Depression

Question 1

What is depression

Answer 1

Many different definitions for depression depending on the perspective. The DSM-5 states unipolar depression to be Five or more symptoms for 2 weeks or longer

Question 2

What are the symptoms of depression?

Answer 2

Depressed mood for most of the day OR
Diminished pleasure in activities
Significant differences in gaining/ loosing weight
Insomnia / hypersomnia
Aggitation
Fatigue / loss of energy
Feelings of worthlessness / guilt
suicide attemps / thoughts

Question 3

Prevalnce of depression in the west?

Answer 3

Lifetime prevalence = 18%
1 year prevalence = 8%
almost twice as common in women than men
However men are less likely to seek help so stats are off there.

Question 4

Describe the Onset (age where depression begins) -kessler 2003

Answer 4

Kessler et al 2003, states that as depression has become more common over the years, the onset has become earlier.

Question 5

Co-mordibity rates

Answer 5

Depression is rarely the only health disorder a person has, often in conjuection with anxiety, substance missuse, and personality disorders such as impulsibility.

depression = 4th most common death in 15-30 year old (WHO)

Question 6

4 Types of Risk factors within depression

Answer 6

-Biological risk factors
-Cognitive risk factors
-Social risk factors
-behavioural risk factors

Question 7

Describe biological risk factors of depression

Answer 7

-genetic vulnerability
-Potential role of neurotransmitters (monoamine hypothosis)
-Serotonine deficiancy

Question 8

Describe the monoamine hypothesis

Answer 8

Monoamine hypothesis proposes that people with depression have a chemical imbalance of neurotransmitters such as serotonin and norepinephrine.
Serotonin = regulation of hormones
Norepinephrine = regulation of arousal, attention, cognitive function, and stress reactions.

Low levels of these neurotransmitters = low mood / lack of pleasure as seen in depressed patients

Question 9

Support of the monoamine theory

Answer 9

SSRI’s
serotonin selective reuptake inhibitors.

Block the reuptake of neurotransmitters responsible for regulation of mood by keeping them in the synapse for longer = increased effects of serotonin.

Supports monoamine theory as people who suffered with depression saw improvements of mood in comparison to non-depressed participants.

Question 10

Evidence against the monoamine hypothesis

Answer 10

SSRI’s take a while to work

Not everyone reacts to them

Conclusion: “no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”

Question 11

Limitation of SSRI’s for depression

Answer 11

important that people take control over their mood otherwise people think taking their medication is the only solution = people end up being on medication for the rest of their lives
-influences decisions about whether to take or continue antidepressant medication
-may discourage people from discontinuing treatment, potentially leading to lifelong dependence

Question 12

Support for Social factors of depression

Answer 12

ACES study
-found that people have experiences a number of different life experiences in past or present.

The more of these experiences faced, the more likely you were to be prescribed antidepressant medications - as close to identifying cause and effects as we can get.

Question 13

Social risk factors include:

Answer 13

• Austerity
• Abuse and bullying
• Prejudice, discrimination and oppression
• Social disadvantage
• Early relationships with caregivers - Attachment, stresses on parents
• Isolation
• Gender and different social experiences
  Migration

Question 14

Interpersonal problems and depression:

Answer 14

Social relationships are really important factor.

Those who have strong social relationship you have less of a chance to get depressed.

However, it is arguably a reverse case whereby if you are depressed, you are more likely to have interpersonal problems, isolate yourself. So is it that people who are not depressed have better social lives or is it that people who have a good support system are less likely to be depressed?

Question 15

Can social support be considered a protective factor of depression

Answer 15

To some extent…

Poor quality of close interpersonal relationships as a vulnerability factor

Not everyone who has a negative life event becomes depressed…
Difficult to disentangle cause and effect
○ Patients with depression tend to become withdrawn
○ They may also rate their interpersonal relationships negatively
○ Others may react negatively to the person with depression
However, research does show a ‘dose effect’: the more ACES you experience, the increased likelihood of developing mental health problems.

Question 16

What does the cognitive model of depression propose?

Answer 16

Depression is due to faulty information processing about self and situations
○ Negative cognitive biases
○ Negative interpretations of self, world and future
○ Experienced as ‘negative automatic thoughts’ which are believed to be accurate representations of reality - stand out thought (NATS)
○ Driven by underlying cognitive structures or ‘core beliefs’(‘schema’) that come from our experiences .
§ Develop based on experiences
§ Influence how we view the world
§ Act like a filter through which we interpret events (experience life)

