Depression Notes

Depression

Outline the Clinical characteristics of depression (2 key characteristics plus 5 further symptoms)

Depression is a low emotional mood, characterised a significant levels of sadness, lost of energy and self-worth, and feeling of guilt.
The diagnosis of major depression requires the presence of at least 5 or more the following symptoms. Affective symptoms: sad, depressed mood, and feeling low
Cognitive symptom: e.g. feeling of guilty about any mistakes, and thinking themselves as worthless
Behavioural symptoms: e.g. social withdraw and restlessness
Psychical Symptoms: changes in sleep patterns, energy levels or appetite these symptoms must cause clinically significant distress or impairment to general function and must not be as result of bereavement.
For depression to be diagnosed, these symptoms must be present all or most of the time, and persist longer than 2 weeks.

Discuss the issues surrounding the validity and reliability of classification and diagnosis systems

Test- retest reliability- this refers when a self-method is repeated with the same participants after an interval, and the results are consistent. This was tested by Beck et al 2006, using the responses of 26 outpatients who were tested on two therapy sessions, two weeks apart. There was correlation of 0.93, indication a significant level of test-retest reliability. Therefore the BDI is a reliable tool for measuring the severity of depression.
Content-validity- this refers whether items of a test are representative of what is been measured. The BDI is thought to be high in content validity, as it is a product of a consensus among mental health clinicians, concerning the symptoms found in psychiatric patients. Therefore the BDI is a valid tool for measuring the severity of depression.

Problems with BDI
One with the BDI is that the process of rehabilitation can be repetitive, and the patient may become too familiar with the test, so much that the quality of the treatment reduces, as the treatment progress.

Labelling depression as disease
Some have argued that the medicalization of normal human feeling and calling it a disorder is wrong. Therefore argue that methods used to diagnose depression are invalid. However others argue that if there are no diagnosis and medicalization of certain human feelings, there are potential serious consequences for people with severe symptoms of depression. Perhaps the problem is not the validity of the diagnosis or labelling, but rather the attitudes attached to it. For the negative label to go away there is needs to be education and awareness of mental health and depression.
Gender
Gender is something that needs to be considered when talking about the diagnosis of depression. It has been found that major depression is twice as high in women as in men and is reflected across many cultures. However some have argued that is a misleading statistics which reflects the diagnosis practice rather real gender differences. For example, it more acceptable for women to admit the symptoms that characterise depression than men, and women may feel more willing to go and ask for help.
Cultural differences
Cultural differences are something that needs to be considered when discussing the diagnosis of depression. Culture can affect the diagnosis of depression, so much so that the classification of depression as a disorder may be may only work for the cultural groups who actually see it so. And less for those who perceive depressive symptoms as social problems or perhaps as an emotional reaction to stressful situations. Therefore the statistics of depression based on diagnosis, may be misleading, as it does not take into account those who fit the criteria but do not put themselves up for treatment. As such classification of depression may be unreliable to a small extent.

Describe and evaluate biological explanations of depression (genetic, biochemical; noradrenalin and serotonin) Bio-chemical
Research suggests that there is a link between neurotransmitters (noradrenaline and serotonin) and the development of depression.
-Depression is thought stem from the deficiency of noradrenaline in certain brain circuits. This can explain why depressed people experience withdrawal and lack of interest.
AO2 evaluation:
Bunney et al found that indirect marker of noradrenaline such as urine and cerebral spinal fluid, are low in depressed individual. In another finding, Post-mortem examinations have revealed increased densities of noradrenaline receptors in the cerebral cortex of depressed suicide victims.
- Leonardo (2000) found that drugs that lower noradrenaline cause depressive mood, whilst those that increases noradrenaline bring anti-depressant states.
Serotonin:
It is also thought that serotonin depletion contributes to the development of depression. Serotonin producing cells extend into many regions, including area where the processes of depressive symptoms take place.
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McNeal et al found that the cerebrospinal fluid in the depressed and suicidal, patients contains a reduced by product of serotonin, indicating reduced serotonin in the brain itself.
Further evidence comes from the success of SSRIs and Tricyclic which prevent the re-absorption of serotonin back into presynaptic cells. As such increase the availability of serotonin.
Further AO2:
One of the major problems with the bio-chemical explanations is that shows the established links between depression and chemistry. It is however not conclusive, since we don’t know whether depression is caused by low serotonin, or depression causes low serotonin.

