PART 5 EXAM 2 (TREATMENTS DEPRESSION AND BIPOLAR) – Flashcards
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Statistics depression treatment
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-Around half of persons with unipolar depression (Major depressive or dysthymic disorder) receive treatment from a mental health professional each year -In addition, many people in therapy experience depressed feelings due to another disorder, so much of therapy being done today is for unipolar depression
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Treatments unipolar depression
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Can be divided into psychological, sociocultural, and biological approaches
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Psychological treatments depression
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Come from three main schools of thought: psychodynamic, behavioral, and cognitive
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Psychodynamic approach depression
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Psychological treatment. Widely used despite no strong research evidence of its effectiveness
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Behavioral approach depression
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Psychological treatment. Primarily used for mild or moderate depression but practiced less than in past decades
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Cognitive approach depression
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Psychological treatment. Has performed so well in research that it has a large and growing clinical following
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Psychodynamic therapy
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-Believing that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people, therapists seek to bring these issues into consciousness and work through them -Use same basic procedures for all psychological disorders: free association, therapist interpretation, and review of past events and feelings -Long term of therapy only occasionally helpful in cases of unipolar depression, short term better
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Limitations psychodynamic therapy
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-For unipolar depression 1. Depressed clients may be too passive or weary to fully participate in subtle therapy discussions 2. Depressed clients may become discouraged and end treatment too early when it is unable to provide quick relief -This is why short term approaches perform better than traditional
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Behavioral therapy
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-Most of this therapy for unipolar depression: 1. Reintroduce clients to pleasurable activities and events, often sing a weekly schedule 2. Appropriately reinforce their depressive and non depressive behaviors 3. Help them improve their social skills
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Cognitive therapy
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-Beck viewed unipolar depression as resulting from a pattern of negative thinking that may be triggered by current upsetting situations -Maladaptive attitudes lead people to "cognitive triad" -These biased views combine with illogical thinking to produce automatic thoughts
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Cognitive triad
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Repeatedly viewing oneself, the world, and the future in negative ways (anxiety!)
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Beck's cognitive therapy
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-Includes a number of behavioral techniques -Designed to help clients recognize and change their negative cognitive process -Approach follows four phases and usually lasts fewer than 20 sessions
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Phases beck's cognitive therapy
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-Increasing activities and elevating mood (behavioral) -Challenging automatic thoughts (cognitive) -Identifying negative thinking and biases (cognitive) -Changing primary attitudes (cognitive)
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Facts cognitive therapy
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-Over past several decades, hundreds of studies have shown that cognitive therapy helps unipolar depression -Around 50-60% of clients show a near total elimination of symptoms
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ACT
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-Beck believed individuals must fully disregard -Growing number of todays cognitive behavioral therapists disagree with this proposition -These therapists guide clients to recognize and accept their negative conditions, this is called
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Mood tracking
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-Cognitive behavioral and other therapists who work with depressed clients often instruct them to do this, follow the way the moods change hour by hour and day by day -Clients also told to note situations and thoughts that cause mood changes -Apps for smartphones can do this, gaining in popularity
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Sociocultural treatment depression
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-Theorists trace the causes of unipolar depression to the broader social structure in which people live and the roles they are required to play -Two groups of these treatments now widely applied, multicultural and family social
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Multicultural treatments
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-Culture sensitive approaches increasingly are being combined with traditional forms of psychotherapy to help maximize likelihood of minority clients overcoming their disorders -Also appears that medication need of many depressed minority clients are inadequately addressed
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Interpersonal therapy
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-A family social treatment -Model holds that four interpersonal problems may lead to depression and must be addressed: -Loss -Role dispute -Role transition -Deficits -Studies suggest that this is as effective as cognitive therapy for treating depression -"IPT"
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Behavioral marital therapy
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-A family social treatment -Main type of couple therapy -Focus on developing specific communication and problem solving skills -If marriage is filled with conflict, BMT is as effective as other therapies for reducing depression -"BMT"
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Biological treatments depression
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-Can bring great relief -Usually means antidepressant drugs, but for severely depressed individuals includes ECT or brain stimulation
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ECT
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-One of the most controversial forms of treatment for depression -Used frequently because it is an effective and fast acting intervention -Procedure consists of targeted electrical stimulation to cause a brain seizure -Usual course of treatment is 6 to 12 sessions spaced over 2 to 4 weeks -Treatment may be bilateral or unilateral -Discovery of effectiveness accidental and based on fallacious link between psychosis and epilepsy -Procedure modified in recent years to reduce some of the negative side effects -For example, patients are given muscle relaxants and anesthetics before and during the procedure -Patients generally report some memory loss
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ECT effectiveness
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-Clearly effective in treating depression, studies find improvement in 60-80% of patients -Procedure seems particularly effective in cases of severe depression with delusions but it has been difficult to determine why it works so well -Although effective, use has declined since the 1950s because the memory loss caused, its frightening nature, and emergence of effective antidepressant drugs
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Benefits second generation
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-In effectiveness and speed of action these drugs are on a par with the tricyclics, yet sales have skyrocketed -Clinicians prefer these drugs because it is harder to overdose on them than other antidepressants -No dietary restrictions like MAO inhibitors -Fewer side effects than tricyclics -However drugs may cause some undesired effects of their own, including a reduction of sex drive
