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Abnormal psych lecture ch07
 

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    Abnormal psych lecture ch07 Abnormal psych lecture ch07 Presentation Transcript

    • Chapter 7 Mood Disorders
    • Mood Disorders
      • Two key emotions on a continuum:
        • Depression
          • Low, sad state in which life seems dark and overwhelming
        • Mania
          • State of breathless euphoria or frenzied energy
      Depression Mania
    • Mood Disorders
      • Most people with a mood disorder experience only depression
        • This pattern is called unipolar depression
          • Person has no history of mania
          • Mood returns to normal when depression lifts
      • Some people experience periods of depression that alternate with periods of mania
        • This pattern is called bipolar disorder
    • Mood Disorders
      • These disorders have always captured people’s interest
        • Millions of people have mood disorders
        • Economic costs of mood disorders amount to more than $80 billion each year
        • Human suffering is incalculable
    • Unipolar Depression
      • The term “depression” is often used to describe general sadness or unhappiness
        • This usage confuses a normal mood swing with a clinical syndrome
      • Clinical depression can bring severe and long-lasting psychological pain that may intensify over time
    • How Common Is Unipolar Depression?
      • About 7% of the U.S. population experiences severe unipolar depression in any given year
        • As many as 5% experience mild depression
      • The prevalence is similar in Canada, England, France, and many other countries
      • Approximately 17% of all adults experience unipolar depression at some time in their lives
        • Rates have been steadily increasing since 1915
    • How Common Is Unipolar Depression?
      • In almost all countries, women are twice as likely as men to experience severe unipolar depression
        • Lifetime prevalence: 26% of women vs. 12% of men
      • These rates hold true across socioeconomic classes and ethnic groups
      • Approximately 50% recover within six weeks, some without treatment
        • Most will experience another episode at some point
    • What Are the Symptoms of Depression?
      • Symptoms may differ from person to person
      • Five main areas of functioning may be affected:
        • Emotional symptoms
          • Feeling “miserable,” “empty,” “humiliated”
          • Experiencing little pleasure
        • Motivational symptoms
          • Lacking drive, initiative, spontaneity
          • Between 6% and 15% of those with severe depression commit suicide
    • What Are the Symptoms of Unipolar Depression?
      • Five main areas of functioning may be affected:
        • Behavioral symptoms
          • Less active, less productive
        • Cognitive symptoms
          • Hold negative views of themselves
          • Blame themselves for unfortunate events
          • Pessimism
        • Physical symptoms
          • Headaches, dizzy spells, general pain
    • Diagnosing Unipolar Depression
      • Criteria 1: Major depressive episode
        • Marked by five or more symptoms lasting two or more weeks
          • In extreme cases, symptoms are psychotic, including
            • Hallucinations
            • Delusions
      • Criteria 2: No history of mania
    • Diagnosing Unipolar Depression
      • Two diagnoses to consider:
        • Major depressive disorder
          • Criteria 1 and 2 are met
        • Dysthymic disorder
          • Symptoms are “mild but chronic”
            • Depression is longer lasting but less disabling
            • Consistent symptoms for at least two years
        • When dysthymic disorder leads to major depressive disorder, the sequence is called “double depression”
    • What Causes Unipolar Depression?
