Depression Flashcards
Characteristics of depression
INSADCAGES IN – Loss of interest in activities S – Sleep disturbances A – Appetite change D – Depressed mood C – Concentration difficulties A – Activity level change G – Guilt or worthlessness E – Energy loss S – Suicidal thoughts/ideation
DSM-5 criteria for major depression
5 or more present in the same 2-week period
Emotional
Depressed mood
Loss of interest or pleasure
Cognitive
Thoughts of worthlessness or guilt
Diminished concentration/indecisiveness
Suicidal ideation
Somatic
Weight loss or gain
Insomnia or hypersomnia
Fatigue or loss of energy
Behavioural
Psychomotor retardation or agitation
Personal Health Questionnaire (PHQ-9)
- 9 question questionnaire
- Add up checked boxes to get a score
- Questions such as ‘little interest or pleasure in doing things’ and ‘feeling tired or having no energy’
- Score from 0 – 3 with 0 being not at all and 3 being nearly every day
- 1-4 = minimal depression
- 5-9 = mild depression
- 10-14 = moderate depression
- 15-19 = moderately severe depression
- 20-27 severe depression
Psychodynamic explanation of depression
Freud drew similarities between feelings caused by mourning the death of a loved one and feelings seen in depression
For Freud, depression resulted from a symbolic or actual loss of a loved individual
This loss has a profoundly negative impact on ones’ self-esteem as well as giving rise to feelings of hurt, rejection, disappointment and anger at the individual who is now gone
The feelings of anger result in guilt and self-criticism at having hostile feelings and these trigger depression (Freud, 1916)
Critique of the psychodynamic explanation of depression
Some support for low self-esteem being a key feature in depression
Some have emphasised the role of guilt in depressive feelings - children of depressed parents may themselves develop depression due to guilty feelings at their imagined role in the parents depressive state (McWilliams, 1994)
Depression does not inevitably lead on from the loss of a loved relationship and Freud’s theory stems from the analysis of a small number of Viennese women (Dozois, 2000)
Behavioural explanation of depression
Lack of social reinforcement plays a role in the development of depression
Lewinsohn (1974) - Social environment and the behaviour of the individual play a role in the development of depression
Social environment – if someone loses their job and has difficulty finding another one then the whole potential for employment-related positive reinforcement is gone
Behaviour – the behaviour of the individual may also contribute to the development of depression if they lack the social skills in order to engage in potentially reinforcing activities
Critique of the behavioural explanation of depression
Criticism of this theory have emphasised the lack of solid empirical research to support the model and the lack of consideration of emotional and cognitive factors which play a role in the disorder (Blaney, 1977; Eastman, 1976)
Critique of the behavioural explanation of depression
Criticism of this theory have emphasised the lack of solid empirical research to support the model and the lack of consideration of emotional and cognitive factors which play a role in the disorder (Blaney, 1977; Eastman, 1976)
Cognitive explanation of depression
People with depression interpret events in a negative way and this leads to a depressive emotional reaction
Example, someone who is unsuccessful at a job interview may blame themselves for their situation and believe that they will fail at any attempt to find work
They may also feel that any initiative to do with work, social life or romance may be destined to fail
(Ellis, 1993)
Individuals with depression focus on negative events (Gotlib & Joormann, 2010)
Pessimistic outlook stems from childhood experiences which are categorised by negative parental interactions (Renner et al., 2012)
Beck (1967) negative cognitive triad
Negative cognitive triad (negative view of self, the world and the future)
Leads to cognitive biases, then to failure, losses and depression
Depression results from distorted thoughts and judgements
Can be learned socially as is the case when children in a dysfunctional family watch their parents fail to successfully cope with stress
Or can results from a lack of experience that would normally lead to the development of adaptive coping skills
Diathesis-stress model
Beck types of faulty thinking
Beck et al., (1987) identified several types of faulty thinking that are present in depression • Overgeneralising • Selective abstraction • Dichotomous thinking • Personalisation • Catastrophising
Learned helplessness
When dogs were given electric shocks, which were unavoidable, they learned that there was no escape and passively accepted the shocks, despite the discomfort (Seligman, 1965)
Demonstrated this in undergraduates and theorised that depression arises when individuals believe they have no control over their physical or social environment (Seligman, 1975)
Environmental factors in the development of depression
Environmental stressors have been linked to the onset, prolongation and reoccurrence of depression both for acute stress and chronic stress (Hammen et al., 2009)
Stress experienced in childhood leads to more severe depression (Lara et al., 2000)
Not all types of stress lead to depression – stress involving loss, social rejection or humiliation are more likely to lead to depression than stress due to dangerous situations (Kendler et al., 2003)
Environmental protectors from depression
Environmental protectors for depression = familial support, financial support and participation in sport (Babiss & Gangwisch, 2009)
Genetic predisposition in depression
Incidence of first-degree relatives of those with depression have an almost 3-fold risk compared to the general population (Hettema, 2010)
Concordance rate of between 16-35% in dizygotic twins compared to 70-90% in monozygotic twins (Sadock & Sadock, 2007)
Serotonin transporter genes in depression
Implicated an abnormality in the serotonin transporter gene (5-HTTLPR) which plays a role in the availability of serotonin, strong evidence that this genetic abnormality increases the risk of people developing depression when under stress (Karg et al., 2011)
Dopamine receptor genes in depression
Has been suggested that the DRD4 gene which encodes the dopamine D4 receptor is faulty in depressive patients (Hettema, 2010)
Critique of gene studies
Gene studies in general are limited by an incomplete understanding of the precise pathophysiology of depression and low subject numbers
Neurotransmitter systems
It was first discovered that neurotransmitters may play a role in depression when the drug reserpine, a treatment for hypertension, was found to have depressive side effects. This drug depletes the amounts of monoamine neurotransmitters including serotonin and noradrenaline. A compound called iproniazid, which increased the neurotransmitters in the system was found to elevate mood (Slattery et al., 2004)
Monoamine hypothesis
Depression results from insufficient quantities of serotonin and noradrenaline
Critique of the monoamine hypothesis
(Hirschfield, 2000)
Monoamine levels are increased rapidly on antidepressant medication, yet the therapeutic effects take at least two weeks
Some compounds increase serotonin or noradrenaline and do not produce antidepressant effects
Cortisol levels in depression
When an individual is under stress the body releases cortisol which forms part of the fight or flight response and causes physiological arousal and anxiety
Individuals with depression have higher levels of cortisol (Young, 2004)
Increased and prolonged reactivity to stressors may deplete neurotransmitter systems, particularly serotonin (Leonard, 2010)
Circadian rhythms in depression
Disturbances in circadian rhythms have been observed in depressed patients with the majority having trouble falling asleep, staying asleep or waking early in the morning
Depressed patients have increased REM sleep and decreased slow-wave sleep
Proposed that the central regulator that controls circadian rhythms is dysfunctional in depression and this contributes to the symptoms experienced (Germain & Kupfer, 2008)
What is a circadian rhythm?
Circadian rhythms are the cyclical physiological changes that occur within an organism over a repeated time period eg our sleep wake cycle
