Psychological management of mood disorders

Abstract

Evidence-based psychological treatments for adults with unipolar depressive disorder and bipolar disorder are reviewed. There is most empirical evidence for cognitive behavioural therapy (CBT), which is examined in terms of what it is and its evidence base in unipolar depression, including severe, chronic, and treatment-resistant cases. The evidence base for the combination of CBT plus antidepressant treatment, including where continuation CBT may be usefully employed, reveals greater effectiveness than antidepressant treatment with continuing clinical support or other forms of psychotherapy in patients with severe, chronic, and treatment-resistant depression or depression with co-morbid personality disorder. Briefer descriptions and evidence for the role of mindfulness-based cognitive therapy, behaviour therapy, problem-solving, interpersonal therapy, psychodynamic therapy and cognitive analytical therapy are reviewed. All of these have some evidence for effectiveness and the roles of some of these treatments are starting to become clearer. Simple psychological treatments for bipolar disorder, such as medication adherence and early warning symptoms interventions, can improve some types of clinical outcome, but longer psychological interventions delivered by highly skilled therapists such as CBT and group psycho-education may have more comprehensive evidence of effectiveness. There is some preliminary evidence for the effectiveness of some psychological treatments in bipolar depression. Overall, the effectiveness of psychological treatments for unipolar depressive disorder and bipolar disorder is now well established and an understanding is starting to be obtained as to when they may be employed most usefully.