• Disorders that feature severe changes in mood respond more successfully to more kinds of treatment than do most other forms of psychological dysfunction

Treatments for Unipolar Depression

• 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

Psychological Approaches

• 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 Approaches

• 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

Biological Approaches

• 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

How Do the Treatments for Unipolar Depression Compare?

• 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

Treatments for Bipolar Disorders

Lithium and Other Mood Stabilizers

• 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

Adjunctive Psychotherapy

• 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