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Antidepressant drugs
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-Biological treatment depression -In the 1950s two kinds of drugs found to reduce symptoms of depression: 1. Tricyclics 2. MAO inhibitors -Drugs have been joined in recent years by another group 3. Second generation antidepressants (ex prozac) -Do not work for everyone, even most successful of them fails to help at least 35% of clients with depression
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Second Generation Antidepressants
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-Structurally different from MAO inhibitors and tricyclics, most of the drugs in this group are labeled selective serotonin repute inhibitors (SSRIs) -These drugs increase seratonin activity specifically (no other NTs effected) -Class includes prozac, zoloft, and lexapro -Selective NRIs and Seratonin NRIs are also now available
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Brain Stimulation
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-Three biological approaches to this: -Vagus nerve stimulation -Transcranial magnetic stimulation -Deep brain stimulation
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Vagus nerve stimulation
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-Depression researchers surmised they might be able to stimulate the brain by electrically stimulating this through the use of a pulse generator implanted under the skin of the chest -Research has found that the procedure brings significant relief to as many as 40% of those with treatment resistant depression -As with ECT, researchers do not know why this reduces depression
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Transcranial magnetic stimulation
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-Another technique designed to stimulate the brain without the undesired effects of ECT, TMS has been found to reduce depression when administered daily for 2 to 4 weeks
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Problems brain stimulation
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While positive initial findings have produced enthusiasm, it is important to recognize and remember that in the past, certain promising interventions (like lobotomies) later proved problematic and even dangerous upon closer inspection
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Deep brain stimulation
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-Theorizing a "depression switch" located deep within the brain, researchers have successfully experimented with electrode implantation in the brains Brodman area 25 (area is rich in serotonin transporters)
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Effectiveness couple therapy
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Treatment outcome studies suggest that when people with unipolar depression experience significant marital discord, this tends to be very helpful
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Comparing treatments depression
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-For most kinds of psychological disorders, no more than one of two treatments, if any, emerge as highly successful -Unipolar depression seems to be an exception, responding to any of several approaches (could this be partly a placebo effect?) -Treatment outcome studies suggest cognitive, cognitive behavioral, interpersonal, and biological therapies are all highly effective treatments for mild to severe unipolar depression -Although cognitive, cognitive behavioral, and interpersonal therapies may lower the likelihood of relapse, they are hardly relapse proof -Trends do not always carry over to depressed children and adolescents
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Effectiveness behavioral therapy
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Treatment outcome studies suggest that depressed people who receive strictly this have shown less improvement than those who receive cognitive, cognitive behavioral, interpersonal, or biological therapy
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Effectiveness psychodynamic therapies
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Findings from a number of treatment outcome studies suggest that traditional these are less effective than other therapies in treating all levels of unipolar depression
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Psychotherapy and drug therapy
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Finings from a number of treatment outcome studies suggest that a combination of these is modestly more helpful to depressed people than either treatment alone
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Effectiveness ECT
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Number of treatment outcome studies suggest that this appears to be somewhat more effective than antidepressant drugs and act more quickly among biological treatments
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Effectiveness brain stimulation
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Number of treatment outcome studies suggest that these new treatments seem helpful for some severely depressed individuals who have been repeatedly unresponsive to drug therapy, ECT, or psychotherapy
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Treatments bipolar disorder
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-Until the latter part of the 20th century, people with this were destined to spend their lives on an emotional roller coaster -Psychotherapists reported almost no success -Antidepressant drugs were of limited help and sometimes triggered manic episodes -ECT only occasionally relieved either the depressive or manic episodes of bipolar disorder
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Lithium and other mood stabilizers
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-Changed the picture for bipolar patients and controlling mania -Effective - Determining the correct dosage for a given patient is delicate, too low not effective and too high poisoning -Given the effectiveness, 1/3 of all persons with bipolar disorder seek treatment in a given year and another 15% are monitored by family physicians
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Effectiveness lithium
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-All research has attested to the effectiveness of this and other mood stabilizers -More than 60% of patients with mania improve on these mediations -Most individuals experience fewer new episodes while on the drug -Findings suggest that the mood stabilizers are also prophylactic drugs, ones that actually help prevent symptoms from developing -Mood stabilizers also help those with bipolar disorder overcome their depressive episodes to a lesser degree
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Understanding mood stabilizers
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-Researchers do not fully know how these operate -They suspect that the drugs change synaptic activity in neurons, but in a different way from that of antidepressant drugs (there are various theories)
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Adjunctive psychotherapy
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-Psychotherapy lone rarely helpful to those with bipolar disorder -Mood stabilizing drugs alone are also not always sufficient -30% or more of patients don't respond, may not receive right dose, and or may relapse while taking it -As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication based therapy) -Focuses on medication management, social skills, and relationship issues
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Effectiveness adjunctive psychotherapy
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-Few controlled studies have tested the effectiveness of this -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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Psychedelics
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-Limited research is promising... -" Clinical trials reported over the past decade have generally shown positive therapeutic potential, but they are notably few in number. Legislative policy has had a freezing effect on evaluation of these compounds, a better understanding of which might improve our knowledge of the processes involved in consciousness, the neuropathology of depression, and potentially open up new pharmacological therapies."
