Treatment MoodDis Student Outline

8/12/2019 Treatment MoodDis Student Outline

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Treatments for mood disordersFebruary 24th, 2014


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Today

Treatments for Mood Disorders

Who gets treatment?

What treatments are used and work best?

Unipolar Depression

Bipolar Depression


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Treatment for unipolar depression(Unipolar Depression = MDD or Dysthymia)50% of all people who suffer from this diagnosisseek treatment

Seeking treatment differs among ethnic groups

34% Hispanic Americans

40% African American 54% Caucasian


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Psychodynamic

- Not well researched mostly based on case studies

- Not suited for many depressed persons, might not

be up for, too passive

Model from which the therapist works:

depression results from unconscious grief over

real or perceived losses compounded by dependence on other people,

relationships with others currently and/or past


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Psychodynamic Treatment goals:

Gain awareness of the losses they have experienced

Cope with losses more effectively

Become less dependent on others

How therapist works with client:

Create safe nonjudgmental nondirective situation

Free association (whatever comes up)

Therapist interpretations (associations, dreams,resistance, transference)

Review of past events, traumas, relationships withparents, and feelings

Longer term treatment


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Behavioral and Cognitive approaches

Shorter term

Usually _10 - 20___ sessions


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Behavioral

(Purely) Behavioral treatments are most commonlyused for __mild or moderate depression

Model: Based on _learning principles (reward,reinforcement)_

Lewinsohn:

Reintroduce clients to pleasurable

events and activities

Appropriately reinforce their non-depressivebehaviors

Help them improve their social skills


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Behavioral Use weekly planner to structure day, plan pleasurable

activities

Can also have clients log their negative behaviors that lead toa decrease in rewarding experiences and interations Help brainstorm behaviors they could replace these with

Contingency Management

Rewarding contructive behavior May involve family members, friends, etc.

Social Skills Training Group therapy settings ?


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Behavioral approach: research and currentuse

Research

Limited help when just??

two or more of the techniques are combined-behavioral strategies lessen mild depression

More recently, behavioral techniques have beencombined with cognitive therapy (CBT)


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Cognitive

MODEL: Becks model of depression is a result ofnegative or unrealistic thoughts

(maladaptive attitudes, cognitive triad, illogicalthinking, automatic thoughts)


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Cognitive Therapy

Cognitive Therapy: designed primarily to helpwith negative cognitive processes but used

together with behavioral techniques cognitive behavioral therapy

1) Increase activities__ and elevate mood

2) Identify negative thinking and biases, unrealistic

expectations3) Challenge _automatic thoughts___


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CBT Research

Cognitive and CBT are effective for unipolardepression

Around 50-60% show a near elimination ofsymptoms

Alternative CBT approaches

Recognize and accept negative cognitions as just astream of thoughts rather than a guide for theirbehaviors

Acceptance and Commitment Therapy (ACT)

Acceptance

Mindfulness


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Social or interpersonal focus

A number of therapies are focused on theimportance of the social or interpersonal contextof depression


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Interpersonal (IPT)

Basis or model

4 interpersonal problems that may lead to depression

Loss, unresolved grief

Role dispute

Role transition

(social skills or interpersonal) deficits or difficultyhaving good quality relationships

Typical treatment 2-4 months


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Couples Therapy

Depression can be closely tied to marital difficulties

Behavioral Marital Therapy (BMT)

Focus on specific _communication and problem-solving skills_____

Studies show if depressed + relationship distress,

then couples therapy has a better outcome thanindividual CBT


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Biological approaches: AntidepressantDrugs 2 kinds of drugs found in the 1950s that

reduce depression symptoms

Monoamine oxidase (MAO) inhibitors MAO breaks down norepinephrine

MAO inhibitors stop this from occurring

Norepinephrine increases and depressionsubsides

Effective in 50% of patients

Side effects: if combined with tyramine- raisesblood pressure Recently, a skin patch was developed that

doesnt appear to have the same food

interactions


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TricyclicsImprimine

Effective in 60-65% of patients, after 10 days

Must be taken for about 5 months after depressivesymptoms have subsided maintenance therapy