Genetic explanation:
The main assumption is that there is a link between genes and the development of depression. The genetic basis may be expressed in terms of bio-chemical imbalance. As such that the genes may begin their expression in later life of the individual’s life or may make them more sensitive to negative life experiences throughout their life, which may lead depression. If the theory is correct we would expect a high rate of depression between genetically similar sufferers.

AO2 evaluation:
Research support:
Harrington et al found that 20% of the relatives of depression sufferers have depression, compared 10% of the rest of the population. This suggests that genes do play a role in depression as shows that first degree relatives are more likely develop depression than general population. However, SLT could explain the findings. For example, a child could easily imitate the depressive symptoms of their parents such as lost interest and loss of appetite. As such the child becomes depressed because they learnt to. Therefore depression may not have a genetic basis.
McGuffin et al: found 46% concordance rate between MZ twins and 20% rate for fraternal twins. This suggest that genetics does play a major role is depression, as findings showed significantly higher concordance rate for genetically identical relatives compared with similar relatives. Therefore the genetic explanation is correct. However, since it was not 100% suggest that genes are not the determinant factor, and may be influence by environment.
Wender et al: studied the biological relatives of adopted individuals who had been hospitalised with severe depression. They found higher incidence of severe depression in the biological relatives of depressed group than in the non-depressed control group.
This suggests that genetics does play a role, because it separated the effects of environment from the biological. With that there was high concordance between biological related relatives. Therefore genetic explanation is correct its assumption that there is a link between genes and depression.

Additional AO2:

Implications of genetic explanation:
-The implication the genetic assumption is that, there is potential for people to be fatalistic, if they incorrectly assume that their genetic predisposition means they will definitely be depressed.
-On the other hand, having the knowledge of genetic predisposition to depression may be an advantage, in a sense that it could help the person take preventive measures, such as change is lifestyle such as frequent exercise, and a healthy diet. Such will bring positivity and proactivity in the person’s life, hence reducing the risk of depression.

Comorbidity -low concordance rate can be understood in terms of comorbidity (When two mental disorders occur at the same time and may have similar cause).
Such view, would say see a higher concordance when looking a range of mental disorders in individuals. Kendler (1992) found a higher concordance when looking at depression and general anxiety, than looking at depression alone. This suggests that depression is product of genes, which is also an underlining cause of other mental disorders. Therefore it supports the role of genes, as such support the main assumption.
Diathesis-stress model- depression can also be better understood as interaction between genes and environmental factor.
In support of this model, Kendler (1995) found that women who were co-twins a depressed sibling, were more likely to suffer depression than those with presumed genetic vulnerability. More significantly, the highest levels of depression were among the group who had been exposed to significant negative life events and were genetically predisposed. This suggests genetically vulnerability depression may only lead to depression triggered by negative life events. Therefore depression is a combination of genes and environmental stressors.

Describe and evaluate biological treatments of depression (ECT, Drug; SSRIs, Tricyclics)

-Drugs (AO1)

Psychoactive drugs are a biological therapy used to treat depression, such as such tricyclics. Theses block the transporter mechanisms that re-absorb noradrenalin and serotonin in the presynaptic cell after it has fired. As a consequence more neurotransmitters are available in the cell, prolonging the their action
(SSRIs) is another drug used as another biological therapy. Instead of blocking the re-uptake of neurotransmitters, they block mainly serotonin, as such increase the availability of serotonin in the synapse. Evidence comes from the success of tricyclics such as Prozac, which are known to increase serotonin. AO2 evaluation of biological treatments in terms of appropriateness and effectiveness:

-The effectiveness of Tri and SSRIs have been demonstrated by Arroll et al 2005, who found that they both produce some significant reduction in depressive symptoms than placebo.
- However, research in into SSRIs indicates that it is only effective in cases of severe depression. As Kirsch et al reviewed clinical trials of SSRIs and concluded that only the cases of severe depression, was there any significant advantage of using SSRIs over placebo. This could be because of severe depression have no expectation, thus removing the placebo effect.

