Abnormal Psychology

Mood Disorders and Suicide 209

dependent on others, other people may eventually criticize and even reject the

person, which could have the effect of confi rming the person’s negative view of

self and his or her prospects for the future. Consider that researchers have found

that depressed undergraduates are more likely than nondepressed undergraduates

to solicit negative information from happy people; such a tendency can lead hap-

pier people to reject the depressed questioner, confi rming negative beliefs about

himself or herself (Wenzlaff & Beevers, 1998).

In short, people’s psychological characteristics affect how they interpret events

and how they behave, which in turn infl uences how they are treated in social inter-

actions, which then infl uences their beliefs about themselves and others (Casbon et

al., 2005). And all of this is modulated by whether or not the person is neurologi-

cally vulnerable to depression. Figure 6.2 illustrates the feedback loops.

Treating Depressive Disorders

As discussed in Chapter 4, different treatments target different factors. However,

successful treatment of any one factor will affect the others. For example, improv-

ing disrupted brain functioning will alter a person’s thoughts, mood, and behav-

ior, and interactions with others.

Targeting Neurological Factors

In treating depressive disorders, clinicians rely on two major types of treatment that

directly target neurological factors: medication and brain stimulation.

Medication

Several types of medications are commonly prescribed for depression; it can take

weeks for one of these medications to bring about any change in depressed mood.

Antidepressant medications include the following:

• Selective serotonin reuptake inhibitors (SSRIs), such as fl uoxetine (Prozac), par-

oxetine (Paxil), and sertraline(Zoloft).SSRIs slow the reuptake of serotonin from

synapses. Because these antidepressants affect only certain receptors, they have

fewer side effects than other types, which can make people less likely to stop tak-

ing them (Anderson, 2000; Beasley et al., 2000). However, SSRIs are the only type

of antidepressant to have the side effect of decreased sexual interest, which can

lead some patients to stop taking them (Brambilla et al., 2005; Gregorian et al.,

2002). Many patients also fi nd that the same dose of an SSRI brings less benefi t

over time (Arana & Rosenbaum, 2000)—an effect nicknamed Prozac poop-out.

SSRIs are also used to treat anxiety disorders, (discussed in Chapter 7), as well as

other disorders.

• Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil). TCAs are so

named because their molecular structure contains three (tri-) rings of atoms; they

have been used since the 1950s to treat depression and, until SSRIs became avail-

able, were the type of medication most commonly used for this purpose. TCAs

are generally as effective as Prozac for depression (Agency for Health Care Policy

and Research, 1999). The side effects of TCAs differ from those of SSRIs: The

most common side effects include low blood pressure, blurred vision, dry mouth,

and constipation, but diminished libido (sex drive) is not a signifi cant side effect

(Arana & Rosenbaum, 2000).

• Monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil). Some neu-

rotransmitters, such as serotonin, dopamine, and norepinephrine, are classifi ed

asmonoamines; monoamine oxidase is a naturally produced enzyme that breaks

down monoamines in the synapse. MAOIs inhibit this chemical breakdown, so the

net effect is to increase the amount of neurotransmitter in the synapse. MAOIs are

more effective for treating atypical depression (Cipriani et al., 2007; Prien & Kocsis,

1995) than typical depression. These medications can be dangerous when patients

Selective serotonin reuptake

inhibitors (SSRIs)

Medications that slow the reuptake of

serotonin from the synapse.

Tricyclic antidepressants (TCAs)

Older antidepressants named after the three

rings of atoms in their molecular structure.

Monoamine oxidase inhibitors (MAOIs)

Antidepressant medications that increase the

amount of monoamine neurotransmitter in

the synapse.