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.

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

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.

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)
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)

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.

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)

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)

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.

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.