In most cases, the most effective form of treatment includes a combination of medication and psychotherapy. Medication prescribed depends on diagnosis and severity of the disorder; commonly, antidepressants are used for the treatment of depression, mood stabilizers are used for bipolar disorder and anti-anxiety medications are used for anxiety disorders. Psychotherapy utilized varies according to diagnosis and can include cognitive behavioral therapy, interpersonal therapy, client centered therapy, and exposure based therapy. Medical treatments, such as ECT or rTMS, can be used as a form of treatment in treatment resistant depression, when all forms of psychotherapy and medication do not help alleviate severe symptoms of depression.
Many individuals who suffer from depression, bipolar disorder or anxiety disorder do not seek help. This could be for several reasons, including the stigma attached to treatment or the belief that they do not need help. Getting treatment is very important and can lead to a reduction in symptoms and help you lead a fulfilling life.
Medication
What Medication is used for Depression and Bipolar Disorder?
Antidepressants work to regulate brain chemicals called neurotransmitters, specifically serotonin, dopamine and norepinephrine. These neurotransmitters play a role in mood regulation. Below are some antidepressant medications that are commonly prescribed:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs allow serotonin to be in the neuro-system longer, increasing the amount of serotonin available in the brain. Because serotonin normally lifts moods, it allows people to have more positive moods for longer periods of time.4 Some well-known SSRIs include fluoxetine (Prozac), citalopram (Celexa) and sertraline (Zoloft).1
SSRIs are the newest form of medication and they are used the most because there are fewer side effects associated with them compared to older antidepressants. Nausea, headaches and sleep disturbance are the most common side effects but they are usually relatively brief. Sexual dysfunction and weight gain are also possible side effects. 3
Other types of medications that are shown to be effective in the treatment of depression include Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and they include venlafaxine (Effexor) and duloxetine (Cymbalta).1
Tricyclics (TCAs)
Tricyclics are an older type of antidepressant. They operate in a similar way to SSRIs by also increasing serotonin and norepinephrine levels in the brain. Studies show that tricyclics are just as effective as SSRIs. 4 However, they may have more severe side effects including blurred vision, constipation, drowsiness and lower blood pressure levels. Imipramine (Tofranil) and amitriptyline (Elavil) are examples of TCAs.
Monoamine Oxidase Inhibitors (MAO-Is)
MAO-Is were created at the same time as tricyclics. Their main function is to reduce the amount of an enzyme (monoamine oxidase) that breaks down neurotransmitters in the brain, like serotonin and dopamine. This reduces enzyme activity and allows the neurotransmitters to build up and increase levels in the brain.4 The MAO-Is usually prescribed include phenelzine (Nardil), followed by tranylcypromine (Parnate) and isocarboxazid (Marplan). 1 MAO-Is are not used as often as tricyclics or SSRIs because of dietary restrictions. MAO-Is can increase blood pressure to dangerous levels if people eat certain foods that contain high amounts of tyramine (such as cheese, wine, beer and chocolate) on a regular basis.3
For all classes of antidepressants, patients must take regular doses for several weeks before they are likely to experience a full, therapeutic effect. Individuals should continue to take the medication as specified by their doctor. Although antidepressants are not habit–forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Medication should be stopped only under a doctor’s supervision. Patients should also consider taking a different type of medication if another does not succeed, since all anti-depressant medications work differently.
Mood stabilizers work to reduce extreme symptoms of both manic and depressive episodes. They do so by reducing the amount of energy-inducing hormones and chemicals in the brain. If successful, people will have more mellow moods in general, lowering the risk of experiencing extreme symptoms.
Lithium
Lithium was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of bipolar disorder and is still extremely effective. However, lithium is not effective in 40% of bipolar patients, especially in those who rapidly cycle between depression and manic episodes. People who are on Lithium should be carefully observed because of higher toxicity levels.2
Anticonvulsant Medications
Anticonvulsant medications, such as valproate (Depakote) or carbamazepine (Tegretol), are also used to stabilize moods in individuals with bipolar disorder. This type of medication is only effective in about 50% of patients, but is sometimes used instead of Lithium because they are safer. 2
Atypical mood disorder medication
Atypical antipsychotic medications include clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), and ziprasidone (Geodon).2 Evidence suggests clozapine may be helpful for people who do not respond well to lithium or anticonvulsants. Olanzapine has also shown to be effective in treating acute mania and psychotic depression.2
Thyroid Function
Too little thyroid hormone can cause symptoms that resemble major depressive disorder. Because of this, individuals seeking treatment for depression should undergo medical evaluation; if hypothyroidism is present, medications that increase levels of thyroid hormone may clear the symptoms. Additionally, people with bipolar disorder often have abnormal thyroid gland function and medication may worsen this functioning. Because too much or too little thyroid hormone can lead to mood and energy changes, it is important that thyroid levels are monitored by a physician. Some people need to take thyroid pills in addition to their medications for bipolar disorder.1
What Medication is used for Anxiety Disorder?
Medication cannot cure an anxiety disorder, but it can help lessen the symptoms, especially when combined with psychotherapy. Anti-anxiety drugs and beta-blockers are the most common form of medication used, but anti-depressants can also be used since depression often co-occurs with anxiety.
