Chapter 9: Treatment of Mood Disorders Flashcards
What is electroconvulsive therapy used to treat?
Severe depression not responding to meds
How is modern ECT like a surgical procedure?
- Anesthesia and muscle relaxants
- Oxygen to reduce memory loss
- Heart monitor, EEG monitoring, etc.
During what time period was ECT overused?
1940s-mid 1960s
Describe the levels and duration of the ECT shocks.
- Levels = 12-65 volts
- Duration < 1/2 sec
How long do ECT convulsions last?
Several mins
How many treatments is ECT?
At least 6-10
What is the relapse rate of ECT?
60%
What are the common and less common side effects of ECT?
- Common = severe headaches, memory loss for events surrounding ECT
- Less common = irretrievable loss of long-term memories
How does transcranial magnetic stimulation work?
Electromagnetic coil is held against patient’s scalp that emits powerful magnetic pulses to alter brain activity
What is TMS used to treat?
Treatment-resistant depression mostly
What is VNS used to treat?
Treatment-resistant depression
What is vagus nerve stimulation? How does it work?
-Surgical implantation of a pulse generator in left upper chest –> wires go from upper chest into the neck and send mild pulses every 5 mins to left vagus nerve –> to the brain areas involved in regulation of mood, motivation, sleep, appetite, etc.
What are some side effects of VNS?
Voice alteration or hoarseness
What is light therapy used to treat?
Seasonal Affective DIsorder
What equipment does light therapy require?
Light boxes (at least 10K lux)
When did tricyclics start becoming available?
Mid 1960s
What are tricyclics? What do they treat?
- Mostly norepinephrine reuptake inhibitors
- Treat mood disorders
What are the side effects of Tricyclics?
- Weight gain
- Sedation
- Constipation
- Dry mouth
What does SSRI stand for?
Serotonin Selective Reuptake Inhibitors
When did SSRIs become available in the U.S.?
1989
How do SSRIs work?
By blocking serotonin reuptake so it stays in the system
What are the advantages of SSRIs over tricyclics?
- Generally fewer side effects
- Less dangerous in overdose
- Less interaction w/ alcohol
- Faster action that tricyclics (2-3 weeks vs. 5-6 weeks)
- More effective for OCD
- More effective for sensitivity to rejection
What are the side effects of SSRIs?
- Sexual = delayed orgasm, decreased desire or arousal
- Headaches and GI probs
- Zombie-like feeling
- Elevated suicide risk b/c very activating
- Increased energy before mood & negative thoughts improve
When did MAO inhibitors become available?
1960s
How do MAO inhibitors work?
- Block enzymes at synapses that degrade excess NT at synapses
- Increase norepinephrine, serotonin, dopamine
What are the problems associated w/ MAO inhibitors?
- Block same enzymes in live and intestines –> causes tyramine build up
- Danger of hypertensive crisis (stroke, heart attack)
- Food restrictions
- Dangerous interactions w/ most other medications
What does SNRI stand for?
Serotonin-Norepinephrin Reuptake Inhibitors
How do SNRIs work?
Block reuptake of both norepinephrine and serotonin
What does NDRI stand for?
Norepinephrine-Dopamine Reuptake Inhibitors
How do NDRIs work?
Blocks reuptake of mostly dopamine and also norepinephrine
What are the effects of NDRIs?
- Very activating
- No weight gain
- No decrease in sexual functioning
What conditions are NDRIs helpful with?
- ADHD
- Former stimulant abusers
What conditions are NDRIs not used for?
- Anxiety
- Panic
- OCD
What are mood stabilizers used for?
Mostly to prevent mania
What other meds can mood stabilizers be combined with?
- Antidepressants
- Antipsychotics
How long does it take for mood stabilizers to kick in?
Require weeks to build up to therapeutic blood levels
How long has lithium been available?
1950s
How does lithium work?
