Slides & Handouts by Karen Clay Rhines, Ph.D.
Seton Hall University
Chapter 9
Treatments for Mood Disorders
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Mood Disorders

Mood disorders – as extraordinarily painful and
disabling as they tend to be – respond more
successfully to more kinds of treatments than
do most other forms of psychological
dysfunction

This diversity of successful treatments has affected
individuals with depression in both positive and
negative ways
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression

Approximately one-third of people with
unipolar depression (major depressive or
dysthymic disorder) enter treatment in a given
year

In addition, many other people in therapy experience
depressed feelings as part of another disorder –
thus, much of the therapy being administered today
is for unipolar depression
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression

A variety of treatment approaches are in
widespread use

These can be divided into psychological,
sociocultural, and biological approaches
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Psychological approaches to treating unipolar
depression come from the three main models:

Psychodynamic – Widely used despite no strong
research evidence of its effectiveness

Behavioral – Primarily used for mild or moderate
depression but practiced less than in past decades

Cognitive – Has performed so well in research that it
has a large and growing clinical following
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Psychodynamic therapy

Believing that unipolar depression results from unconscious
grief over real or imagined losses, compounded by excessive
dependence on other people, psychodynamic therapists seek
to bring these issues into consciousness and work through
them

Psychodynamic therapists use the same basic procedures for
all psychological disorders:

Free association

Therapist interpretation
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Treatments for Unipolar Depression:
Psychological Approaches

Psychodynamic therapy

Despite successful case reports, researchers have found that
long-term psychodynamic therapy is only occasionally helpful
in cases of unipolar depression

Two features may be particularly limiting:


Depressed clients may be too passive or weary to fully participate in
clinical discussions

Depressed clients may become discouraged and end treatment too
early when treatment doesn’t provide fast relief
Short-term approaches have performed better than
traditional approaches
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Behavioral therapy

Lewinsohn, whose theory tied a person’s mood to
his/her life rewards, developed a behavioral therapy
for unipolar depression in the 1970s:

Reintroduce clients to pleasurable activities and events,
often using a weekly schedule

Appropriately reinforce their depressive and
nondepressive behaviors


Use a contingency management approach
Help them improve their social skills
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Behavioral therapy

The behavioral techniques seem to be of only
limited help when just one of them is applied

When treatment programs combine two or three of the
techniques, as Lewinsohn had envisioned, depressive
symptoms (especially mild symptoms) seem to be reduced
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Cognitive therapy

Beck views unipolar depression as resulting from a
pattern of negative thinking that may be triggered by
current upsetting situations

Maladaptive attitudes lead people to the “cognitive triad”


Negatively viewing oneself, the world, and the future
These biased views combine with illogical thinking to
produce automatic thoughts
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Treatments for Unipolar Depression:
Psychological Approaches

Cognitive therapy



Beck’s cognitive therapy – the leading cognitive treatment
for unipolar depression – is designed to help clients
recognize and change their negative cognitive processes
This approach follows four phases and usually lasts fewer
than 20 sessions
Phases:
1.
2.
3.
4.
Increasing activities and elevate mood
Challenging automatic thoughts
Identifying negative thinking and biases
Changing primary attitudes
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Psychological Approaches

Cognitive therapy

Over the past three decades, hundreds of studies
have shown that cognitive therapy helps unipolar
depression

Around 50%–60% of clients show a near-total
elimination of symptoms

This treatment has also been used in a group therapy
format
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Sociocultural Approaches

Theorists trace the causes of unipolar
depression to the broader social structure in
which people live, and the roles they are required
to play

The most effective sociocultural approaches to
treating unipolar depression are interpersonal
psychotherapy and couple therapy

The techniques used in these approaches borrow
from other models
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Sociocultural Approaches

Interpersonal therapy (IPT)


This model holds that four interpersonal problems
may lead to depression and must be addressed:

Interpersonal loss

Interpersonal role dispute

Interpersonal role transition

Interpersonal deficits
Studies suggest that IPT is as effective as cognitive
therapy for treating depression
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Sociocultural Approaches

Couple therapy

The main type of couple therapy is behavioral
marital therapy (BMT)


Focus is on developing specific communication and
problem-solving skills
If marriage is conflictual, BMT is as effective as
other therapies for reducing depression
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Biological treatments can bring great relief to
people with unipolar depression

