How are mood disorders treated?
Treatment will depend on the specific illness and symptoms that are present. Usually, therapy involves a combination of medication and psychotherapy (also called “talk therapy”). Therapy sessions may be conducted by a psychologist, psychiatrist, or other health professional.
Medications to treat depression and/or bipolar disorders
- Antidepressants - Many different medications are available to treat depression and depressive episodes of bipolar disorder. Some of the most widely used drugs are selective serotonin reuptake inhibitors (SSRIs). These include citalopram (Celexa®), escitalopram (Lexapro®), sertraline (Zoloft®), fluoxetine (Prozac®), and paroxetine (Paxil®). Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta®) and venlafaxine (Effexor®) also are commonly prescribed and are similar to SSRIs in their action. Bupropion (Wellbutrin®) is used to treat depression and seasonal affective disorder. It works differently than SSRIs or SNRIs. Older types of antidepressants include tricylic antidepressants, monoamine oxidase inhibitors, and tetracyclic antidepressants. Although different types are found to work equally well, some antidepressants may be more effective depending on the individual. It is important to take the antidepressants as prescribed and continue taking them even if you feel better. Usually an antidepressant must be taken as prescribed for 4 to 6 weeks before it begins to work.
- Mood stabilizers - These medications help to regulate the mood swings that occur with bipolar disorder or other disorders. They reduce abnormal brain activity. Mood stabilizers may also be prescribed along with antidepressants in some cases. Some of the most widely used mood stabilizers include lithium and anticonvulsant drugs, such as valproic acid (Valproic®), lamotrigine (Lamictal®), carbamazepine (Tegretol®), and oxecarbazepine (Trileptal®).
- Antipsychotics - Patients with bipolar disorder who experience mania or mixed episodes may be treated with an atypical antipsychotic drug, such as aripiprazole (Abilify®). Atypical antipsychotics may also sometimes be used to treat depression, if symptoms are not controlled with an antidepressant alone.
Psychotherapy (talk therapy)
Patients with depression and other mood disorders may benefit from various types of psychotherapy or counseling sessions. Types of therapy include:
- Cognitive-behavioral therapy
- Interpersonal therapy
- Problem-solving therapy
Brain stimulation therapies
Brain stimulation therapies are thought to work by causing changes in the chemicals in the brain that are known to be associated with symptoms of depression and bipolar disorders. There are several types of brain stimulation therapies including:
- Electroconvulsive therapy (ECT) - ECT has long been used to treat severe depression or bipolar disorder in cases when medication or psychotherapy have been unsuccessful. Before having ECT, a patient is placed under general anesthesia and is given a muscle relaxant. Electrodes are placed in certain locations on the scalp or forehead. An electric current is passed through the brain to induce a seizure. The patient awakens after five to 10 minutes. The ECT sessions can be performed on an outpatient basis. Usually, two or three sessions per week are required, over a period of two weeks or more. Generally, six to 12 sessions are required.
- Repetitive Transcranial Magnetic Stimulation (rTMS) - This noninvasive procedure uses a magnetic coil to apply short electromagnetic pulses to specific nerve cells in the brain. The magnet is positioned against the forehead, while pulses are sent through the skull. The procedure is used to treat major depression for patients who do not respond to at least one antidepressant drug.
Treatments for seasonal depression
Antidepressant medications, such as SSRIs and bupropion, and psychotherapy are used to treat seasonal affective disorder. In addition, patients may benefit from light therapy and vitamin D supplements.
- Light therapy - This technique has long been used to treat SAD. It is based on the idea of supplementing natural sunlight with bright artificial light during the fall and winter. Patients may use a light box that provides cool-white fluorescent light. Each morning, the person is exposed to the artificial light for about 20 to 60 minutes. The light is about 20 times more intense than regular indoor lighting.