Question 17

What are some common unhelpful biases

Answer 17

All-or-nothing thinking: seeing things in black-and-white. If your performance isn’t perfect, you see yourself as a complete failure
Overgeneralisation: tendency to see a single negative behaviour or event as a never-ending pattern or characteristic: ‘Jack got sent home from school, so I must be a bad mother’
Personalisation: seeing yourself as the cause of an external event for which you couldn’t be responsible: ‘What did I do to cause this?’
Mental filtering: the tendency to pick out a negative detail of a situation and dwell on it, to the exclusion of all positive aspects
Jumping to conclusions: arriving at an erroneous (negative) interpretation of events on the basis of little evidence
* E.g., ‘Mind Reading’: ‘she’s behaving strangely so I must have done something to upset her’
Catastrophising: exaggerating the importance of specific events (usually one’s own mistakes) – ‘I failed my first exam, so I’m going to fail the course’
Minimising: playing down your own positive qualities or achievements - ‘I got a good mark because I was lucky with the questions’
Disqualifying the positive – achievements ‘don’t count’ for some arbitrary reason

Question 18

Explain The negative triad

Answer 18

Thoughts about themselves, future = negative

Negative views about self –> negative view about the world –> negative views about the future

This cycle causes and maintains symptoms of depression

Question 19

Behavioural factors of depression include:

Answer 19

• Reduced activity
• Lack of exercise
• Fewer opportunities for rewarding activities
• Not living in line with values
• Isolation - more likely to have physical health and mental health problems when you are living alone / lonely.
• No sense of achievement
• Coping strategies that perpetuate problem e.g. excessive alcohol consumption (perpetuating factors)

Question 20

Name a Treatment and support for mild depression

Answer 20

CBT

Question 21

Name 4 treatments and support for moderate-severe depression

Answer 21

CBT
IPT
+ antidepressants
MBCT

Question 22

How long does CBT last?

And what is included in it?

Answer 22

CBT can range from 6 to 20 sessions
Key components of CBT for depression:

Behavioural activation
Increasing daily activities to reduce withdrawal and immobility
Increase involvement in positively reinforcing activities
Targets avoidance
Cognitive restructuring
Becoming aware of negative ‘automatic’ thoughts
Evaluating these thoughts (particularly negative opinions about the self) and generating more helpful alternatives
Testing negative beliefs against reality
Relapse prevention

Question 23

CBT activities include:

Answer 23

Diary entries:
Thought diaries

Question 24

IPT in-depth treatment strategies

Answer 24

Exploring interpersonal problems
Increase understanding
Evaluate significance of interpersonal roles/relationships
Identify patterns

Addressing interpersonal problems
Normalise experience (grief over death, role transition)
Explore alternative responses
Develop new relationships/ways of interacting with others
Develop new social support
Resolve conflict
Develop new social skills

Relapse prevention

Question 25

IPT key processes

Answer 25

1. Identifying interpersonal problems maintaining depression
   2. Addressing interpersonal problems (how depends on problem area)
   3. Relapse prevention

Question 26

IPT duration

Answer 26

Shorter than CBT
16-20 weekly 1:1 sessions over 20 weeks
Target the key interpersonal problem/s thought to be maintaining depression
Increasingly led by patient rather than therapist (less structured that CBT)

Question 27

Briefly explain landmarks study comparing these treatment methods

Answer 27

Compared CBT, IPT, antidepressant medication plus clinical management, placebo medication plus clinical management

Similar levels of for all treatments at 18 month follow-up
Similar levels of effectiveness for antidepressants, CBT and IPT and placebo (!)

Question 28

Explain Meta-analysis (Cuijpers et al. 2011) - most of the meta-analysis will be by this person.

Answer 28

Meta-analysis Examined psychological treatments for depression (CBT, behavioural activation, IPT) and pharmacotherapy

Findings: ○ Similar effects for all psychotherapies (inc. CBT, IPT, behavioural activation)
SSRIs marginally better than psychotherapy BUT higher drop-out – about as effective if you take this into account

Question 29

Limitations of Cuijpers et al. 2011) meta-analysis of depressive treatments

Answer 29

Examined short-term treatment outcomes only

Effect of psychotherapy likely over-estimated
Many poor quality studies
Publication bias

Question 30

Cuijpers et al. 2013 studies the long term effects of CBT vs SSRI’s (12-month follow up)
What did he find?

And 1 limitation

Answer 30

Follow-up period of 12 months
CBT was found to be superior to both acute and continued pharmacotherapy

• Small number of studies (N=9)
  Unrepresentative - ?

Question 31

IPT vs CT in Lemmen’s 2019 study

Answer 31

Improvements in cognitive and interpersonal functioning observed in both treatments
Cause or consequence of improving depression?
Conclusion: CBT and IPT were both superior to the wait-list, but did not differ significantly from one another.

Question 32

Explain the need for cultural adaptation to theories and treatments (Rathod et al, 2018; 2019)

Answer 32

Culturally adapted CBT is more acceptable and more effective

Need for robust methodology for adapting treatments (work in progress)

“Everyone should also have the right to describe and make sense of their problems in the way that is most helpful for them. No one has all the answers, particularly in this controversial area”.