Psychotherapy for Unipolar Depression
Cognitive Behavioural Therapy; Interpersonal Psychotherapy
CBT Goal
Based on cognitive theory of depression that states that one’s emotional reactions to a situation are determined by one’s thoughts about that situation. Most extensively evaluated of all psychological treatments for depression. Teaches people to become aware of the meanings and attributions to events in their lives, and to examine how these cognitions contribute to the emotional reactions that follow. Typically involves 16 - 20 sessions
Activity Scheduling (CBT)
Encourages clients to start scheduling activities they emjoy back into their lives
Thought Record (CBT)
Encourages clients to write down all the thoughts running through his/her mind during the situation. Therapist works with client to evaluate the accuracy of these thoughts
Behavioural Experiments (CBT)
Encourage people to view their maladaptive thoughts as scientific hypotheses that can be tested (ex. the assumption “if I try to talk to new people I will be rejected” is easy to est empirically. Client does the experiment then observes what took place)
Interpersonal Psychotherapy
Presumes that depression occurs in an interpersonal context and that addressing current problems that depressed clients face in the interpersonal realm is key to reliving symptoms. Brief treatment that runs form 12 - 16 weekly session. Towards beginning of treatment, client and therapist work together to identify client’s source or interpersonal dysfunction with relevance to interpersonal disputes, role transition, greid, and interpersonal deficits
Interpersonal Disputes (IPT)
Conflicts in partital, family, or other social relationships. IPT therapist intervenes by identifying sources of misunderstanding and using communication and problem solving training to empower the client to change the situation
Role Transition (IPT)
Situations in which the client as difficulty adapting to a life change - retirement, jobs, loss, empty nest). IPT therapist intervenes by helping client reappraise old and new roles, identify problems in adapting to the new role, and altering dysfunctional appraisals of new role
Grief (IPT)
IPT Therapist use empathetic listening to help the client work through the mourning process and encourages the client to form new relationships
Medications to Treat Major Depression
Tricyclics, Monoamine Oxidase Inhibitors, Selective Serotonin Reuptake Inhibitors
Interpersonal Deficits
Main problem for a client who reports either a low number or poor quality of interpersonal relationships. ITP therapist tries to identify personality issues in the client (hostility, excessive dependency) that may be interfering with the formation of close relationships, and uses the therapeutic relationship as a model for improving social competence
Ticyclics
Oldest class of antidepressant. Blocks the reuptake from the synapse of NE and/or less commonly 5-HT AKA more of these neurotransmitters are available in the synapse to bind to postsynaptic receptors and trigger new action potentials. Rarely used as a first line treatment today because of their many side effects
Monoamine Oxidase Inhibitors
MAOIs work by inhibiting an enzyme (monamine oxidase) that breaks down monoaminergic neurotransmitters (eg. dopamine, norepinephrine, serotonin) in the presynaptic cell. More monoamines are available to be released into the synapse, to bind with postsynaptic receptors and trigger new action potentials. MAOIs are rarely used as first line treatment due to their potentially dangerous side effects
Selective Serotonin Reuptake Inhibitors
SSRIs are currently the first line of treatment for unipolar depression due to their relatively mild side effects, high safety profile and ease or administration. SSRI’s bloc the reuptake of serotonin into presynaptic cell AKA more serotonin is available in the synapse to bind post synaptic receptors and trigger new action potentials
Negatives to Pharmacotherapy
Associated with a high risk of relapse
Medications to Treat Bipolar Disorder
Lithium; Anticonvulsants; Antipsychotics; Antidepressants
Lithium
Used asa treatment for manie
Anticonvulsants
Work by increasing the synthesis and release of the neurotransmitter gamma - aminobutyric acid (GABA), which plays a general inhibitory role in the brain. Others work by decreasing the synthesis and release of the neurotransmitter glutamate, which as general excitatory effect of the brian
Antipsychotics
May be used as a short term treatment during acute manic or sever depression episodes. These medications may be used to control psychotic symptoms such as hallucinations or delusions and also may be used to help with the insomnia and agitation. Some antpsychotic meds have been found to have a mood stabilizing effect on their own and can be used for those patients who do not respond to lithium or anticonvulsants
Antidepressants
All antidepressants are associated with a risk for triggering mania in bipolar patients, however some of these medications are typically used in conjunction with one of the mood stabilizing medications
Combinations of Psychotherapy and Medication for Unipolar Disorder
For patients with severe depression, there is evidence that the combo of IPT and medication is superior to either alone. For patients with persistent depression there is evidence that the combo of CBASP (version of CBT modified for persistent depression) and medication is superior to either alone. Evidence shows that adding CBT for patients who fail to respond fully to medication improves remission rates and helps preventing relapse. Evidence that combo of CBT and medication is superior to either alone in the treatment of adolescents w/depressiong
Adjunctive Psychotherapy for Bipolar Disorder
Most effective treatment for BD is medication
Family Focused Therapy (BD)
Consists of education for that patient and their family members about the disorder and its effect on the patient’s functioning, as well as communication and problem solving training all family members
Interpersonal and Social Rhythm Therapy (BD)
Based on the theory that disruptions in daily routines and conflicts in interpersonal relationships can cause relapses of bipolar episodes. In treatment, patients are taught to regulate their routines to cope more effectively with stressful events
