Treatment options for Depression + Bipolar Disorders
So far this month we’ve blogged about sadness vs depression and bipolar and related disorders, looking at the criteria used by trained health professionals to make a diagnosis.
We’re taking a different approach today, and focusing on a brief rundown of the available treatments.
TREATMENTS FOR DEPRESSION
There are basically four main psychological treatments for depression that have been scientifically validated as effective time and time again [1]. Yes, ongoing research is being conducted into new and promising treatments, however our focus here is more on the tried and true gold standard classics for depression [2].
1. Behaviour therapy (BT)
BT focuses on what you do, not what you think. This is one of the effective therapies that has been around the longest, and involves supporting depressed individuals to engage in activities that they enjoy or get some sense of mastery or achievement from. At the same time, a therapist will analyse how avoidance and withdrawal impact on the individual, and provide techniques to stop those bad habits that are making the problem even worse.
2. Cognitive behaviour therapy (CBT)
Like BT, CBT focuses on what you do, but it also addresses what you think. A therapist will analyse the helpful and the unhelpful thinking processes, attitudes and beliefs you hold. They will provide techniques to build up and maintain the helpful thinking, while challenging the unhelpful thinking. CBT is almost an overarching phrase now, as there have been many ways that a CBT foundation has been use to branch off into new directions. Two examples of this, which both have a growing evidence base in the treatment of depression are Schema Therapy and Mindfulness Based Cognitive Therapy [3].
3. Interpersonal psychotherapy (IPT)
IPT recognises that relationships can have a huge impact on depression, for better or worse. The focus in IPT is on identifying unhelpful patterns in relationships that are contributing to depression. The emphasis is then on learning new skills to interact in a different way.
4. Acceptance and commitment therapy (ACT)
ACT aims to encourage acceptance of those things that are outside of personal control, while also encouraging commitment to the things that are within your control that will enrich your life.
For depression, this means learning different techniques to manage painful thoughts and emotions, while also clarifying the values that bring true meaning and life satisfaction to you, and supporting you in bringing these values to life [4].
MEDICATION FOR DEPRESSION
We've predominantly outlined psychological treatment options for depression, however there remains the question of the role of medication (e.g. SSRIs, SNRIs, tricyclic antidepressants) in depressive disorders. There is a body of evidence to support the use of antidepressant medication [5],[6], and the decision as to whether or not to take medication is best made in consultation with your general practitioner. In general, a decision in relation to medication may be based on factors such as individual preferences, severity of depression symptoms, and access to other forms of treatment.
Read on to find out about treatment options for bipolar disorders.
BIPOLAR DISORDER
There is an extensive body of research into treatments for bipolar disorder, and we've rounded up those that have been demonstrated as effective in the management of bipolar symptoms.
1. Medication
Research has demonstrated a case for medication in managing bipolar symptoms [7]. Mood stabilisers are often used to assist with managing the symptoms of mania (refer to our post on bipolar disorders for a recap on these symptoms), and antidepressants may be used as an adjunct to mood stabilisers [8]. Managing both the highs and lows that are seen in bipolar disorder can be a balancing act, so please speak with your general practitioner or psychiatrist about what combination of medication is most suitable for your symptoms.
2. Cognitive behaviour therapy (CBT)
CBT can play a role in bipolar disorder in assisting with depression symptoms, the management of depression symptoms, and preventing or delaying relapses, though this is generally as an adjunct to medication rather than as a standalone treatment [9],[10].
3. INTERPERSONAL AND SOCIAL RHYTHYM THERAPY (IPSRT)
This form of therapy looks at stabilising daily routines, minimising interpersonal difficulties, and improving adherence to medication, and has shown promise as an adjunct to medication for bipolar symptoms [11],[12].
In summary, we've covered a range of psychological treatments for depression and bipolar disorders, and briefly discussed medication in relation to these disorders. Still confused by which treatment would be most beneficial for you? Please speak to your general practitioner or a psychologist to find out what will best suit your symptoms.
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REFERENCES
[1] Robinson, L.A., Berman, J.S., & Neimeyer, R.A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychology Bulletin, 108, 30-49.
[2] Hollon, S. D. & Ponniah, K. (2010) A review of empirically supported psychological therapies for mood disorders in adults. Depression and Anxiety, 27, 891-932.
[3] Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. (2002) Zindel Segal, J. Mark Williams and John Teasdale. New York. Guilford Press.
[4] A-Tjak, J.G., Davis, M.L., Morina, N., Powers, M.B., Smits, J.A., & Emmelkamp P. M., (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84, 30-36.
[5] Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R.J., Addis, M.E., et al. (2006). Randomized trial of behavioural activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-670.
[6] Gartlehner, G., Gaynes, B. N., Amick, H. R., Asher, G. N., Morgan, L. C., Coker-Schwimmer, E., et al. (2016).Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression: An evidence report for a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 164, 331-341.
[7] Geddes, J.R., & Miklowitz, D.J. (2013). Treatment of bipolar disorder. Lancet, 381, 1672-82.
[8] Sachs, G.S., Nierenberg, A.A., Calabrese, J.R., Marangell, L.B., Wisniewski, S.R., Gyulai, L., et al. (2007). Effectiveness of adjunctive antidepressant treatment for bipolar depression. The New England Journal of Medicine, 356, 1-12.
[9] Gonzalez-Pinto, A., Gonzalez, C., Enjuto, S., Fernandez de Corres, B., Lopez, P., Palomo, J., et al. (2004). Psychoeducation and cognitive-behavioral therapy in bipolar disorder: an update. Acta Psychiatrica Scandinavica, 109, 83-90.
[10] Hofmann, S.G., Asnaani, A., Vonk, I.J.J., Sawyer, A.T., & Fang, A. (2012). The efficacy of cognitive behavioural therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427-440.
[11] Crowe, M., Beaglehole, B., & Inder, M. (2016). Social rhythym interventions for bipolar disorder: a systematic review and rationale for practice. Journal of Psychiatric and Mental Health Nursing, 23, 3-11.
[12] Frank, E., Swartz, H.A., & Kupfer, D.J. (2000). Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological Psychiatry, 48, 593-604.