      • Stress may be a trigger for depression
        • People with depression experience a greater number of stressful life events during the month just prior to the onset of their symptoms
        • Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors
          • The utility of this distinction is questionable and today’s clinicians usually concentrate on recognizing the situational and the internal aspects of any given case
    • What Causes Unipolar Depression? The Biological View
      • Genetic factors
        • Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a predisposition
          • Researchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general population
          • Twin studies demonstrate a strong genetic component:
            • Rates for identical (MZ) twins = 46%
            • Rates for fraternal (DZ) twins = 20%
          • Molecular biology studies also have implicated a genetic factor in many cases of unipolar depression
    • What Causes Unipolar Depression? The Biological View
      • Biochemical factors
        • NTs: serotonin and norepinephrine
          • In the 1950s, medications for high blood pressure were found to cause depression
            • Some lowered serotonin, others lowered norepinephrine
          • This led to the “discovery” of effective antidepressant medications which relieved depression by increasing either serotonin or norepinephrine
          • Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, and other NTs may be involved
    • What Causes Unipolar Depression? The Biological View
      • Biochemical factors
        • Endocrine system / hormone release
          • People with depression have been found to have abnormal levels of cortisol
            • Released by the adrenal glands during times of stress
          • People with depression have been found to have abnormal melatonin secretion
            • “ Dracula hormone”
          • Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression
    • What Causes Unipolar Depression? The Biological View
      • Biochemical factors
        • Model has produced enthusiasm but has significant limitations:
          • Relies on analogue studies: depression-like symptoms created in lab animals
            • Do these symptoms correlate with human emotions?
          • Measuring brain activity has been difficult
            • Current studies using modern technology are attempting to address this issue
    • What Are the Biological Treatments for Unipolar Depression?
      • Biological treatments can bring great relief to people with unipolar depression
      • Usually biological treatment means antidepressant drugs, but for severely depressed persons who do not respond to other forms of treatment, it sometimes includes electroconvulsive therapy
    • What Are the Biological Treatments for Unipolar Depression?
      • Electroconvulsive therapy (ECT)
        • The use of ECT was -- and is -- controversial
          • It is now used frequently but only in severe cases
        • The procedure consists of targeted electrical stimulation to cause a brain seizure
          • The usual course of treatment is 6 to 12 sessions spaced over two to four weeks
          • Treatment may be bilateral or unilateral
    • What Are the Biological Treatments for Unipolar Depression?
      • Electroconvulsive therapy (ECT)
        • The discovery of the effectiveness of ECT was accidental and based on a fallacious link between psychosis and epilepsy
        • The procedure has been modified in recent years to reduce some of the negative effects
          • For example, patients are given muscle relaxants and anesthetics before and during the procedure
        • Patients generally report some memory loss
    • What Are the Biological Treatments for Unipolar Depression?
      • Electroconvulsive therapy (ECT)
        • ECT is clearly effective in treating unipolar depression
          • Studies find improvement in 60% – 70% of patients
        • The procedure seems particularly effective in cases of severe depression with delusions, but it has been difficult to determine why ECT works so well
        • Although effective, the use of ECT has declined since the 1950s, because of the memory loss caused by the procedure and the emergence of effective antidepressant drugs
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs
        • In the 1950s, two kinds of drugs were found to be effective:
          • Monoamine oxidase inhibitors (MAO inhibitors)
          • Tricyclics
        • These drugs have been joined in recent years by a third group, the second-generation antidepressants
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: MAO inhibitors
        • Originally used to treat TB, doctors noticed that the medication seemed to make patients happier
        • The drug works biochemically by slowing down the body’s production of MAO
          • MAO breaks down norepinephrine
          • MAO inhibitors stop this breakdown from occurring
          • This leads to a rise in norepinephrine activity and a reduction in depressive symptoms
            • About half the patients who take these drugs are helped by them
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: MAO inhibitors
        • MAO inhibitors potentially pose a serious danger!
          • Blood pressure may rise to a potentially fatal level if one eats foods with tyramine (cheese, bananas, wine) while taking MAO inhibitors
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: Tricyclics
        • In searching for medications for schizophrenia, researchers discovered that imipramine lessened depressive symptoms
          • Imipramine and related drugs are known as tricyclics because they share a three-ring molecular structure
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: Tricyclics
        • Hundreds of studies have found that depressed patients taking tricyclics have improved much more than similar patients taking placebos
          • About 60% – 65% of patients find symptom improvement
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: Tricyclics
        • Most patients who immediately stop taking tricyclics upon relief of symptoms relapse within one year
          • Patients who take tricyclics for five additional months (“continuation therapy”) have a significantly decreased risk of relapse
          • As a result, clinicians often keep their patients on the drugs indefinitely
    • What Are the Biological Treatments for Unipolar Depression?
