Mood Disorders Program

Since depression and bipolar disorder, including bipolar depression, have a completely different pharmacological approach, our first goal is to understand exactly the diagnosis of the patient following an accurate assessment. Once the diagnosis has been ascertained, our psychiatrists prescribe a pharmacological treatment following a personalized-based approach. It means that the best pharmacological combination, in line with the international guidelines and with cutting-edge pharmacological knowledge, are offered to our patients minimizing the side effects.

We offer drug combinations for people who suffer from depression or bipolar disorders not responding to conventional treatments and at the same time the patients receive different psychotherapy approaches.

Electroconvulsive Therapy (ECT) is offered to select patients for whom it is indicated and may be done on an inpatient or outpatient basis at the Montreal General Hospital. 

Offered by the Neuromodulation unit at MUHC, rTMS is a specialized treatment. It has been endorsed by the Canadian Network for Mood and Anxiety Treatments as an effective treatment for depression and other psychiatric and neurological disorders. A safe and painless procedure, it involves stimulation of targeted cerebral activity by a pulsed magnetic field. Depending on the patient, rTMS comprises 20-30 treatments, each lasting 30-60 minutes, over four to six consecutive weeks.

Although psychopharmacology is the bedrock of treatment for mood disorders, medications alone are seldom enough to achieve optimal results. Among the adjunct forms of psychological intervention, psychoeducation has become part of every treatment plan. It is incorporated on an individual basis, but also in group format. When there are enough willing participants, the group meets for two hours weekly for four weeks and discusses Bipolar Disorder and Depression in a systematic way. In addition to basic information, each member reviews their own journey with the disorder, learning to recognize symptoms, triggers of stress, and their typical coping style. The goal is to have more control over the episodes and improve the quality of their lives. Members typically appreciate the opportunity to meet others with similar issues and learn additional ways to manage.

Although the majority of patients are followed by one physician, a number of patients will require the services of a Case Manager. This person may be a nurse, occupational therapist or social worker who will, in conjunction with the treating physician, plan, implement, evaluate and coordinate the overall needs and care. This may be required over a short or longer part of their stay in our program.

CBT is based on the idea that there is an interaction between how we think (cognition), how we feel (emotion) and how we act (behaviour); specifically, that it is our thoughts which determine our feelings and our behavior. CBT is an established therapy for a range of problems in daily living, particularly those involving mood and anxiety symptoms. This approach was introduced almost 50 years ago and has been refined and tested since. In addition to a large research literature supporting its effectiveness, the major advantage of this approach is that it is active and collaborative.  

Although the basic assumption is that thoughts held by people influence their emotions and in the case of depression, these thoughts are typically negative and unrealistic -- the therapist does not arrive with any preconceptions about the accuracy of these thoughts, but works collaboratively with the person to examine them objectively and fairly. After identifying and testing those thoughts, which may be inaccurate and maladaptive, these are then targeted for change using various techniques. Finally, CBT involves a close examination and challenging of the roots of these patterns of thought. Wee call these core beliefs— those long-standing, stable, and usually negative beliefs about ourselves, others or the world, beliefs of which we may not be fully aware of but which give rise to these negative thoughts.

The behavioural part of the therapy comes in with the testing of thoughts and of core beliefs (i.e., setting up and doing behavioural experiments between sessions), as well as in increasing pleasurable and competency-building activities that can counter depression. Such activities are often reduced or avoided when one is in the throes of depression. 

Although this type of therapy is effective whether offered on an individual or group basis, we have found the group context to be especially helpful, not only in allowing participants to share their experiences with depression, but especially in having them work together to learn and practice the various techniques. CBT is, of course, offered on an individual basis. 

Click here to read about the MUHC CBT Unit.

The Mood Disorders Program can refer patients to our Psychology Department for a variety of time-limited psychotherapy options.

Working with family members of people who suffer from mood disorders is an important dimension to patient care. The Mood Disorders Program is expanding its mandate to include sessions with family members so they feel respected as part of the treatment process. Their questions can be answered and they can provide information that can help the treatment team better understand the problems that require attention. In addition, periodic information sessions will be offered in group format to families.

The role of the occupational therapist (OT) in the Mood Disorders Program is to evaluate a person’s level of functioning after the onset of an illness. The OT provides a variety of recovery oriented interventions (individual and group) that promote autonomy, adaptation to illness and re-integration.  

Psychiatric Rehabilitation Services: Groups offered by OTs

Academic Reintegration: A 10-12 week group (1x/week) to support individuals who would like to return to school after mental illness has disrupted their studies.  Sessions address topics such as readiness, symptom management, study skills, resources, and stigma. Individual follow-up is also available.

Wellness: A 10-12 weeks group (2x/week) for individuals who have or are at risk of metabolic syndrome. Sessions are aimed at increasing awareness surrounding metabolic syndrome, nutrition, stress management, and exercise. This group is led by a multidisciplinary team including nurses, OTs, and psychoeducator.

Work Integration: A 10-12 week group (1x/week) to support individuals who would like to return to competitive employment. The sessions address topics such as readiness, values, education, vocational skills, resources, social action, and advocacy. Individual follow-up is also available.

Connecting Body and Mind: This is an ongoing weekly group that uses yoga postures and breathing techniques to create a breath/mind/body awareness and “present moment” consciousness. It has been found to be useful for individuals whose function is impeded by anxiety, autonomic stress reactivity, poor emotional management and negative self-image.

The services include:

Psychosocial assessment and treatment plans

• Crisis intervention – for any type of drastic change of life events, personal, relationship, financial and work related issue
• Housing – Placement of psychiatric patients in foster, group homes, supervised apartments, low income housing and community follow up
• Financial counseling – information and assistance in budgeting, social welfare, disability, old age pension, unemployment insurance requests, financial administration (MUHC Patient Trust Funds)
• Patient advocacy – within and outside of the Institution.
• Referral to community and government resources and CLSC for services
• Assessments of incapacity – Public, Private Curatorship assessments - reserved act for social workers

Professional affiliation:

• Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux de Québec

The Mood Disorders Program is providing care for the older patients who suffer from mood disorders and require specialized psychogeriatric services. This is a population that is growing fast and the rate of mood disorders, mainly Major Depressive Disorder (MDD), is higher than in the younger population. We offer the psychopharmacological, biological and social model approach to this population.