Evidence-based treatment of mood disorders

There is growing interest among mental health nurses and other clinicians in providing interventions with demonstrated efficacy and effectiveness in vast practice settings [1]. This movement to develop and implement treatment modalities extends beyond traditional outcomes, such as adherence to treatment and exacerbation of symptoms, and includes helping patients reach an optimal level of functioning and quality of life. Providing empirically based treatment is crucial in the treatment of mood disorders. Mood disorders can occur at any age and to people of any race, ethnic group, or social class. In the United States, more than 19 million adults have depression. Depression has a lifetime prevalence of 24% for women and 15% for men [2,3]. Among developed nations, including the United States, major depression is the leading cause of disability for individuals age 5 and older. Also near the top of the list of disabilities in the United States and throughout the world is bipolar disorder [2]. Also called manic depressive disorder, bipolar disorder affects 1%, or more than 2 million, of American adults. An equal number of men and women experience bipolar disorder. It is inherited, and it is found to occur more frequently in some families. There is also a seasonal relationship, with more "highs" or mania occurring in the spring and fall, whereas depression often occurs in winter [2,4]. Abnormalities in the brain biochemistry and in the communication of certain brain circuits are responsible for the shifts experienced in mood disorders [5,6]. Although there are a variety of mood disorders, this article addresses major treatment issues, including differential diagnosis, pharmacologic and nonpharmacologic approaches, and the role of the nurse caring for patients, in major depression and bipolar disorders.