      • Antidepressant drugs: Tricyclics
        • Tricyclics are believed to reduce depression by affecting neurotransmitter (NT) reuptake
          • To prevent an NT from remaining in the synapse too long, a pumplike mechanism recaptures the NT and draws it back into the presynaptic neuron
          • The reuptake process appears to be too effective in some people, drawing in too much of the NT from the synapse
          • This reduction in NT activity in the synapse is thought to result in clinical depression
          • Tricyclics block the reuptake process, thus increasing NT activity in the synapse
    • What Are the Biological Treatments for Unipolar Depression?
      • Second-generation antidepressant drugs
        • A third group of effective antidepressant drugs is structurally different from the MAO inhibitors and tricyclics
          • Most of the drugs in this group are labeled selective serotonin reuptake inhibitors (SSRIs)
        • These drugs act only on serotonin (no other NTs are affected)
          • This class includes fluoxetine (Prozac) and sertraline (Zoloft)
        • Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available
    • What Are the Biological Treatments for Unipolar Depression?
      • Second-generation antidepressant drugs
        • The effectiveness and speed of action of these drugs is on par with the tricyclics yet they boast enormous sales
          • Clinicians often prefer these drugs because it is harder to overdose on them than on other kinds of antidepressants
          • There are no dietary restrictions like there are with MAO inhibitors
          • There have fewer side effects than the tricyclics
        • These drugs may cause some undesired effects of their own, including a reduction in sex drive
    • Psychological Models of Unipolar Depression
      • Three main models:
        • Psychodynamic model
          • Not strongly supported by research
        • Behavioral model
          • Modestly supported by research
        • Cognitive model
          • Has considerable research support
    • Psychological Models of Unipolar Depression
      • Psychodynamic view
        • Link between depression and grief
          • When a loved one dies, the mourner regresses to the oral stage
            • For most people, grief is temporary
            • If grief is severe and long-lasting, depression results
            • Those with oral stage issues ( unmet or excessively met needs) are at greater risk for developing depression
          • Some people experience “symbolic” (not actual) loss
          • Newer psychoanalysts focus on relationships with others (object relations theorists)
    • Psychological Models of Unipolar Depression
      • Psychodynamic view
        • Strengths:
          • Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss
          • Research supports the theory that early losses set the stage for later depression
          • Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after suffering a loss
    • Psychological Models of Unipolar Depression
      • Psychodynamic view
        • Limitations:
          • Early losses don’t inevitably lead to depression
            • May not be typically responsible for development of depression
          • Many research findings are inconsistent
          • Theory is largely untestable because of its reliance on unconscious processes
    • Psychological Models of Unipolar Depression
      • Psychodynamic therapy
        • Psychodynamic therapists use the same basic procedures for all psychological disorders:
          • Free association
          • Therapist interpretation
    • Psychological Models of Unipolar Depression
      • Psychodynamic therapy
        • Despite successful case reports, researchers have found that long-term psychodynamic therapy is only occasionally helpful in cases of unipolar depression
        • Two features may be particularly limiting:
          • Depressed clients may be too passive or weary to fully participate in clinical discussions
          • Depressed clients may become discouraged and end treatment too early when treatment doesn’t provide fast relief
        • Short-term approaches have performed better than traditional approaches
    • Psychological Models of Unipolar Depression
      • Behavioral view
        • Depression results from changes in rewards and punishments people receive in their lives
          • As life changes, we experience a change (loss) of rewards
        • Research by Lewinsohn supports the relationship between the number of rewards received and the presence or absence of depression
          • Social rewards are especially important
    • Treatments for Unipolar Depression: Psychological Approaches
      • Behavioral therapy
        • Lewinsohn developed a behavioral therapy for unipolar depression:
          • Reintroduce clients to pleasurable activities and events, often using a weekly schedule
          • Appropriately reinforce their depressive and nondepressive behaviors
            • Use a contingency management approach
          • Help them improve their social skills
    • Treatments for Unipolar Depression: Psychological Approaches
      • Behavioral therapy
        • The behavioral techniques seem to be of only limited help when just one of them is applied
          • When treatment programs combine two or three of the techniques, as Lewinsohn had envisioned, depressive symptoms (especially mild symptoms) seem to be reduced
