Treatment Options

On this page:
Who offers therapy?
Different therapies
Medications
Alternative Therapies
Social Supports
Finding the Right Combination

Treatment options for a mood disorder vary depending on your diagnosis and personal preference. There are many options and this may seem overwhelming at times. Take your time to learn what is available and to discuss with your health care professional what the best course of action for you might be.

In many cases, a combination of therapies is most effective and this can include different forms of medication, psychotherapy, social supports and alternative therapies. Finding the right treatment may take some time so don't give up - you can feel better.

Health care professionals who offer therapy

A health care professional brings knowledge and skill to a therapeutic relationship. Their job is to provide the safety and guidance necessary to make you feel supported and secure in the important work that you are doing.

There are different types of health care professionals who offer therapy and the choice is a personal one, depending on what appeals to you and what your diagnosis is. Here are some of the most common types of health care professionals you might consider:

Psychiatrists: medical doctors that specialize in psychiatric disorders
Psychologists: trained professionals (Ph.D. or Psy.D.) that specialize in counselling and mental health issues
General Practioners: many GPs are trained in psychotherapy and some specialize in psychotherapy
Psychiatric Nurses: nurses who specialize in psychiatric disorders
Social workers: qualified professionals (BSW or MSW), some of who specialize in mental health issues, and many of whom are trained in psychotherapy

To learn more about what you should look for in a therapist and where you can find one, click here

Different therapies you might consider

There is a wide range of therapies available and, again, your choice will in part depend on what makes sense to you and what your particular concerns are. Here is a list of some the more common therapies used to treat people who are suffering from a mood disorder.

1. Psychotherapy

Psychotherapy involves talking to a trained professional about the issues and concerns you have about your health. It can involve one on one, couple, family or group psychotherapy. Psychotherapy involves an agreement between you and a health professional for the purpose of resolving the mood disorder and promoting the healing process.

Different kinds of psychotherapy:

Cognitive behaviour therapy - this therapy works on patterns of thinking we have that happen in many situations. The therapist examines these "automatic" thoughts and helps you to develop and practice alternate and healthier patterns.
Supportive counselling - this kind of counselling focuses on what's going on in your life, right now. It helps to provide a supportive environment where you can feel safe to talk about day-to-day concerns and issues.
Interpersonal therapy - this therapy focuses on how we deal with important relationships in our lives and our different roles at work, school and at home. It helps with transitions or changes in these roles that occur with the development of a mood disorder.
Psychodynamic psychotherapy - this therapy focuses on the relationship between childhood and early life experiences and how we are functioning and feeling today.
Other therapies - such as biofeedback, desensitization and hypnotherapy are often prescribed and can be of benefit, but are not scientifically proven to be effective in treating mood disorders as yet.

Several of these therapies can be offered for couples, families or groups. The principles are the same, but the purpose is somewhat different. For couples, the focus of the therapy is naturally the relationship and building more healthy communication patterns and interactions. Family therapy is often used when there are issues across the generations in a family. It is also used when a family member has a mood disorder and their behaviour is affecting the family or when the family is keen to change or develop a new pattern of interactions that might help their loved one who is ill.

2. Other treatments

Other treatments may be offered to you that can reduce symptoms of, and help you recover from, a mood disorder. These treatments can be used alone but are often used in combination with psychotherapy.

Medication therapy Medications may be prescribed to alleviate the symptoms associated with your mood disorder.
Hormone replacement therapy (HRT) Prescribed preparations of the hormones estrogen and progesterone are sometimes used to improve mood in women dealing with PMS, PMDD, menopause and postpartum depression, although the scientific research regarding their effectiveness is not strong at present.
Light therapy Specifically designed therapeutic light units are used to treat a depression that recurs annually, known as Seasonal Affective Disorder.
Electroconvulsive Therapy (ECT) Small and brief electrical impulses are delivered to the brain that result in a reduction of symptoms and often complete resolution of symptoms.
Trans-cranial Magnetic Stimulation (TMS) Small and brief magnetic impulses are delivered to the brain that result in a reduction in symptoms of depression and often complete resolution of symptoms.

