Summary #6
Treatment of mood disorders
Recently increase in people who seek treatment for mood disorders.
- More treatments avalaible
- More awareness of availability of effective treatments
- Less stigma about mood disorders
60% still doesn’t receive adequate treatment
Pharmacotherapy
1. Monoamine oxidase inhibitors (MAOI’s)
= inhibit monoamineoxidase which is an enzyme responsible for the breakdown of
monoamines prevents breakdown of NE & serotonin
Evaluation?
Equally effective as other antidepresant
Dangerous/potentially fatal side effects (especially with specific diet)
2. Trycyclic antidepressant (TCA’s)
= increase in the transmission of monoamines (NE and some serotonin)
Evaluation?
Many studies have proven that they cause reduction of depressive symptoms
Unpleasant side effects take some time to diminish (people quit preliminary
to this reduction in severity s); dry mouth, constipation; sex. Dysfunction.
Still many residual symptoms
High toxicity when overdose (may facilitate suicide)
3. Selective serotonin reuptake inhibitors (SSRI’s)
= block reuptake of serotonin, more serotonin in the synapse. Treatment effects are
only significant when treating severe depression
Evaluation?
Equally effective as tricyclics (TCA’s might even be more effective)
Fewer side effects/better tolerated medication
Less toxicity in higher doses less risk of suicide
Side effects: less sexual activity/orgasm, insomnia, physical agitation
4. Lithium
= widely used mood stabilizer, used in treatment of episodes in bipolar disorder
(antimanic and anti-depressant)
Evaluation
¾ of those in mania show at least partial improvement
= no better effects than anti-depressants, but anti-depressants may evoke
episodes of mania/rapid cycling whereas lithium decreases this risk (actual
mood stabilizer)
Prevents cycling between episodes
1/3 is episode free over course of 5 years
Lithium leads to fewer epidsodes
lethargy, cognitive slowing, weight gain, motor coord., kidney damage
Reduction of elation/mania may be missed difficult to comply with taking
meds.
, 5. Anticonvulsants
= mood stabilizers that are implemented if lithium seems ineffective (may be added
to lithium dose)
6. Antipsychotics
= sometimes antipsychotics are added to a dose of antidepressant or mood
stabilizers when people show some signs of psychosis.
Course?
o Drugs take 3-5 weeks to take effect.
o If no effects after 6 weeks switch to new (combination of) meds
o Underlying depression is still present, drugs only inhibits symptomatic expression
quit drugs? Often results in recurrence
= drugs have to be taken long-term
o Pharmacotherapy may also be used as a means of prevention
o 50% of those who don’t respond to initial treatment do respond significantly when
switched to a different (combination of) medication.
o Full symptom remission is important in order to reduce chances of relapse
Other biological treatments
ECT
= the induction of seizure under anesthesia. No idea how it affects depressive
symptoms
mainly used in those who are severely depressed because of its (almost)
immediate effects on reducing depressive symptoms.
Significant side effects: confusion, negative effects on cognition/memory
Usually combined with pharmacotherapy to prevent relapse
TMS
= brief intense pulsating magnetic electrical activation in certain parts of the cortex
(non-invasive)
5 days a week, 2-6 weeks
Promising to those who are resistant to other treatments
Less cognitive consequences/side effects (opposed to ECT)
Deep brain stimulation
= planting an electrode in the brain and stimulating deep brain tissue
last resort when nothing else works
potential but not too much evidence
Bright light therapy
= exposure to bright light
used for seasonal affective disorder
recently evidence that it may be beneficial to general depression
Psychotherapy
CBT
= brief treatment (10-20 sessions), that focusses on here and now problems (no
remote causal issues), that uses structured and systematic approaches to evaluate
dysfunctional beliefs and automatic negative thoughts.
Identify and alter biases and information distortions
Uncover underlying depressogenic beliefs and assumptions
Treatment of mood disorders
Recently increase in people who seek treatment for mood disorders.
- More treatments avalaible
- More awareness of availability of effective treatments
- Less stigma about mood disorders
60% still doesn’t receive adequate treatment
Pharmacotherapy
1. Monoamine oxidase inhibitors (MAOI’s)
= inhibit monoamineoxidase which is an enzyme responsible for the breakdown of
monoamines prevents breakdown of NE & serotonin
Evaluation?
Equally effective as other antidepresant
Dangerous/potentially fatal side effects (especially with specific diet)
2. Trycyclic antidepressant (TCA’s)
= increase in the transmission of monoamines (NE and some serotonin)
Evaluation?
Many studies have proven that they cause reduction of depressive symptoms
Unpleasant side effects take some time to diminish (people quit preliminary
to this reduction in severity s); dry mouth, constipation; sex. Dysfunction.
Still many residual symptoms
High toxicity when overdose (may facilitate suicide)
3. Selective serotonin reuptake inhibitors (SSRI’s)
= block reuptake of serotonin, more serotonin in the synapse. Treatment effects are
only significant when treating severe depression
Evaluation?
Equally effective as tricyclics (TCA’s might even be more effective)
Fewer side effects/better tolerated medication
Less toxicity in higher doses less risk of suicide
Side effects: less sexual activity/orgasm, insomnia, physical agitation
4. Lithium
= widely used mood stabilizer, used in treatment of episodes in bipolar disorder
(antimanic and anti-depressant)
Evaluation
¾ of those in mania show at least partial improvement
= no better effects than anti-depressants, but anti-depressants may evoke
episodes of mania/rapid cycling whereas lithium decreases this risk (actual
mood stabilizer)
Prevents cycling between episodes
1/3 is episode free over course of 5 years
Lithium leads to fewer epidsodes
lethargy, cognitive slowing, weight gain, motor coord., kidney damage
Reduction of elation/mania may be missed difficult to comply with taking
meds.
, 5. Anticonvulsants
= mood stabilizers that are implemented if lithium seems ineffective (may be added
to lithium dose)
6. Antipsychotics
= sometimes antipsychotics are added to a dose of antidepressant or mood
stabilizers when people show some signs of psychosis.
Course?
o Drugs take 3-5 weeks to take effect.
o If no effects after 6 weeks switch to new (combination of) meds
o Underlying depression is still present, drugs only inhibits symptomatic expression
quit drugs? Often results in recurrence
= drugs have to be taken long-term
o Pharmacotherapy may also be used as a means of prevention
o 50% of those who don’t respond to initial treatment do respond significantly when
switched to a different (combination of) medication.
o Full symptom remission is important in order to reduce chances of relapse
Other biological treatments
ECT
= the induction of seizure under anesthesia. No idea how it affects depressive
symptoms
mainly used in those who are severely depressed because of its (almost)
immediate effects on reducing depressive symptoms.
Significant side effects: confusion, negative effects on cognition/memory
Usually combined with pharmacotherapy to prevent relapse
TMS
= brief intense pulsating magnetic electrical activation in certain parts of the cortex
(non-invasive)
5 days a week, 2-6 weeks
Promising to those who are resistant to other treatments
Less cognitive consequences/side effects (opposed to ECT)
Deep brain stimulation
= planting an electrode in the brain and stimulating deep brain tissue
last resort when nothing else works
potential but not too much evidence
Bright light therapy
= exposure to bright light
used for seasonal affective disorder
recently evidence that it may be beneficial to general depression
Psychotherapy
CBT
= brief treatment (10-20 sessions), that focusses on here and now problems (no
remote causal issues), that uses structured and systematic approaches to evaluate
dysfunctional beliefs and automatic negative thoughts.
Identify and alter biases and information distortions
Uncover underlying depressogenic beliefs and assumptions