- Affects the flow of sodium through nerve & muscle cells
- Interferes w/ relay and amplification of neuronal messages
What are the restrictions of lithium?
- Requires build up in system
- Narrow therapeutic range
- Regular blood draws required
What are the side effects of lithium?
- Fine hand tremors
- Short-term memory impairment
- Weight gain
- Possible sedation
- Kidney toxicity
- Flu-like symptoms, lack of coordination, confusion
When are anticonvulsants preferred?
- For rapid cycling or mixed episodes
- If history of head injury of drug use
Describe the anticonvulsant Depakote. Side effects?
- Requires blood draws
- Side effects = sedation, weight gain, danger of liver damage, diabetes
Describe the anticonvulsant Tegretol. Side effects?
- Requires blood draws
- Good for explosive anger probs
- Side effects = tremor, sedation, increased liver enzymes
Describe the anticonvulsant Trileptal. Side effects?
- No blood draws required
- Some sedation
Describe Lamictal. Side effects? Medication of choice for? Less helpful for?
- No blood draws required
- No weight gain or sedation
- Need to start at low dose and titrate up to avoid skin rash
- Med of choice for bipolar depression and rapid cycling
- Less helpful to prevent severe mania by itself
What are the 3 medication groups for mood disorders?
- Antidepressants
- Mood stabilizers
- Newer antipsychotics
What do newer antipsychotics do?
- Treat psychosis in both manic and depressive episodes
- Bring down mania quickly
- Have some mood-stabilizing properties
- Used w/ antidepressants for depression
Explain humanistic-existential therapy and how it works.
- Focus on finding meaning and purpose in life
- Discover one’s strengths and talents
- Overcome alienation and develop true self
Explain behavioral therapy and how it works.
- Change behaviors to change feelings
- Change reward structure in everyday life
- Chart progress
Explain cognitive therapy and how it works.
-Change maladaptive, irrational thoughts to change negative feelings
What is the most common form of psychotherapy for depression today?
Cognitive therapy
What does Aaron Beck’s cognitive therapy of depression treat?
- Cognitive triad = negative thoughts about self, world, future
- Maladaptive cognitive schemas and errors in logic (magnification, minimization, overgeneralization)
How is lack of sleep a trigger for bipolar episodes?
- Irregular wake-sleep hrs
- Working irregular shifts
- Travel to diff time zones
- Caffeine and other stimulant drugs
How is caffein a trigger for bipolar episodes?
Interferes w/ sleep and triggers manic states
How are antidepressants a trigger for bipolar episodes?
Manic switch on antidepressants w/o mood stabilizers
How is anesthesia a trigger for bipolar episodes?
- Can trigger mania
- Throws off internal clock
How are life events a trigger for bipolar episodes?
- Anything interfering w/ sleep, increasing stress and excitement
- Sad events often trigger mania, not depression
How is medication a trigger for bipolar episodes?
Side effects put client at risk for non-compliance
What are the initial goals for individual therapy for bipolar disorder?
- Accept diagnosis and work through denial
- Accept life-long disorder requiring meds
- Work through grief over lost life opportunities
- Help client accept new “slower” self
- Deal w/ embarrassment about mania
- Help clean up the aftermath of mania
What are the goals of individual therapy for bipolar disorder during therapy?
- Monitor moods, provide feedback
- Identify risk factors and triggers
- Stay in touch w/ fam
- Emphasize medication compliance
- Help w/ decision making
What are the goals for family counseling for bipolar disorder?
- Recognize that mani is an illness
- Recognize signs and triggers for mood changes
- Help fam deal w/ consequences of mania
- Help solve power struggle about medication compliance
- Develop action plan to intervene early
Individuals with bipolar I disorder do well when?
- Meds are effective
- Good judgment and insight
- No comorbid psychological disorders
- No comorbid substance abuse
- Supportive friends and fam
- Keep regular sleep-wake cycle
- Suitable job or meaningful volunteer work
- Manage time well and avoid stress