Usually biological treatment means
antidepressant drugs, but for severely depressed
persons who do not respond to other forms of
treatment, it sometimes includes
electroconvulsive therapy
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Electroconvulsive therapy (ECT)

The use of ECT was -- and is -- controversial


It is now used frequently but only in severe cases
The procedure consists of targeted electrical
stimulation to cause a brain seizure

The usual course of treatment is 6 to 12 sessions spaced
over two to four weeks

Treatment may be bilateral or unilateral
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Electroconvulsive therapy (ECT)

The discovery of the effectiveness of ECT was
accidental and based on a fallacious link between
psychosis and epilepsy

The procedure has been modified in recent years to
reduce some of the negative effects


For example, patients are given muscle relaxants and
anesthetics before and during the procedure
Patients generally report some memory loss
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Electroconvulsive therapy (ECT)

ECT is clearly effective in treating unipolar depression

Studies find improvement in 60%–70% of patients

The procedure seems particularly effective in cases of severe
depression with delusions, but it has been difficult to
determine why ECT works so well

Although effective, the use of ECT has declined since the
1950s, because of the memory loss caused by the procedure
and the emergence of effective antidepressant drugs
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs


In the 1950s, two kinds of drugs were found to be
effective:

Monoamine oxidase inhibitors (MAO inhibitors)

Tricyclics
These drugs have been joined in recent years by a
third group, the second-generation antidepressants
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: MAO inhibitors

Originally used to treat TB, doctors noticed that the
medication seemed to make patients happier

The drug works biochemically by slowing down the body’s
production of MAO

MAO breaks down norepinephrine

MAO inhibitors stop this breakdown from occurring

This leads to a rise in norepinephrine activity and a reduction in
depressive symptoms

About half of patients who take these drugs are helped by them
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: MAO inhibitors

MAO inhibitors potentially pose a serious danger!


Blood pressure may rise to a potentially fatal level if one
eats foods with tyramine (cheese, bananas, wine) while
taking MAOIs
In recent years, a new MAO inhibitor in the form of
a skin patch has become available

Dangerous food interactions do not appear to be as
common a problem with this kind of MAO inhibitor
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: Tricyclics

In searching for medications for schizophrenia,
researchers discovered that imipramine lessened
depressive symptoms

Imipramine and related drugs are known as tricyclics
because they share a three-ring molecular structure
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: Tricyclics

Hundreds of studies have found that depressed
patients taking tricyclics have improved much more
than similar patients taking placebos

Drugs must be taken for at least 10 days before such
improvement is seen

About 60%–65% of patients find symptom improvement
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: Tricyclics

Most patients who immediately stop taking tricyclics
upon relief of symptoms relapse within one year

Patients who take tricyclics for five additional months
(“continuation therapy”) have a significantly decreased
risk of relapse

Patients who take antidepressant drugs for three or more
years after initial improvement (“maintenance therapy”)
may reduce the risk of relapse even more
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: Tricyclics

Tricyclics are believed to reduce depression by affecting
neurotransmitter (NT) reuptake

To prevent an NT from remaining in the synapse too long, a
pumplike mechanism recaptures the NT and draws it back into the
presynaptic neuron

The reuptake process appears to be too effective in some people,
drawing in too much of the NT from the synapse

This reduction in NT activity in the synapse is thought to result in
clinical depression

Tricyclics block the reuptake process, thus increasing NT activity in
the synapse
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Antidepressant drugs: Tricyclics

There is growing evidence that when tricyclics are ingested,
they initially slow down the activity of the neurons that use
norepinephrine and serotonin

After a week or two, the neurons adapt to the drugs and go
back to releasing normal amounts of the NTs

Today tricyclics are prescribed more often than MAO
inhibitors

They do not require dietary restrictions

Some patients show higher rates of improvement
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Second-generation antidepressant drugs

A third group of effective antidepressant drugs is structurally
different from the MAO inhibitors and tricyclics


These drugs act only on serotonin (no other NTs are
affected)


Most of the drugs in this group are labeled selective serotonin
reuptake inhibitors (SSRIs)
This class includes fluoxetine (Prozac) and sertraline (Zoloft)
Selective norepinephrine reuptake inhibitors and serotoninnorepinephrine reuptake inhibitors are also now available
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Unipolar Depression:
Biological Approaches

Second-generation antidepressant drugs


The effectiveness and speed of action of these drugs is on
par with the tricyclics yet they boast enormous sales

Clinicians often prefer these drugs because it is harder to overdose on
them than on other kinds of antidepressants

There are no dietary restrictions like there are with MAO inhibitors

There have fewer side effects than the tricyclics
These drugs may cause some undesired effects of their own,
including a reduction in sex drive
Comer, Abnormal Psychology, 6e – Chapter 1
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How Do the Treatments for
Unipolar Depression Compare?