Research studies have indicated that anti-depressants are not appropriate for children and adolescents. For example, Geller et al found no superiority over placebo for antidepressants in children and adolecents. However, this may be because of the difference in the development of the brain chemistry.
One problem with research into depression is publication bias. There are tendencies to only publish research which a positive outcome of anti-depressant drugs, thus exaggerating the benefits of the drugs. One implication is that doctors may be led to treatment decisions, which not are in the best interest of the patient.

ECT (AO1)
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There are two methods of ECT, unilateral and bilateral.
The Patient is given a short anaesthetic.
In a unilateral ECT, an electrode is place on the non-dominant side of the brain, while another is placed in the middle of forehead. In a bi-lateral ECT, both electrodes are placed on the both sides of the temple.
The patient is given a nerve ending injection, so relax the muscles as to prevent them from contracting and causing fractures,
Then 0.6 amps of current is passed through the brain for about half a second, producing a seizure which lasts for about a minute.
This treatment is usually given 3 times a week for patients with severe depression, thought to be on the brink of suicide.

AO2 Evaluation of ECT

It is said to be highly effective for severe depression, bi-polar disorder and in the treatment of secondary (mood) disorder, in schizophrenics.
Its effectiveness is immediate, which makes it desirable for those with suicidal thoughts, in comparison to drug treatment with can take weeks.
However, ECT may cause death in 1 in 200 patients over 60, partly due the associated procedures, such anaesthesia, carry a degree of risk in themselves
Research study has found that consistent use, can cause cerebral damage
However, in the review of ECT use, small et al, found that ECT produces some short-term intellectual impairment but this is not inevitable and rarely permanent.

Describe and Evaluate psychological explanations of depression (Beck’s Cognitive theory, Seligman’s learned helplessness, Hopelessness. Beck’s cognitive theory AO1

Beck argues that depression result from acquired negative childhood schemas, such the loss of parents, and social rejection by peers or depressive attitude of a parent. These form dysfunctional thoughts and beliefs based on the cognitive triad, whereby the person has negative of themselves, the world and the future. These beliefs are activated when the person encounters a similar situation to the negative schemas. Theses depend on the type of negative experiences that formed the person’s dysfunctional beliefs. A sociotrope will more than likely trigger their dysfunctional belief, if they experience social rejection, or lack of recognition for their efforts. Whereas, autonomous individual may triggers their dysfunctional beliefs, if they fail to meet a set target or goal. The activation of dysfunctional beliefs leads to biased information, such overgeneralisation of situation, or personalisation of events. This leads to the symptoms of depression such of lack of interest, social withdrawal and feeling of guilt.
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-Research and therapies
Cognitive theories have stimulated huge amounts of research into depression in the past decades. This has contributed greatly to the understanding of the disorder, and has led to rise of cognitive behavioural therapies, which provide treatment the symptoms of depression.
-Correct predictions
Roth and Rehm have found that depressed patients perceive and recall more negative information, and Krantz and Hammen found that depressed patients responded negatively to problematic situations. Both studies support beck as their finding are line with Beck’s prediction that depressed individuals have bias information processing.
-Contradictory evidence
Studies found contrary to the predictions made by Beck, depressed individuals do not show a attention bias and his theory does not account for why biased information processing doesn’t affects explicit memory and not implicit. This suggests that there are flaws in Beck’s theory; as such it limits the validity of the explanation.

Learned Helplessness- AO1
- According the learned helplessness view of depression, people become depressed when they perceive a loss of control of the reinforcing aspects of their life. If this attributed to internal, global and stable factors, they will feel helpless about preventing future negative outcomes and may develop unipolar depression.