Medications

For more information on specific medications, how they work, their uses, and side effects, check out:
The National Institute of Mental Health

The medications that are used to treat mood disorders have changed a great deal in the past ten years and new ones are being developed and researched all the time. The most common medications used to treat mood disorders are:

1. Antidepressants

Each antidepressant affects many brain and body chemical systems. The older antidepressants were defined by their chemical structure, but the newer medications are categorized by which chemicals in the brains they have the most impact upon.

Early antidepressants include:

>Tricyclic antidepressants

Tricyclic antidepressants are very effective treatments for depression. Overall, more people have side effects on these medications than the newer ones. So, although most specialists in mood disorders would agree that it is quite reasonable to start someone on a tricyclic antidepressant to treat depression, these medications are not usually prescribed as a first choice any more.

Tricyclic antidepressants include:

Amitriptyline (Elavil, Endep, Emitrip, Enovil)
Amoxapine (Asendin)
Clomipramine (Anafranil)
Desipramine (Nopramin, Pertofrane)
Doxepin (Adapin, Sinequin)
Imipramine (Janimine, Tipramine, Tofranil)
Nortriptyline (Pamelor, Aventyl)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

>Monoamine oxidase inhibitors (MAOIs)

There are some food limitations for anyone who is taking an MAOI. These include restrictions on foods which contain significant levels of tyramine, including (but definitely not limited to - the list is long!) red wine, cheese and soy products. Talk to your health care practitioner about this issue.

These medications can have serious side effects and are less commonly prescribed. However, with careful attention to diet, these side effects can be minimized. This class of medication can be very effective, but are usually reserved for people who do not respond to newer antidepressants.

MDAOI antidepressants include:

Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (Emsam)

Newer antidepressants include:

>Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors are a newer group of antidepressants that act primarily on the neurotransmitter serotonin. They tend to have fewer side effects than the older antidepressants and are commonly prescribed to treat depression and other mood disorders, as well as anxiety and eating disorders.

SSRI antidepressants include:

Citalopram (Celexa)
Escitalopram oxalate (Cipralex)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)

>Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Similar to the older tricyclic antidepressants, these medications affect serotonin and norepinephrine. Unlike the older antidepressants, they have fewer side effects on other brain and body systems, and so have far fewer side effects.

SNRI antidepressants include:

Duloxetine (Cymbalta)
Venlafaxine (Effexor)

>Norepinephrine and dopamine reuptake inhibitors (NDRIs) These medications increase levels of norepinephrine and dopamine in the brain by inhibiting their re-absorption into cells. There is currently only one NDRI approved to treat depression:

Bupropion (Wellbutrin)

>Norepinephrin and Serotonin Specific Agents

These medications have an action unlike the previously mentioned agents. They lead to an increase in the release of norepinephrin and serotonin. There is only one medication in this class at present

Mirtazapine (Remeron)

2. Antipsychotic medications

Antipsychotic medications were first used to control psychotic symptoms, such as hallucinations or delusions that sometimes occur in very severe depressive or manic episodes. However, they have beneficial effects in a variety of mood disorders whether or not there are psychotic symptoms present.

There are 2 kinds of antipsychotics: older antipsychotics (called "typical" antipsychotics) and newer antipsychotics (called "atypical" antipsychotics). The older types of these medications have been known to cause a serious movement disorder called tardive dyskinesia (TD).

Older antipsychotic medications include:

Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Perphenazine (Trilafon)

As the newer "atypical" antipsychotics have fewer side effects, they are usually the first choice when an antipsychotic is prescribed. More importantly, the newer "atypical" agents are very effective in treating mania, in stabilizing mood after recovery from mania, in treating depression, and in treating certain anxiety disorders.

Newer antipsychotic medications include:

Aripiprazole (Abilify)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)

3. Antianxiety medications

Antianxiety medications include the benzodiazepines, which can relieve symptoms within a short time. SSRIs and SNRIs are also commonly prescribed to treat anxiety.

Benzodiazepine medications include:

Alprazolam ( Xanax )
Clonazepam ( Klonopin )
Diazepam ( Valium )
Lorazepam ( Ativan )

Another medication used to treat anxiety is Buspirone ( BuSpar ). This medication must be taken consistently for two weeks to be effective and therefore cannot be used on an "as needed" basis the way the benzodiazepines can.

Important things to remember when taking medication

Don't stop on your own

You may start to feel a lot better once your medication is working for you. Many people don't like the idea of being on medication and decide to stop taking it or reduce their dosage without consulting their health care professional. This can be dangerous and can have long-term health affects for you. Talk to your health care professional before you stop taking any medication or change your dosage.