Anti-Anxiety Drugs
Benzodiazepines
Benzodiazepines combat anxiety by increasing GABA activity. GABA is a neurotransmitter that normally inhibits brain activity; when GABA is increased in the brain, the brain is not as excited and anxiety can decrease. 5 Benzodiazepines have very few side-effects, except for drowsiness, but are very addictive and should be taken in low doses only. Examples of benzodiazepines are Clonazepam (Klonopin), lorazepam (Ativan) and alprazolam (Xanax).3
Beta-Blockers
Beta-blockers, such as propranolol (Inderal) are used to treat heart conditions and can prevent physical symptoms that often accompany certain anxiety disorders, particularly social phobia. When a feared situation is predictable, a doctor may prescribe a beta-blocker to keep the physical symptoms under control.3
Psychotherapy
Psychotherapy involves talking about your feelings with a trained mental health professional. Psychotherapist is the common title for these types of professionals, and this title can apply to a psychiatrist, psychologist, licensed social worker or counselor. Psychotherapists use a wide range of techniques based on relationship building, dialogue, communication and behavior change.6 There are many types of effective psychotherapy, selection depends on personal preference.
Cognitive-Behavioral Therapy
Cognitive behavioral therapy is one type of psychotherapy. It is an umbrella term for many psychological techniques that share a theoretical basis in behavioristic learning theory. Cognitive-behavioral therapy (CBT) is often used for treatment of mood and anxiety disorders. CBT helps alter an individual’s thinking patterns, as well as the ways he or she responds to certain situations.1
Exposure-Based Therapy
Exposure based therapy exposes individuals to situations or objects which cause them great fear and discomfort. It is often used to treat specific phobias, such as fear of germs or social situations. The individual encounters the object or situation that is feared in gradual steps, perhaps at first only through pictures or tapes, then later in close physical proximity. The premise behind this therapy is that gradual exposure desensitizes the anxiety caused by the feared object or situation.
Person (Client) Centered Therapy
Client centered therapy is a type of psychotherapy in which the therapist's role is to act as a facilitator. Rather than direct the therapy session and offering their thoughts on how the patient might wish to change, the therapist encourages the patient to share their feelings, mirroring the individual’s thoughts back to them and encouraging the individual to explore their thoughts in their own way. Two primary goals of person-centered therapy are increasing the individual’s self-esteem and developing a greater openness to experience.9
Interpersonal Therapy
Interpersonal therapy (IPT) is a short-term supportive psychotherapy with a focus on building interpersonal skills. The idea behind interpersonal therapy is that symptoms can be treated by improving the communication patterns and how people relate to others. This is a short term psychotherapy which typically involves up to 20 sessions and maintains a focus on key issues which exacerbate the individual’s depression.7
Family or Couples Therapy
Family or couples therapy is a type of psychotherapy in which significant others or family members work together to nurture change and development in their relationships. Individuals seek to improve interaction between each other, and problems and solutions are viewed as a collective responsibility. The therapist’s responsibility is to influence effective conversation between family members.7 This type of therapy emphasizes positive familial relations as integral to recovery and a happy and functioning life.8
Group Therapy
Group therapy is a form of psychotherapy where several individuals meet together and work with one or more therapists (group leaders). This method is often utilized for support groups, where support from others is essential in recovery. Group therapy is commonly used in the treatment of depression, since it provides people with much needed emotional support and the shared benefit of knowing they are not struggling alone.6
Medical Treatments
Medical treatments are often utilized when an individual has severe depressive symptoms and has not been helped from any type of medication or psychotherapy.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain of anesthetized patients, deliberately triggering a brief seizure for a therapeutic effect. ECT is only used in cases where individuals suffer from severe depression and have not responded to other treatments. ECT is also used to treat mania associated with bipolar illness.
Repetitive Transcranial Magnetic Stimulation (rTMS)
Repetitive Transcranial Magnetic Stimulation (rTMS) is a relatively new treatment that is often used for individuals with treatment resistant depression, but can also be used a primary treatment option. Receiving FDA approval in 2008, rTMS has not yet been extensively studied, but has been shown to be effective. In contrast to medication and ECT, rTMS has relatively few side effects. There is no anesthesia involved and no surgery, weight gain, or brain damage.
1 What medications are used to treat depression? Retrieved June 22, 2009
2 What medications are used to treat bipolar disorder? Retrieved June 22, 2009
3 What medications are used to treat anxiety disorders? Retrieved June 22, 2009
4 Oltmanns, T. & Emery, R. (2007). Abnormal Psychology (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
5 Breedlove, S., Rosenzwieg, M. & Watson, N. (2007). Biological Psychology (5th ed.). Sunderland, MA: Sinauer Associates, Inc.
6 Montgomery, C. (2002). Role of dynamic group therapy. Advances in Psychiatric Treatment, 8(1), 34-41.
7 Interpersonal psychotherapy for depression. Retrieved June 22, 2009
8 Family focused therapy effective in treating depressive episodes of bipolar youth. Retrieved June 16, 2009
9 Bruno, F. (1977). Client centered counseling: Becoming a person. Human Adjustment and Personal Growth: Seven Pathways. John Wiley & Sons.