Biological and Psychological Treatments for Mood Disorders: Depression and Bipolar - Prof., Study notes of Abnormal Psychology

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Treatment

of Mood Disorders

Biological Treatments - Depression



Tricyclic Antidepressants

 Prevent reuptake of NE and SE

 Reasonably effective for 60% of people with

acute depression



Lots of side effects: dry mouth, excessive

persipration, blurred vision, constipation,

sexual dysfunction, urinary retention

 Can take 4-8 weeks to have effect

 Can be fatal in overdose



Imipramine, Amitriptylene, Desipramine

Biological Treatments - Depression



Monoamine Oxidase inhibitors (MAOIs)

 Increases levels of monoamines (stops

breakdown)



As effective as tricyclics



Dangerous drug and food interactions

( tyramine in red wine, beer, chocolate)

 Dangerous side effects (liver damage, severe

lowering of blood pressure, weight gain)

 Selegiline

Biological Treatments - Depression

 (^) Selective Serotonin Reuptake Inhibitors (SSRIs)  (^) Work directly on SE  (^) Not more effective than tricyclics  (^) May be more effective in treatment of chronic depression  (^) Effective after a couple of weeks  (^) Less severe side effects  (^) Not fatal in overdose  (^) May also be helpful with anxiety symptoms, binge eating  (^) Wellbutrin, Zyban, Effexor, Cymbalata

Biological Treatments – Bip0lar  (^) Lithium  (^) Controlled trials demonstrate effectiveness in preventing relapse  (^) May stabilize serotonin, dopamine, glutamate  (^) More effective in reducing mania than depression  (^) Up to 55% of people develop tolerance after 3 yrs; only 1/3 remain symptom free on lithium  (^) Proper dosage is difficult  (^) Very small therapeutic window – toxic side effects (diabetes, hypothyroidism, kidney dysfunction, birth defects)  (^) Side effects – nausea, vomiting, abdominal pain, diarrhea, tremors, twitches, blurred vision, difficulty concentrating  (^) Compliance is a major issue

Biological Treatments – Bip0lar

Alternatives to Lithium…

 Anticonvulsants –Tegretol, Depakote

 May be effective for severe or acute mania

 May not have long-term efficacy

 Side effects: blurred vision, fatigue, vertigo,

nausea, liver disease

 Antipsychotics – clozapine, risperidone

 Reduce levels of dopamine

 Useful for psychotic mania

 Many neurological side effects: tardive dyskinesia

 (^) Calcium Channel Blockers

 More recent, show some effectiveness

Psychological Treatments – Depression  Behavioral Therapy  Increase positive reinforcers, decrease aversive experiences  (^) Change ways of interacting with environment/people  (^) Usually short-term (12 wks)  Begin with functional analysis  (^) What is the connection between circumstances & symptoms?  (^) Pinpoint behaviors that will be focus of therapy  (^) Challenges assumption that client is helpless

Psychological Treatments – Depression  Behavioral Therapy  Strategies for change

Changes in Environment

rewarding activities

Changes in Skills

for more positive social interactions

Changes in mood-management

strategies for negative circumstances

Psychological Treatments – Depression  Cognitive-Behavioral Therapy  Change negative, hopeless thinking  Develop problem-solving and build skills Effectiveness

 60-70% full improvement after 12 wks

 Useful for children, adolescents, older adults

Psychological Treatments – Depression  Cognitive-Behavioral Therapy Cognitive Techniques

1. Discover negative, automatic thoughts… Identify link between thoughts & depression
2. Challenge negative thoughts More than 1 way to interpret a situation
3. Recognize deeper assumptions that create depression e.g., If I’m not a success at everything, I’m worthless Behavioral Techniques Teach new skills: Assertiveness, Social Skills

Psychological Treatments – Depression  Interpersonal Therapy Grief, Loss  (^) Face loss, accept feelings & evaluate relationship  (^) Let go & invest in new relationships Interpersonal Role Disputes  (^) Recognize the dispute  (^) Guide in making choices, Identify concessions  (^) Develop better communication

Psychological Treatments – Depression  Interpersonal Therapy Role Transitions  (^) Develop realistic perspective on roles that are lost  (^) More positive view on new role  (^) Develop sense of mastery in new roles Interpersonal Skills Deficits  (^) Review past relationships to understand impact on current relationships  (^) Directly teach social skills

Psychological Treatments – Depression  Psychodynamic Therapy Observe transference to therapist  (^) Represent unconscious conflicts Identify themes in recollections of past, dreams  (^) Abandonment, hostility, disappointment

Goals are to help the client:

1. Gain insight

2. Accept unconscious concerns

3. Move beyond them

What’s the best treatment?  Comparing CBT, Interpersonal, Drug Therapies:  (^) Appear equally effective for treating most people with depression  (^) Combination of psychotherapy + drug therapy may be more effective for chronic depression than either alone 681 people randomly assigned to drug, CBT or drug +CBT  (^) 50% of drug group and CBT group improved  (^) 85% of drug + CBT improved  (^) Relapse  (^) For Bipolar Disorder, medication plus