Don't use other drugs or alcohol

Illicit drugs and alcohol can interact with certain prescription medications, leading to serious health issues. Talk to your health care professional about the medication you have been prescribed and any interactions it may have with other substances.

4. Mood stabilizers

Mood stabilizers are prescribed to help control both the mania and depression of bipolar disorder. People with bipolar disorder often need to continue treatment with mood stabilizers for long periods of time after the mania or depression is controlled.

Mood stabilizers include:

>Lithium (Carbolith, Duralith, Lithane, Lithizine)

Lithium is the medication most often prescribed to treat bipolar disorder. Lithium evens out mood swings (both mania and depression) and is prescribed as an ongoing maintenance treatment for bipolar disorder.

As it can take lithium several weeks or months to fully control bipolar disorder, antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder.

>Anticonvulsants

Valproate (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
Gabapentin (Neurontin)
Topiramate (Topamax)

Anticonvulsant medications also can have mood stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Anticonvulsant medications may be combined with mood stabilizers, or with each other, for maximum effect.

Alternative Therapies

There are many types of alternative therapies that can be used in combination with traditional therapies to support you in your recovery. These include:

Exercise: When you exercise your body produces endorphins which are known to have a positive effect on mood.
Relaxation: Learning how to relax through a panic attack can be an effective tool in managing an anxiety disorder.
Vitamins: Certain vitamins, such as B12, are reported to support an enhanced mood.
Herbal Medicines: Some herbal medicines, such as St. John's wort, are reported to alleviate the symptoms of depression.

All of the alternative therapies listed above offer interesting options in your recovery. It's important to discuss any alternative therapies, especially vitamins and herbal remedies, with your health care professional as they may interact with any other medications you may be taking.

Social Supports

Feeling alone and isolated can keep you from getting the help you need and can make your symptoms seem worse. Social support can play an important role in your recovery.

There are lots of places where you can get social support:

peer groups
faith based groups
family and friends

Even though it may seem overwhelming at times, try to reach out. Once you hear people tell how they went through similar situations, or you have a friend or family member involved in your recovery, you may be surprised at how much energy you have to get better.

For information on peer support groups at MDAO, click here.

Finding the Right Combination

Often the best approach to tackling a mood disorder is a combination of treatments. Here is a menu of options commonly offered to treat specific mood disorders. You don't have to use all of them but can discuss each option with your health care practitioner. Once you find the combination that works best for you, you're on your way to leading a healthy and stable life.

Depression

Antidepressants
Cognitive behaviour therapy
Individual therapy
TMS
Exercise
Relaxation
Vitamins
Herbal medications

Anxiety Disorders

Antidepressants
Antianxiety medications
Cognitive behaviour therapy
Individual therapy
Interpersonal therapy
Hypnotherapy
Desensitization
Relaxation
Herbal medications

Bipolar Disorder
(including bipolar II and rapid cycling)

Note: Some tricyclic antidepressants can increase the severity and frequency of manic episodes in bipolar disorder. Speak with your health care provider about this issue before taking any antidepressant medications.

Antidepressants
Antianxiety medications
Antipsychotics
Mood stabilizers
Cognitive behaviour therapy
Individual therapy
Interpersonal therapy
Group therapy
Family therapy
ECT
TMS
Exercise
Relaxation
Vitamins
Herbal medications

Seasonal Affective Disorder

Antidepressants
Light therapy
Interpersonal therapy
Group therapy
Family therapy
ECT
Cognitive behaviour therapy
Individual therapy
Interpersonal therapy
Exercise
Vitamins
Herbal medications

Concurrent Disorders

Note: Treatment of concurrent disorders can be very complex and will vary depending on the severity and nature of the substance abuse and mental health issues being addressed.

Antidepressants
Antianxiety medications
Antipsychotics
Individual therapy
Cognitive behaviour therapy
Exercise
Relaxation
Vitamins
Herbal medications

Hormone Related Mood Disorders
(including postpartum mood disorders, PMS &PMDD and perimenopause/menopause)

Antidepressants
Individual therapy
Family therapy
Group therapy
HRT
Individual therapy
Exercise
Vitamins
Herbal medications

Sources