Depression

Question 1

Depression

Answer 1

treated as a mood disorder alongside bipolar disorders

opposite is mania

Question 2

DSM Criteria

Answer 2

persistent depressed mood and/or marked loss of interest
at least 5 of the following symptoms (change in weight/appetite, altered sleep, psychomotor agitation/retardation, fatigue/loss of energy, worthlessness/guilt, impaired concentration/indecision, thoughts of death)
lasts at least 2 weeks
clinically significant impairment
symptoms not better accounted for by other conditions or due to effects of substance use

Question 3

Issue in diagnosis

Answer 3

5 symptoms needed but some people may only experience 3 yet feel equal or greater distress and impairment in functioning

Question 4

Epidemiology

Answer 4

Waraich et al., 2004 - lifetime risk is 4-10% for major depression
average age for first onset = 20 years
2x more common in women than men
rare in children (Nolen-Hoeksema, 2002)
episodic, average episode lasts 6-months
Simon et al., 2002 - 50% still have diagnosis after 1 year

Question 5

Relapse and recurrence

Answer 5

for many it is recurrent
Belsher and Costello, 1988 - 50% relapse after 1 year
Kupfer, 1991 - 90% of those who have had three episode will have another episode whereas 50% of those who have one episode will have further episodes

Question 6

Impact of depression

Answer 6

Thomas and Morris, 2003 - at least £8 billion lost productivity in UK annually
at least £370 million spent on treatment in UK annually - 84% of this is on antidepressant medication
stigmatisation - if this becomes normalised through treatment as biological illness then run risk of medicalisation of normal everyday experience of negative emotions

Question 7

Approaches to depression

Answer 7

Biological: neural processes, genetics
Psychological theories: psychodynamics, behavioural model (reward and reinforcement), cognitive model (learned helplessness)
Social theory: life events

Question 8

Aetiology:
Biological approach
Neurochemical processes

Answer 8

serotonin and norepinephrine found to be important in depression (low levels)
many of these theories are inconsistent and difficult to understand
quite simplistic

Question 9

Aetiology:
Biological approach
Genetic influence

Answer 9

depression shares some extent of heritability - but not greatly
Sullivan 2000 - meta-analysis of family/twin studies - found although depression is heritable, environmental influences are substantial
Plomin, 1990 - twins interviewed regarding negative life events - estimate heritability of controllable and uncontrollable life events - genes found to influence likelihood that certain types of negative events will occur

Question 10

Aetiology:

Psychodynamic approach

Answer 10

depression is response to loss
first stage response = introjection (fallback to oral stage) - begin to experience self-hatred
not everyone has experienced loss so introduced symbolic loss (loss of significance to individual)
some empirical evidence but evidence also supports other psychological theories

Question 11

Aetiology:
Behavioural approach
Reward and reinforcement

Answer 11

Fester, 1973; Lewinsohn, 1974
symptoms are consequence of low rates of positive reinforcement
non-rewarded behaviours no longer performed - extinction - leads to inertia/inactivity and behavioural vacuum
depressed mood changes behaviour and social skills impaired

Question 12

Support for behavioural approach

Answer 12

Lewinsohn and Graf, 1973 - 90 participants interviewed about daily activities - depressed group had lower positive activities than control groups - no. of positive activities correlated significantly with mood
Jacobson et al., 2004 - those with depression report fewer rewards in their life than those without depression- introduction of rewards elevates mood

Question 13

Aetiology:
Cognitive approach
Learned helplessness

Answer 13

Seligman, 1975 - negative life events may lead to a cognitive set that teaches individuals to become helpless, lethargic and depressed
perceived uncontrollability of these life events results in thinking that these negative life events will happen whatever they do
support: Seligman, 1975
- dogs subject to inescapable shock, found escape responses were later impaired, learned helplessness proposed to have parallels with depression
Abramson, 1989 - adds in hopelessness - belief that negative events will recur

Question 14

Aetiology:
Cognitive approach
Negative cognition

Answer 14

Beck, 1967
depression caused by biases in thinking and processing information
formation of negative schema - negative triad (negative views of self, world and future)
so when critical incidents occur these schemas are activated and lead to automatically negative thoughts and depressive symptoms