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Two main theories:
          • Learned helplessness
          • Negative thinking
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • Theory holds that people become depressed when they think that:
            • They no longer have control over the reinforcements in their lives
            • They themselves are responsible for this helpless state
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • Theory is based on Seligman’s work with laboratory dogs
            • Dogs subjected to uncontrollable shock were later placed in a shuttle box
            • Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so
            • Seligman theorized that the dogs had “learned” to be “helpless” and drew parallels to human depression
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • There has been significant research support for this model
            • Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials
            • Animal subjects lose interest in sex and social activities
            • In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • Recent versions of the theory focus on attributions
            • Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression
              • Example: “It’s all my fault [internal]. I ruin everything I touch [global] and I always will [stable]”
            • If people make other kinds of attributions, this reaction is unlikely
              • Example: “The way I’ve behaved the past couple of weeks blew this relationship [specific], I don’t know what got into me – I don’t usually act like that [unstable], and she never did know what she wanted [external]”
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Learned helplessness
          • Strengths:
            • Hundreds of studies have supported the relationship between styles of attribution, helplessness, and depression
          • Limitations:
            • Laboratory helplessness does not parallel depression in every way
            • Much of the research relies on animal subjects
            • The attributional component of the theory raises particularly difficult questions in terms of animal models of depression
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Negative thinking
          • According to Beck, four interrelated cognitive components combine to produce unipolar depression:
            • Maladaptive attitudes
              • Self-defeating attitudes are developed during childhood
              • Beck suggests that upsetting situations later in life can trigger further rounds of negative thinking
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • This negative thinking often takes three forms, called the cognitive triad:
          • Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Negative thinking
          • Depressed people also make errors in their thinking, including:
            • Arbitrary inferences
            • Minimization of the positive and magnification of the negative
          • Depressed people experience automatic thoughts
            • A steady train of unpleasant thoughts that suggest inadequacy and hopelessness
    • Psychological Models of Unipolar Depression
      • Cognitive views
        • Strengths:
          • There is significant research support for Beck’s model:
            • High correlation between the level of depression and the number of maladaptive attitudes
            • Both the cognitive triad and errors in logic are seen in people with depression
            • Automatic thinking has been linked to depression
        • Limitations:
          • Research fails to show that such cognitive patterns are the cause and core of unipolar depression
    • Psychological Models of Unipolar Depression
      • Cognitive therapy
        • Beck’s cognitive therapy – the leading cognitive treatment for unipolar depression – is designed to help clients recognize and change their negative cognitive processes
        • This approach follows four phases and usually lasts fewer than 20 sessions
        • Phases:
          • Increasing activities and elevate mood
          • Challenging automatic thoughts
          • Identifying negative thinking and biases
          • Changing primary attitudes
    • Psychological Models of Unipolar Depression
      • Cognitive therapy
        • Over the past three decades, hundreds of studies have shown that cognitive therapy helps unipolar depression
        • Around 50% – 60% of clients show a near-total elimination of symptoms
        • This treatment has also been used in a group therapy format
    • The Sociocultural Model of Unipolar Depression
      • Sociocultural theorists propose that unipolar depression is greatly influenced by the social structure in which people live
        • This belief is supported by the finding that depression is often triggered by outside stressors
        • Researchers have also found links between depression and culture, gender, race, and social support
    • The Sociocultural Model of Unipolar Depression
      • How are culture and depression related?
        • Depression is a worldwide phenomena, but the experience of symptoms differs from culture to culture
          • For example, non-Westerners report more physical (rather than psychological) symptoms
          • As cultures become more Western, symptoms shift
    • The Sociocultural Model of Unipolar Depression
      • How do gender and race relate to depression?
