Module 5 - Treatments for Mood and Anxiety Flashcards
What was the Treatment of Depression Collaborative Research Program in the early 1980s?
A large multi-site randomized controlled trial that compared CBT, IPT, an antidepressant medication called imipramine, and a placebo pill condition.
The overall results indicated that there were no differences in efficacy among CBT, IPT, and imipramine, and that all the active treatments were significantly superior to placebo.
What does CBT for unipolar depression involve?
Teach people to become aware of the meanings of and attributions to events in their lives, and to examine how these cognitions contribute to the emotional reactions that follow.
Usually 16-20 sessions. Activity Scheduling, Thought Records, Behavioural Experiments etc
What is Mindfulness-Based Cognitive Therapy (MBCT)?
An innovative adaptation of CBT incorporates mindfulness meditation as a way of preventing depression relapse. Based on traditional Buddhist mindfulness meditation principles.
What does Interpersonal Psychotherapy (IPT) for unipolar depression involve?
Based on the early work of psychodynamic theorists that viewed loss and disordered attachment as underlying factors in major depression.
IPT presumes that depression occurs in an inter-personal context and that addressing current problems that depressed clients face in the interpersonal realm is key to relieving symptoms. 12 to 16 sessions.
What are the 3 classes of anti-depressants?
1) Tricyclics (TCAs) - oldest class. Blocks the reuptake from the synapse of NE and/or, less commonly, 5-HT. No antidepressant that has been developed since the TCAs has been found to have greater efficacy BUT they’re rarely used as a first-line treatment today because of their many side effects (blurry vision, sedation, weight gain, exacerbate cardiac arrhythmias) and are highly lethal in overdose.
2) Monoamine Oxidase Inhibitors (MAOIs) - inhibiting an enzyme (monoamine oxidase) that breaks down monoaminergic neurotransmitters (e.g., dopamine, norepinephrine, serotonin) in the presynaptic cell. RARELY used as first-line treatment because of potentially dangerous side effects (MAOIs inhibit breakdown of amines especially tyramine (cheese, chocolate, wine), too much tyramine can raise blood pressure to dangerous levels. Can’t take Sudafed.
3) Selective Serotonin Reuptake Inhibitors (SSRIs) - first line treatment for unipolar depression. They block the reuptake of serotonin into the presynaptic cell.
What is an important downside of medication?
They are associated with a high risk of relapse. Therefore, these medications are by no means a “cure” for depression and, as stated above, are significantly less effective in the long run than cognitive-behavioural therapy.
True or False?
For patients with mildly to moderately severe unipolar depression, antidepressant medication was no more effective than a placebo.
True.
The benefit of antidepressant medication over placebo was found only for patients with severe depression.
What are the 4 major classes of medications used to treat bipolar disorder?
1) Lithium - deactivates an enzyme called GSK-3B that may be related to the circadian clock. It’s an antagonist of glutamate. Glutamate has a general excitatory effect on the brain. So, decreasing the synthesis and/or release of glutamate may account for lithium’s stabilizing effect.
2) Anticonvulsants - Most increase the synthesis and release of GABA, which plays a general inhibitory role in the brain.
3) Antipsychotics - may be used as a short-term treatment during acute manic or severe depressive episodes. Some have a mood stabilizing effect on their own. They’re antagonists of multiple neurotransmitter receptors, including serotonin and dopamine. Could cause tardive dyskinesia (irreversible syndrome involving involuntary, dyskinetic movement). Proceed with caution.
4) Antidepressants - Buproprion appears to be less likely to trigger manic episodes than some of the other antidepressants. In addition, there is some evidence that venlafaxine works more quickly than do other antidepressants.
Why does use of lithium require regular monitoring by a psychiatrist and blood tests?
Because the therapeutic window is very narrow. This means that the dose required to attain a therapeutic effect is only slightly less than the toxic dose.
Since antidepressant medication, IPT, and CBT have all been shown to be efficacious in treating major depression, shouldn’t combining them be even more effective?
Not necessarily. Randomized controlled trials of CBT, IPT, medication, and their combination have consistently shown that for non-persistent depression of mild to moderate severity, there is no advantage to combining psychotherapy and medication.
(Exceptions include severe depression, persistent depressive disorder + depressed adolescents - in which cases a combo approach is better.)
The most effective treatment for bipolar disorder is:
A) Medication
B) Psychotherapy
Medication.
BPD patients show significant impairments in work, family, and social relationships even while medicated. So in addition to meds, what 3 psychological treatments have been developed for treatment of BPD?
1) Family-focused therapy (FFT)
2) Interpersonal and social rhythm therapy (IPSRT) - regulate their routines and to cope more effectively with stressful events.
3) Cognitive therapy (CT) - similar to CBT for unipolar depression but address the unique issues faced in bipolar disorder (ie: regularize routines, monitor mood and triggers for mania etc)
What is the first-line treatment for seasonal affective disorder?
Light therapy.
(However, phototherapy may precipitate manic episodes in individuals with bipolar SAD.)
What is treatment-resistant depression?
defined as a failure to achieve remission following at least two trials of antidepressant medication at an appropriate dose and duration.
True or False?
In Electroconvulsive therapy (ECT), applying an electrical current to only one side of the brain (unilateral ECT) appears to be associated with fewer memory problems than is seen with bilateral ECT.
True.
