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  1. Home
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  3. Clinical Handbook for the Management of Mood Disorders
  • Cited by 2
Publisher:
Cambridge University Press
Online publication date:
May 2013
Print publication year:
2013
Online ISBN:
9781139175869
DOI:
https://doi.org/10.1017/CBO9781139175869
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

This Clinical Handbook for the Management of Mood Disorders will equip clinicians with the knowledge to refine their diagnostic skills and implement treatment plans for mood disorders based on the most up-to-date evidence on interventions that work. Covering the widest range of treatments and techniques, it provides clear guidance for the management of all types and subtypes of both minor and major depression. Chapters cover the latest and most innovative treatments, including use of ketamine, deep brain stimulation and transcranial magnetic stimulation, effective integration of pharmacological and psychotherapeutic approaches, as well as providing a thought-provoking look at the future research agenda and the potential for reliable biomarkers. This is the most comprehensive review of depression available today. Written and edited by leading experts mostly from Columbia University, this is an essential resource for anyone involved in the care and treatment of patients with mood disorders.

Reviews

'This is the most comprehensive book on mood disorders available, and it is written by top experts in the field. Whether treating a newly diagnosed patient with depression or a patient with treatment-resistant depression, this is the source to have right at your fingertips.'

Source: Doody's Review Service

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Contents

Page 2 of 2

Contents
  • 23 - Combining medication and psychotherapy in the treatment of depression
    pp 299-310
  • View abstract

    Summary

    This chapter describes the prevalence of mood disorders in the context of borderline personality disorder (BPD). Atypical depression is characterized by mood reactivity in the context of a depressive episode and at least one of the following symptoms: increased sleep, increased appetite, leaden paralysis, and rejection sensitivity. Suicide attempters with co-occurring BPD and major depressive disorder (MDD) have more lifetime suicide attempts, make their first attempt at a younger age, report more interpersonal triggers to attempts, and have higher levels of life-time aggressive behaviors, hostility, and impulsivity than depressed attempters without BPD. A number of studies have reported altered brain structure and function in patients with BPD relative to controls. Although the brain imaging findings in BPD may lead to diagnostic biomarkers, many of the altered brain regions and systems associated with BPD overlap with mood disorders and other Axis I disorders.
  • 24 - Electroconvulsive therapy
    pp 311-324
  • View abstract

    Summary

    The detection and appropriate management of depression among women of reproductive age before or early in pregnancy is critical. The majority of studies have not found an association with major congenital malformations (MCMs) and first-trimester exposure to selective serotonin reuptake inhibitors (SSRIs). Non-SSRI and non-tricyclic antidepressants (TCA) antidepressants have been the focus of small studies. These medications include trazodone, mirtazapine, nefazodone, mianserin, and reboxetine. A neonatal behavioral syndrome (NBS) has been described in neonates exposed to antidepressants in utero. Lithium carbonate remains one of the mainstays for acute and maintenance treatment of bipolar disorder. There have been several registries that have collected information on the use of lamotrigine in the first trimester of pregnancy. A single case study found vagal nerve stimulation (VNS) to be safe during pregnancy in a woman receiving treatment throughout pregnancy, labor, and delivery.
  • 25 - Transcranial magnetic stimulation and deep brain stimulation
    pp 325-331
  • View abstract

    Summary

    This chapter discusses the symptoms that occur repeatedly in association with the menstrual cycle and during the menopause transition (MT). Several studies have refuted the hypothesis that premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) is associated with abnormalities in circulating ovarian hormones. Antidepressant medications with primary serotonergic action, such as the selective serotonin reuptake inhibitors (SSRIs), have become the mainstay of pharmacological treatment of PMDD, with proven safety and efficacy. Given that women with PMDD are more sensitive to the normal hormonal fluctuations of the menstrual cycle, several trials have been conducted to examine whether manipulation of the female sex hormones could lead to an effective treatment of PMDD. Prospective studies have consistently shown that during MT women are at higher risk to develop depressive symptoms and/or to meet criteria for major depressive disorder (MDD). Antidepressants remain the first choice for the management of depression in any given age/reproductive staging group.
  • 26 - Chronotherapeutics
    pp 332-344
  • Light therapy, wake therapy, and melatonin
  • View abstract

