Chapter Introduction

CHAPTER
8

Treatments for Depressive and Bipolar Disorders

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TOPIC OVERVIEW

Treatments for Unipolar Depression

Psychological Approaches

Sociocultural Approaches

Biological Approaches

How Do the Treatments for Unipolar Depression Compare?

Treatments for Bipolar Disorders

Lithium and Other Mood Stabilizers

Adjunctive Psychotherapy

Putting It Together: With Success Come New Questions

Mid-twenties life circumstances were poor and I really plummeted…. The thing that made me go for help … was probably my daughter … I thought, this isn’t right, this can’t be right, she cannot grow up with me in this state…. I got counseling … [The therapist] absolutely saved me.

J. K. Rowling, author of the “Harry Potter” books (in Amini, 2008)

When you’re clinically depressed the serotonin in your brain is out of balance and probably always will be out of balance. So I take medication to get that proper balance back. I’ll probably have to be on it the rest of my life.

Terry Bradshaw, Super Bowl quarterback and sports analyst (in Morgan & Shoop, 2004)

[A holistic healer] introduced me to this new way of kind of treating depression, which is without the uptake inhibitors, to slowly get off the uptake inhibitors with the help of a doctor … Supplements… It is vitamins… It’s a wonderful thing.

Jim Carrey, comedy actor (Carrey, 2013, 2008)

I struggled with chronic depression. I was in bad shape…. I did do therapy and antidepressants for a brief period, which helped me. Which is what therapy does: it gives you another perspective when you are so lost in your own spiral … And honestly? Antidepressants help! If you can change your brain chemistry enough to think: “I want to get up in the morning.”.

John Hamm, actor, star of Mad Men (Hamm, 2010)

In my case, ECT [elctroconvulsive therapy] was miraculous. My wife was dubious, but when she came into my room afterward, I sat up and said “Look who’s back among the living.” It was like a magic wand.

Dick Cavett, talk show host (Cavett, 1992)

I took [lithium] faithfully and found that life was a much stabler and more predictable place than I had ever reckoned. My moods were still intense and my temperament rather quick to the boil, but I could make plans with far more certainty and the periods of absolute blackness were fewer and less extreme….

Kay Redfield Jamison, clinical researcher (in Jamison, 1995, pp. 5, 153, 212)

[T]he hospital was my salvation, and it is something of a paradox that in this austere place with its locked and wired doors and desolate green hallways … I found the repose, the assuagement of the tempest in my brain, that I was unable to find in my quiet farmhouse…. For me the real healers were seclusion and time.

William Styron, novelist (in Styron, 1990, pp. 68–69)

Each of these people suffered from and overcame a depressive or bipolar disorder. And, clearly, all believe that the treatment they received was a key to their improvement—a key that opened the door to a more normal, stable, and productive life. Yet the treatments that seemed to help them differed greatly. Psychotherapy helped bring meaning back to the life of J. K. Rowling. Antidepressant drugs were the key for Terry Bradshaw, vitamins for Jim Carrey, and a combination of psychotherapy and medications for John Hamm. Electroconvulsive therapy, popularly known as shock treatment, lifted Dick Cavett from the black hole of his unipolar depression. Hospitalization and its temporary retreat were the answer for William Styron. And Kay Jamison escaped the roller-coaster ride of bipolar disorders with the help of lithium, a common element found in mineral salts.

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A place for laughter Many comedians have histories of depression. Drew Carey, for example, suffered from severe depression for much of his life. The popular host of the TV game show The Price Is Right reports that he has been able to overcome this mood disorder successfully by developing a positive outlook—through reading psychology books, listening to tapes on positive thinking and, of course, by generating and communicating humorous thoughts.

How could such diverse therapies be so helpful to people suffering from the same or similar disorders? As this chapter will show, disorders that feature severe changes in mood—as painful and disabling as they tend to be—respond more successfully to more kinds of treatment than do most other forms of psychological dysfunction (Cuijpers et al., 2014). This range of treatment options has been a source of reassurance and hope for the millions of people who desire desperately to regain some measure of control over their moods (see Figure 8-1).

Figure 8.1: figure 8-1
How do people feel about depression and treatment?
According to a recent survey, more than 80 percent of Americans believe that depression is a serious condition that requires treatment. Nineteen percent consider depression to be a sign of personal weakness.