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Non-depressed participants

-Maier and Seligman conducted research on non-depressed participants, and after subjecting them inescapable situation. It was found that the participants did not try to escape, in a similar situation which was escapable. This supports the learned helplessness theory, as it showed that failed attempts to escape a stressful event, facilitates helplessness on the next time a similar event occurs. -Inconsistent findings: Findings of learned helplessness in humans have not always been replicated. In fact some studies showed that helplessness actually facilitated subsequent performance.
-There are major limitations over the use of analogue experiments. This is because we can never sure that the behaviour shown in lab is the same as that shown in genuine depression. Therefore if the similarities are superficial then the research could draw wrongs conclusions.
-Like many cognitive theories, the learned helplessness, is seen as inadequate as a complete explanation of depression, as it doesn’t take into account of biological process.

Describe and Evaluate psychological treatments of depression; Psychodynamic theory (catharsis, dream analysis, projective tests), CBT (Cognitive triad, ABC diary, cognitive distortion).

CBT - (AO1)

- CBT is one of the most popular psychological therapies of depression. CBT emphasises the role of negative (maladaptive thoughts) and thinking in the origins and maintenance of depression. Therefore, the aim of CBT is to indentify and alter these negative cognitions, as well as any dysfunctional behaviour that may be contributing to the depression. CBT is focused on current problems and current dysfunctional behaviours.
-One of the key aspects of CBT is though catching. This happens, when depressed are taught to challenge their negative thoughts and replace them more constructive ones, thus reducing the symptoms of depression. This should lead to a behavioural activation, such as more active. Since of one of the characteristics of depressive individuals is inactivity. So being active, leads to rewards that act as an antidote to depression.

CBT - AO2 Evaluation:
-The effectiveness of CBT for depression was demonstrated by a meta-analysis by Robinson et al (1990). They concluded that CBT was superior in treating non-control groups. - However, when these control groups were divided into waiting list and placebo groups, CBT was no superior to placebo in treatment of depressive symptoms

- The apparent effectiveness of CBT depends of the competence of the therapist; a less competent therapist is less likely is change the negative thoughts of someone with depression. There is also an issue with a belief in the therapy, drop out rate as high as 8 percent; this may suggest that patients lack belief in the therapy.

CBT is appropriate for many different age groups, such as elderly, children and depressed teenagers.
When combined with anti-depressants, CBT is particularly effective in reducing symptoms of depression and suicidal thoughts. Alternative approaches to CBT such as psychotherapy is both appropriate and successful, Mohr et al (2005).

PSYCHOANALYSIS
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The aim is to enable the client to cope better with inner emotional conflicts with are causing the disturbances.
The aim of the therapy is to uncover unconscious conflict and anxieties, which have their origins in the past, in order to understand current psychological disturbances.
Some of the key aspects of this therapy are involve, free association, dream analysis, transference and interpretation. All the aforementioned techniques are used by the therapist to allow the client to reveal hidden issues which under normal circumstances, wouldn’t happen. A focal point in in therapy is achieving catharsis, so that it can be dealt during the therapeutic process.

AO2 Evaluation (effectiveness and appropriateness)

Thase’s meta-analysis studies which compared, psychotherapy with drugs, and psychotherapy alone. They found in the less depressed people, psychotherapy is effective own its one. However it was also found that, psychotherapy combined with drugs had showed much significant improvement for severe depression, than psychotherapy alone. Therefore, psychotherapy is more effective for low depression. For this reason it is prudent to combine psychotherapy and drugs for severely depressed.

There are methodological issues with assessing the effectiveness. It’s very difficult to assess the effectiveness of psychoanalysis, because in order to make comparison; they has to a standard criteria for cure, as well as a reliable psychiatric diagnosis

Some research suggests that psychoanalysis is not only worthless but also damaging. Esysenck found that 77 % of clients recovered with the GP treatment, while 44% only with psychoanalysis improved. Other research suggests that 30% of depressive patients recovered even without treatment.