar Drugs: Psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder
More than 60% of patients with mania improve on these medications
Second Messengers: Chemical changes within a neuron just after the neuron receives a neurotransmitter message and just before it responds
Reduce bipolar symptoms by improving the functioning of or communications between key structures in the brain
Many clinicians now use individual, group, or family therapy as an adjunct to mood stabilizing drugs
Doubles the likelihood that bipolar ppl will continue to take their medications properly
Disorders that feature severe changes in mood respond more successfully to more kinds of treatment than do most other forms of psychological dysfunction
Around half of those with unipolar depression receive treatment from a mental health professional each year
Many people in therapy experience depressed feelings as part of another disorder
Psychodynamic Therapy
Unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people
Encourage the depressed client to associate freely during therapy
Suggest interpretations of the client’s associations, dreams, and displays of resistance and transference
Help the person review past events and feelings
Therapists expect that in the course of treatment, depressed clients will eventually gain awareness of the losses in their lives, become less dependent on others, cope with losses more effectively, and make corresponding changes in their functioning
Long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
Depressed clients may be too passive and feel too weary to join fully in the subtle therapy discussions
They may become discouraged and end treatment too early when this long-term approach doesn’t provide the quick relief they seek
Psychodynamic therapy helps most in cases of depression that
are modest or moderate in severity
Involve a clear history of childhood loss or trauma
Involve a long-standing sense of emptiness, feelings of perfectionism, and extreme self-criticism
Short-term psychodynamic therapies have performed better than the longer-term approaches, especially when combined with psychotropic medications
Cognitive-Behavioral Therapy
Therapists combine behavioral and cognitive techniques to help clients suffering from depression
Behavioral Activation: Therapists work systematically to increase the number of constructive and pleasurable activities and events in a client’s life
Reintroduce depressed clients to pleasurable events and activities
Adding positive activities to a person’s life can lead to a better mood
Guide clients to monitor their negative behaviors and try new, more positive ones
Consistently reward nondepressive behaviors and withhold rewards for depressive behaviors
Contingency management approach
Help clients improve their social skills
Group therapy programs
Of limited help when its the sole feature of treatment
When combined with cognitive techniques, becomes quite helpful
Beck’s Cognitive Therapy
Cognitive Therapy: Helps people identify and change the maladaptive assumptions and ways of thinking that help cause their psychological disorders
Phase 1: Increasing activities and elevating mood
Encourage clients to become more active and confident
Prepare a detailed schedule of hourly activities for the coming week
As they become more active, their mood is expected to improve
Phase 2: Challenging automatic thoughts
Individuals recognize and record automatic thoughts as they occur and bring their lists to each session
Therapist and client test the reality behind the thoughts, often concluding that they’re groundless
Phase 3: Identifying negative thinking and biases
Therapists show clients how illogical thinking processes are contributing to these thoughts
Therapists guide clients to change their interpretation of events
Phase 4: Changing primary attitudes
Help clients change their maladaptive attitudes
New Wave Cognitive Behavioral Therapy: Use mindfulness training and other cognitive-behavioral techniques to help depressed clients recognize and accept their negative cognitions as streams of thinking and not as guides for behavior
Sociocultural theorists trace the causes of unipolar depression to the broader social structure in which people live and the roles they’re required to play
Culture-sensitive therapies are being combined with traditional forms of psychotherapy to help minority clients overcome their disorders
Family-Social Treatments
Help clients change how they deal with the close relationships in their lives
Interpersonal Psychotherapy
Any of four interpersonal problem areas may lead to depression and must be addressed
Interpersonal Loss: The loss of a loved one
Explore their relationship with the lost person
Express any feelings of anger they may discover
Develop new ways of remembering the lost person
Look for new relationships
Interpersonal Role Dispute: Two people have different expectations of their relationship and the role each should play
Help clients examine and resolve their role disputes
Interpersonal Role Transition: Feeling overwhelmed by the role changes brought about by major life changes
Therapists help them develop the social supports and skills the new roles require
Interpersonal deficits
ex: extreme shyness or social awkwardness
Prevents the client from having intimate relationships
Therapists help clients recognize their deficits
Teach social skills and assertiveness in order to improve their social effectiveness
Couple Therapy: The approach in which a therapist works with two people who share a long-term relationship
Integrative Behavioral Couples Therapy: Combine cognitive-behavioral and sociocultural techniques to teach couples specific communication and problem-solving skills, guide them to recognize their problematic interactions, and steer them to become more acceptive and supportive of each other
Depressed clients who receive couple therapy are more likely than those in individual
Antidepressant Drugs
MAO Inhibitors: Drugs that slow the body’s production of the enzyme MAO
Stop the destruction of serotonin and norepinephrine, which causes a reduction in depressive symptoms
Ppl who take MAO inhibitors can't eat foods containing the chemical tyramine
Causes their blood pressure to rise dangerously
Tricyclics
Reduce depression by acting on the neurotransmitter “reuptake” mechanisms of key neurons
Block the overly vigorous reuptake process
Allows serotonin and norepinephrine to remain in their synapses longer
Increases their stimulation of receiving neurons
Once the reuptake processes are corrected, serotonin and norepinephrine activity becomes smoother and more appropriate throughout their depression-related brain circuit
Structures and interconnections across that circuit become much more functional
Depression subsides for many patients
Don’t require dietary restrictions
Side effects: very dry mouth, constipation, blurred vision
Second-Generation Antidepressants
SSRIS: Increase serotonin activity specifically, without affecting norepinephrine or other neurotransmitters
Selective Norepinephrine Re-uptake Inhibitors: Increase norepinephrine activity only
Serotonin-norepinephrine Reuptake Inhibitors: Increase both serotonin and norepinephrine activity
Brain Stimulation: Interventions that directly or indirectly stimulate certain areas of the brain
Electroconvulsive Therapy: A treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion
Bilateral ECT: One electrode is applied to each side of the forehead, and a current passes through both sides of the brain
Unilateral ECT: The electrodes are placed so that the current passes through only one side
Practitioners give patients strong muscle relaxants to minimize convulsions
Give patients anesthetics to put patients to sleep during the procedure, reducing their terror
50-80% of ECT patients improve
Vagus Nerve Stimulation: A treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve, which then stimulates the brain
Vagus Nerve: The longest nerve in the human body
Can bring significant relief
Transcranial Magnetic Stimulation: A treatment in which an electromagnetic coil, which is placed on or above a patient’s head, sends a current into the individual’s brain
Deep Brain Stimulation: A treatment for depression in which a pacemaker powers electrodes that have been implanted in subgenual cingulate, thus stimulating that brain area
Unipolar depression may respond to any of several approaches
Depression treated by cbt is less likely to recur than depression treated by antidepressant drugs
Traditional psychodynamic therapies are less effective than other therapies for treating all levels of unipolar depression
Combination of psychotherapy and drug therapy is more helpful than either alone
These trends don’t always carry over to the treatment of depressed children and adolescents
Lithium: A metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders
Too low a dose will have little/no effect on the bipolar mood swings
Too high a dose can result in lithium intoxication
Mood Stabilizing / Antibipolar Drugs: Psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder
More than 60% of patients with mania improve on these medications
Second Messengers: Chemical changes within a neuron just after the neuron receives a neurotransmitter message and just before it responds
Reduce bipolar symptoms by improving the functioning of or communications between key structures in the brain
Many clinicians now use individual, group, or family therapy as an adjunct to mood stabilizing drugs
Doubles the likelihood that bipolar ppl will continue to take their medications properly