Psychological models of mood disorders

Different psychological models are reviewed for both unipolar depressive disorder and bipolar disorder. The psychological models are useful to understand and plan care. They have been developed into effective clinical interventions, although all of them have some limitations and none of them is suitable for every patient. The most useful general model of cognitive behaviour therapy is probably the Five Areas Approach, which examines how physical, social, cognitive, and behavioural factors contribute to mood. The life events and social support model identifies social factors that make an individual vulnerable to depression, precipitate depression, and maintain it. Such an approach depends on understanding the contextual meaning of life events, life difficulties, and social support on the basis of past experience. Clinical intervention is possible to reduce the threat of life events and difficulties, for example through better social support, and to promote recovery though positive life events. A modern psychodynamic model of the mind based on object relations and discrepancies between the ideal and actual self has some empirical support and may help to understand how depression has developed. A medication adherence model is presented to help the understanding of how pharmacological treatment can be explained and treatment with it enhanced through improved adherence. Finally a simple psychological model explaining how early symptoms of relapse into mania and depression can be recognized and managed is presented. Optimal clinical care is probably achieved when these psychological and social models are integrated with evidence-based pharmacological treatment in a system of organized care.