        • Rates of depression are much higher among women than men
          • One sociocultural theory holds that the complexity of women’s roles in society leaves them particularly prone to depression
        • Few differences have been seen overall among Caucasians, African Americans, and Hispanic Americans, but striking differences exist in specific subcultures:
          • In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall
          • These findings are thought to be the result of economic and social pressures
    • The Sociocultural Model of Unipolar Depression
      • How does social support relate to depression?
        • The availability of social support seems to influence the likelihood of depression
        • Rates of depression vary based on marital status
          • Interpersonal conflict may be a factor
        • Isolation and lack of intimacy also are key factors
          • Research shows that depressed people who lack social support remain depressed longer than those who have a supportive spouse or warm friendships
    • The Sociocultural Model of Unipolar Depression
      • The most effective sociocultural approaches to treating unipolar depression are interpersonal psychotherapy and couple therapy
        • The techniques used in these approaches borrow from other models
    • The Sociocultural Model of Unipolar Depression
      • Interpersonal therapy (IPT)
        • This model holds that four interpersonal problems may lead to depression and must be addressed:
          • Interpersonal loss
          • Interpersonal role dispute
          • Interpersonal role transition
          • Interpersonal deficits
        • Studies suggest that IPT is as effective as cognitive therapy for treating depression
    • The Sociocultural Model of Unipolar Depression
      • Couple therapy
        • The main type of couple therapy is behavioral marital therapy (BMT)
          • Focus is on developing specific communication and problem-solving skills
        • If marriage is conflictual, BMT is as effective as other therapies for reducing depression
    • Bipolar Disorders
      • People with a bipolar disorder experience both the lows of depression and the highs of mania
        • They describe their life as an emotional roller coaster
    • What Are the Symptoms of Mania?
      • Unlike those experiencing depression, people in a state of mania typically experience dramatic and inappropriate rises in mood
      • Five main areas of functioning may be affected:
        • Emotional symptoms
          • Active, powerful emotions in search of outlet
        • Motivational symptoms
          • Need for constant excitement, involvement, companionship
    • What Are the Symptoms of Mania?
      • Five main areas of functioning may be affected:
        • 3. Behavioral symptoms
          • Very active – move quickly; talk loudly or rapidly
            • Key word: flamboyance!
        • 4. Cognitive symptoms
          • Show poor judgment or planning
            • Especially prone to poor (or no) planning
        • 5. Physical symptoms
          • High energy level – often in the presence of little or no rest
    • Diagnosing Bipolar Disorders
      • Criteria 1: Manic episode
        • Three or more symptoms of mania lasting one week or more
          • In extreme cases, symptoms are psychotic
        • Criteria 2: History of mania
          • If currently experiencing hypomania or depression
    • Diagnosing Bipolar Disorders
      • DSM-IV-TR distinguishes between two kinds of bipolar disorder:
        • Bipolar I disorder
          • Full manic and major depressive episodes
            • Most sufferers experience an alternation of episodes
            • Some experience mixed episodes
        • Bipolar II disorder
          • Hypomanic episodes and major depressive episodes
    • Diagnosing Bipolar Disorders
      • Without treatment, the mood episodes tend to recur for people with either type of bipolar disorder
      • Regardless of particular pattern, individuals with bipolar disorder tend to experience depression more than mania over the years
    • Diagnosing Bipolar Disorders
      • Between 1% and 2.6% of adults in the world suffer from a bipolar disorder at any given time
      • The disorders are equally common in women and men
        • Women may experience more depressive episodes and fewer manic episodes than men
    • Diagnosing Bipolar Disorders
      • The prevalence of the disorders is the same across socioeconomic classes and ethnic groups
      • Onset usually occurs between 15 and 44 years of age
      • In most cases, the manic and depressive episodes eventually subside, only to recur at a later time
    • Diagnosing Bipolar Disorders
      • A final diagnostic option:
        • If a person experiences numerous episodes of hypomania and mild depressive symptoms, a diagnosis of cyclothymic disorder is appropriate
          • Mild symptoms for two or more years, interrupted by periods of normal mood
          • Affects 0.4% of the population
          • May blossom into bipolar I or II disorder
    • What Causes Bipolar Disorders?
      • Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress
      • More recently, biological research has produced some promising clues
        • New insights have come from research into NT activity, ion activity, brain structure, and genetic factors
    • What Causes Bipolar Disorders?
      • Neurotransmitters
        • After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania
          • This theory is supported by some research studies; bipolar disorders may be related to overactivity of norepinephrine
    • What Causes Bipolar Disorders?
      • Neurotransmitters
        • Because serotonin activity often parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity
          • Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory…
    • What Causes Bipolar Disorders?
      • Neurotransmitters
        • This apparent contradiction is addressed by the “permissive theory” about mood disorders:
          • Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take:
            • Low serotonin + Low norepinephrine = Depression
            • Low serotonin + High norepinephrine = Mania
    • What Causes Bipolar Disorders?
      • Ion activity
        • Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder
        • This improper transport may cause neurons to fire too easily (mania) or to resist firing (depression)
          • There is some research support for this theory
    • What Causes Bipolar Disorders?
      • Brain structure
        • Brain imaging studies have identified a number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others
          • It is not clear what role such structural abnormalities play
    • What Causes Bipolar Disorders?
      • Genetic factors
        • Many experts believe that people inherit a biological predisposition to develop bipolar disorders
          • Family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:
            • Identical (MZ) twins = 40% likelihood
            • Fraternal (DZ) twins and siblings = 5% to 10% likelihood
            • General population = 1% to 2.6% likelihood
    • What Causes Bipolar Disorders?
      • Genetic factors
        • Recently, genetic linkage studies have examined the possibility of “faulty” genes
        • Other researchers are using techniques from molecular biology to further examine genetic patterns
        • Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders
    • What Are the Treatments for Bipolar Disorders?
      • Until the latter part of the 20 th century, people with bipolar disorders were destined to spend their lives on an emotional roller coaster
        • Psychotherapists reported almost no success
        • Antidepressant drugs were of limited help
          • These drugs sometimes triggered manic episodes
        • ECT only occasionally relieved either the depressive or the manic episodes of bipolar disorder
    • What Are the Treatments for Bipolar Disorders?
      • The use of lithium, a metallic element occurring as mineral salt, has dramatically changed this picture
        • It is extraordinarily effective in treating bipolar disorders and mania
        • Determining the correct dosage for a given patient is a delicate process
          • Too low = no effect
          • Too high = lithium intoxication (poisoning)
    • What Are the Treatments for Bipolar Disorders?
      • Lithium provides improvement for more than 60% of patients with mania
        • Most patients also experience fewer new episodes while on the drug
        • Lithium also is a prophylactic drug, one that actually prevents symptoms from developing
      • Lithium also helps those with bipolar disorder overcome their depressive episodes
    • What Are the Treatments for Bipolar Disorders?
      • Researchers do not fully understand how lithium operates
        • They suspect that it changes synaptic activity in neurons, but in a different way than antidepressant drugs
          • Although antidepressant drugs affect a neuron’s initial reception on NTs, lithium seems to affect a neuron’s second messengers
        • Another theory is that lithium corrects bipolar functioning by directly changing sodium and potassium ion activity in neurons
    • What Are the Treatments for Bipolar Disorders?
      • Psychotherapy alone is rarely helpful for persons with bipolar disorder
      • Lithium therapy alone is also not always sufficient, either
        • 30% or more of patients don’t respond, may not receive the correct dose, or may relapse while taking it
      • As a result, clinicians often use psychotherapy as an adjunct to lithium (or other medication-based) therapy
    • What Are the Treatments for Bipolar Disorders?
      • Therapy focuses on medication management, social skills, and relationship issues
      • Few controlled studies have tested the effectiveness of such adjunctive therapy
        • Growing research suggests that it helps reduce hospitalization, improve social functioning, and increase clients’ ability to obtain and hold a job