For most kinds of psychological disorders, no
more than one or two treatments, if any, emerge
as successful

Unipolar depression seems to be the exception,
responding to any of several approaches
Comer, Abnormal Psychology, 6e – Chapter 1
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How Do the Treatments for
Unipolar Depression Compare?

Findings from a number of research studies
suggest that:

Cognitive, interpersonal, and biological therapies are
all highly effective treatments for mild to severe
unipolar depression

Although cognitive and interpersonal therapies may
lower the likelihood of relapse, they are hardly
relapse-proof
Comer, Abnormal Psychology, 6e – Chapter 1
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How Do the Treatments for
Unipolar Depression Compare?

Findings from a number of research studies
suggest that:

When persons with unipolar depression experience
significant marital discord, couple therapy tends to
be very helpful

Depressed people who receive strictly behavioral
therapy have shown less improvement than those
who receive cognitive, interpersonal, or biological
therapy
Comer, Abnormal Psychology, 6e – Chapter 1
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How Do the Treatments for
Unipolar Depression Compare?

Findings from a number of research studies
suggest that:

Psychodynamic therapies are less effective than
other therapies in treating all levels of unipolar
depression

A combination of psychotherapy and drug therapy
is modestly more helpful to depressed people than
either treatment alone
Comer, Abnormal Psychology, 6e – Chapter 1
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How Do the Treatments for
Unipolar Depression Compare?

Findings from a number of research studies
suggest that:

Among biological treatments, antidepressant drugs
and ECT appear to be equally effective for reducing
depression, although ECT seems to act more quickly
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorders

Until the latter part of the 20th century, people
with bipolar disorders were destined to spend
their lives on an emotional roller coaster

Psychotherapists reported almost no success

Antidepressant drugs were of limited help


These drugs sometimes triggered manic episodes
ECT only occasionally relieved either the depressive
or the manic episodes of bipolar disorder
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorders:
Lithium Therapy

The use of lithium, a metallic element occurring
as mineral salt, has dramatically changed this
picture

It is extraordinarily effective in treating bipolar
disorders and mania

Determining the correct dosage for a given patient is
a delicate process

Too low = no effect

Too high = lithium intoxication (poisoning)
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorder:
Lithium Therapy


Lithium provides improvement for more than
60% of manic patients

Most patients also experience fewer new episodes
while on the drug

Lithium also is a prophylactic drug, one that actually
prevents symptoms from developing
Lithium also helps those with bipolar disorder
overcome their depressive episodes
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorder:
Lithium Therapy

Researchers do not fully understand how lithium
operates

They suspect that it changes synaptic activity in neurons, but
in a different way from that of antidepressant drugs


Although antidepressant drugs affect a neuron’s initial reception on
NTs, lithium seems to affect a neuron’s second messengers
Another theory is that lithium corrects bipolar functioning by
directly changing sodium and potassium ion activity in
neurons
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorder:
Adjunctive Psychotherapy

Psychotherapy alone is rarely helpful for persons with
bipolar disorder

Lithium therapy alone is also not always sufficient,
either


30% or more of patients don’t respond, may not receive the
correct dose, or may relapse while taking it
As a result, clinicians often use psychotherapy as an
adjunct to lithium (or other medication-based) therapy
Comer, Abnormal Psychology, 6e – Chapter 1
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Treatments for Bipolar Disorder:
Adjunctive Psychotherapy

Therapy focuses on medication management,
social skills, and relationship issues

Few controlled studies have tested the
effectiveness of such adjunctive therapy

Growing research suggests that it helps reduce
hospitalization, improves social functioning, and
increases clients’ ability to obtain and hold a job
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