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Practical Aspects of Light Therapy
In general, it is best to begin light therapy with the patient receiving 10,000 lux. Lower intensities are effective but take significantly more time out of…

Formal Aspects of Light Therapy
As noted earlier in this chapter, light therapy appears to be mediated via the eyes rather than the skin. It is important for clinicians to inform…

Evidence for Efficacy

Acute-Phase Treatment
Because the recipient of light therapy is not “blind” to the treatment being administered, the development of a suitable control treatment for light therapy has been a problem…

Light Therapy Diagnostic Indications and Contraindications

Indications
The chief indication for light therapy is seasonal affective disorder (SAD) (Rosenthal et al. 1984) or, as classified in DSM-IV (American Psychiatric Association…

Electroconvulsive Therapy: Case Examples

Electroconvulsive Therapy: Stimulus Electrode Placement
For many years, stimulus electrodes were applied bitemporally, with midpoints of the electrodes approximately 1 inch above the midpoint of a line connecting the external canthus with the…

Electroconvulsive Therapy: Seizure Monitoring

Monitoring of Motor Response
Seizure monitoring has long been an integral component of ECT technique (Weiner et al. 1991). Traditionally, this monitoring has consisted of the detection of…

Electroconvulsive Therapy: Continuation/Maintenance Therapy

Continuation/Maintenance Pharmacotherapy
For the most part, individuals referred for ECT have disorders that are associated with a high risk of recurrence, particularly during the first 6 months…

Staffing and Location of ECT Treatments
The safe and effective provision of ECT requires a highly trained and experienced staff that includes a psychiatrist, a provider of anesthesia, and, generally,…

Electroconvulsive Therapy Technique

Electroconvulsive Therapy: Side Effects

Electroconvulsive Therapy: Contraindications and High-Risk Situations
It is now recognized that there are no “absolute” contraindications for the use of ECT. The decision to give any treatment is based on…

Electroconvulsive Therapy: Other Disorders

Mental Disorders
There is a long history of ECT being used for the primary treatment of a variety of conditions other than major mood disorders and schizophrenia, including…

Electroconvulsive Therapy: Schizophrenia

Evidence for Acute-Phase Efficacy
Although the first use of ECT was reported in patients with schizophrenia, it was not long before it was appreciated that the efficacy of ECT in…

Electroconvulsive Therapy: Manic Episodes

Evidence for Acute-Phase Efficacy
ECT is highly effective in its ability to induce a remission in manic states, with 80% of patients showing marked improvement (Mukherjee et al.…

Electroconvulsive Therapy: Major Depressive Episodes

Evidence for Acute-Phase Efficacy
It is generally accepted that ECT is the most rapid and effective treatment available for major depressive episodes (Weiner and Coffey 1988).…

Electroconvulsive Therapy: Indications
General Issues
When Is ECT Indicated?

Indications for any treatment are governed by two types of considerations: the presence of an episode of a disorder for which the treatment…

Combined Medication and Psychotherapy: Combined Treatment
It is not always clear where pharmacotherapy ends and psychotherapy begins; almost all pharmacotherapy is provided in the context of a therapeutic relationship that goes beyond the mere…

Combined Medication and Psychotherapy: Other Indications and Contraindications
As suggested by the AHCPR guidelines, combined treatment may be indicated when clinical circumstances suggest two discrete targets of therapy that are each best…

Combined Medication and Psychotherapy: Evidence for Acute-Phase Efficacy
The first question of interest is whether providing combined treatment to patients who are acutely symptomatic does anything to enhance response over that achieved…

Combined Medication and Psychotherapy: Diagnostic Indications and Contraindications
At this time, there are few indications for combined treatment that have been established on an empirical basis, but some patterns are suggestive (Rush…

Psychodynamic Psychotherapies: Negative Effects
Little information exists on possible negative effects of the dynamic psychotherapies on depressed patients. Indeed, in a survey of the literature, Hollon and Emerson (1985) were unable to…

Psychodynamic Psychotherapies: Suicidality
Retrospective studies have clearly established that well over 90% of persons who commit suicide have a diagnosable psychiatric illness, usually depression (Asnis et al. 1993). Treatment of the suicidal…

Psychodynamic Psychotherapies: Treatment Principles
Although psychodynamic approaches to depression are lumped together in the design of this present volume, they may vary considerably in their technical strategies. The actual interventions used in…

Psychodynamic Psychotherapies: Efficacy

Evidence for Acute-Phase Efficacy
No controlled efficacy studies exist for extended dynamic therapy or psychoanalysis of depression. Brief dynamic therapy, on the other hand, has been studied in 10 randomized…