Prescribed more often than MAOIs

Effects the neurotransmitterreuptake mechanism


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Selective serotonin reuptake InhibitorsSSRIs In the past few decades, these drugs have been joined by a third

group called second-generation antidepressants

Most of these are called Selective serotonin reuptake inhibitors(SSRIs)

Increases serotonin activity (no other NTs are impacted)

Now there are also some norepinephrine and serotonin-norepinephrine reuptake inhibitors available

Advantages Harder to overdose No _dietary restrictions_ restrictions Fewer __side effects (but may cause some undesirable effects like

reduction in sex drive)_____

Effective for about 2/3rds of patients Very popular: 2.5 mil people prescribed in 1980 164 mil today


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Biological approach

The problem with antidepressants with drugsis that they are prescribed differently todifferent groups of people: White Americans

2 X Hispanic Americans Over 5 X African Americans during the early stagesof treatment

Among those prescribed antidepressant drugs

African Americans significantly > likely than whiteAmericans to receive older antidepressant drugs

White Americans more likely than africanAmericans to receive newly marketed second-generation antidepressant drugs

Older drugs tend to be less expensive for insurance

providers


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Electroconvulsive Therapy (ECT) One of the most controversial forms of treatment Procedure in which 2 electrodes are attached to the head

and 65-140 volts of electricity are passed through the brain

for half a second or less Electrical stimulation causes the brain to seize from 25 seconds

to a few minutes Can be bilateral or __unilateral_______ Average __9__ sessions, works quickly and often when other

tx doesnt

Severe side effects such as __memory loss_____

Modifications: Now, use ___muscle relaxants and anesthetics__ Report less memory loss Improves in 60-80% of patients

Particularly effective in severe cases with delusions


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Brain stimulation Vagus Nerve Stimulation Longest nerve in the body running??? Can stimulate the brain through the Vagus nerve-pulse

generator last resort

40% of those who havent responded to other treatmentsrespond to vegus nerve stimulation

Transcranial Magnetic Stimulation Developed in 1985- place a magnetic coil above the head

and send a current to the prefrontal cortex Reduces depression when administered daily for 2-4 weeks

Deep Brain Stimulation Implant electrodes in ___???___ (depression switch) Stimulation reduced activation to a normal level 4 of 6 patients became depression-free within months RESEARCH IS IN EARLY STAGES

No long-term safety or impact studies


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Summing it up:

Current research suggests for unipolar depression:

Cognitive, CBT, interpersonal and biologicaltherapies are the most effective treatments

all helped 50-60% of patients, all better thanplacebo

Thought cognitive, CBT, and interpersonaltherapies show the lowest rates of relapse (30% in

a few years), they arent relapse-proof If the depression is rooted in marital conflict,

couples therapy is the most effective


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Treatments for bipolar disorder Until the late 20thcentury, people with bipolar

were stuck on the emotional roller coaster

Lithium extremely effective Approved by FDA in 1970

Difficulty in determining dosage

Too high = poison, too low = no impact Now, 1/3 of all bipolar patients seek therapy

Another class of mood stabilizers followedlithium???


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Treatments for bipolar disorder They really do work!

60% of patients improve

Most individuals experience few newer episodes on meds Findings suggest that mood stabilizers are prophylactic(preventative)

Works on depression as well, but to a lesser degree

How does it work? Researchers arent quite sure

Probably change synaptic activity in neurons- but clearly notthe way that antidepressants do

Increase the productions of neuroprotective proteins

Change the sodium and potassium ion activity in the neurons


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Combined Treatment for bipolar disorder

Psychotherapy alone isnt as helpful for peoplewith bipolar, but sometimes mood stabilizers

arent enough either Therapy, psycho-education, and close monitoring

of symptoms together can be a useful to combinewith medication

helps reduce hospitalization, improve socialfunctioning, and increase a clients ability toobtain and hold a job


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For next time

Read Chapter 10: Suicide for Wednesday, Feb.26th

Review for Test on Friday, Feb 28th

Documents

Treatment MoodDis Student Outline