    Summary

    This chapter discusses depression in the context of alcoholism and other substance-use disorders. Independent depression syndrome describes a patient who meets criteria for major depression or dysthymia, and it is clear in the history that the depression is independent of effects of substances. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) introduced substance-induced depression to recognize the existence of syndromes of depression that cannot be established to be independent, but that nonetheless appear to exceed the usual effects of substance intoxication or withdrawal and require clinical attention. A number of other psychiatric disorders e.g. bipolar disorder, ADHD, PTSD, and some other anxiety disorders, antisocial and borderline personality, co-occur with substance-use disorders and may account for some of the association between depression and substance abuse. Chronic medical disorders, especially those producing chronic pain, also need to be considered.
  • 27 - Ketamine in treatment-resistant depression
    pp 345-357
  • View abstract

    Summary

    This chapter discusses complementary and alternative medicine (CAM) treatments preferred by patients with mood disorders. Omega-3 fatty acids are lower in depressed suicide attempters and completers compared with depressed nonattempters, a concentration-dependent effect, suggesting increased suicide risk in individuals with extremely low omega-3 levels. St. John's wort (SJW) has been extensively studied as a monotherapy for the treatment of depression. Among the CAM treatments, evidence supports the use of SJW as a monotherapy, and omega-3, S-adenosyl-methionine (SAMe), and several methylators as augmentation strategies in the treatment of depression. Methodological flaws are a consistent critique of CAM, and larger, longer-term studies are needed to assess CAM efficacy. Interventions such as yoga, acupuncture, and improved nutrition are inherently difficult to blind, complicating their assessment. Clinical experience suggests that CAM may be helpful in engaging patients and useful in the treatment of carefully selected patients.
  • 28 - Brain imaging
    pp 358-367
  • View abstract

    Summary

    This chapter focuses on a member of a much larger family of interventions known as cognitive behavior therapy (CBT). Cognitive therapy (CT) was first developed as a time-limited treatment of depression. Dysfunctional cognitions about medication can be modified with CT, and behavioral interventions, such as reminder systems and behavioral plans to overcome obstacles to adherence, can be used. The efficacy of CT has been subjected to hundreds of controlled investigations across a wide range of disorders. CT is the most exhaustively studied psychosocial intervention for depressive disorders. The primary analyses of six subsequent studies, all making greater efforts to ensure that pharmacotherapy was adequately administered, found CT and pharmacotherapy to be comparably effective across 12-16 weeks. It is noteworthy that the two most recent studies used selective serotonin reuptake inhibitors and, hence, have greater generalizability to contemporary practice.
  • 30 - Electrophysiological predictors of clinical response to antidepressants
    pp 380-393
  • View abstract

    Summary

    Interpersonal psychotherapy (IPT) is a time-limited, evidenced-based therapy, initially developed to treat major depressive disorder (MDD) in adults. In clinical trials, the duration of IPT for depression typically ranges from 8-16 sessions and is conducted in three distinct phases: initial, middle, and termination. In the initial phase of treatment, the therapist and patient make an explicit contract about the frequency and length of treatment. Termination is periodically mentioned throughout treatment, and several sessions prior to the agreed-upon end, the upcoming termination becomes more of a focus. Patients should be advised to seek further help as needed and a review of the events which trigger episodes is completed. Maintenance IPT (IPT-M) with or without medication is an option. The future of IPT and of psychotherapy in general is somewhat guarded in the United States, but not elsewhere. Psychotherapy in the USA has had a diminishing role in outpatient mental health treatment.
  • 31 - Prospects for the future of mood disorder therapeutics
    pp 394-399
  • View abstract

    Summary

    Dialectical behavior therapy (DBT) is a form of cognitive behavior therapy (CBT) for mood disorders. There are three categories of core strategies employed in DBT: change strategies, acceptance and validation strategies, and dialectical strategies. Change strategies in DBT, for the most part, are based on learning principles. One rationale for using DBT to treat mood disorders is the significant co-morbidity between borderline personality disorder (BPD) and mood disorders. Adapting DBT is different from adopting DBT. In the latter, DBT, e.g. the modes of treatment delivery, may be changed to meet the needs of the setting or target population. Programs which adopt comprehensive DBT benefit from the existing evidence base. DBT is an efficacious treatment proven to reduce suicidal behavior and nonsuicidal self-injury. DBT has been adapted for both bipolar adolescents and geriatric patients with treatment-resistant depression or depression co-morbid with BPD.

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