Question 15

Support for negative cognition approach

Answer 15

Gotlib and Cane, 1987 - depressed individuals were slower at naming colour of negative words (emotional stroop test) than positive words - suggests attention drawn to meaning of negative words
Miranda and Persons, 1988 - 30 women with depression, 13 without - dysfunctional attitude scale assess cognition proposed by Beck - depression vulnerable individuals showed increases in depressogenic cognition with increasing negative mood

Question 16

Aetiology:
Social factors
Life events

Answer 16

Finlay-Jones and Brown, 1991 - 151 women - life events assesed 12-m prior to interview or disorder onset - depression primarily associated with loss events, anxiety with danger events

Question 17

Aetiology:
Social factors
Vulnerability model

Answer 17

Brown and Harris, 1978 - sample of women - higher rates of life events and depression in working class vs middle class women - social difficulties/vulnerability factors alone are not triggers of depression but do increase proneness

Question 18

Limitations of social theory (4)

Answer 18

issues in assessing life events
descriptive not explanatory
not all depressive episodes preceded by negative life event
limited implications for treatment

Question 19

Treating depression:

NICE, 2004

Answer 19

should be tailored to severity of symptoms - stepped-care model

1. GPs advised to ensure proper assessment not just medication
2. medication should be only for moderate to severe depression
3. mild depression to be treated with brief behavioural and cognitive interventions first

Question 20

Treating depression:
Biological therapy
Drug therapy

Answer 20

try to address imbalance of serotonin and norepinephrine
3 main types: tricyclic drugs, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors
most common are SSRIs

Question 21

Support for drug therapy

Answer 21

Fournier, 2010 - effectiveness of drugs increases with severity of symptoms
Gitlin, 2002 - approx. 60-65% those on tricyclic drugs show improvement
Thase et al., 1995 - 50% of those on MAOIs show improvement

Question 22

Limitations of drug therapy

Answer 22

no evidence for long term benefits once stopped - relapse common
it is more effective to combine it with psychological therapies
Hollon et al., 2005 - overall results of effectiveness of drug therapy are disappointing

Question 23

Treating depression:
Biological therapy
ECT

Answer 23

first discovered in 1938
originally used for schizophrenia, now used for severe depression
pass current through head for approx. 30 secs
only short-term relief
many side effects - i.e. memory loss

Question 24

Treating depression:
Psychological therapy
Behavioural activation therapy

Answer 24

negative life event may represent loss of important sources of reward and reinforcement
aims to increase access to pleasant events and rewards
setting patterns of activities and getting routine
Dimidjian et al., 2006 - treats avoidance behaviours and targets maladaptive behaviours

Question 25

Support for behavioural activation therapy

Answer 25

Gortner et al., 1998 - as effective as CBT in preventing relapse after 12 months

Question 26

Treating depression:
Psychological therapy
Cognitive therapy

Answer 26

one of most successful and most widely adopted therapies
developed by Beck
structured treatment
teaches client to recognise negative thinking patterns, re-evaluate these using cognitive and behavioural strategies, challenge these negative thoughts and then replace them

Question 27

Support for cognitive therapy

Answer 27

Rush et al., 1977 - as effective as drug therapy in treating symptoms
Blackburn and Moorhead, 2000 - superior to drug therapy at 1 year follow up

Question 28

Challenge to cognitive therapy

Answer 28

still some debate over how it achieves its effects

Question 29

Treating depression:
Psychological therapy
Mindfulness-based cognitive therapy

Answer 29

attempt to combat linkage between periods of dysphoria and onset of negative thinking - prevent relapse
learn to recognise automatic modes and respond by taking decentred perspective, accepting difficulties and following action plan for dealing with early indicators of relapse

Question 30

Support for MBCT

Answer 30

Piet and Hougaard, 2011 - 593 pps in meta-analysis - MBCT reduced risk of relapse by 34% compared to usual treatment or placebo
Ma and Teasdale, 2004 - MBCT reduced relapse from 78% to 36% - significant therapeutic gains