topic 3 - unipolar depression

Question 1

what is unipolar depression?

Answer 1

unipolar depression, also known as depressive episodes, are a type of mental health problem characterised as mood disorders. Unipolar depression makes people feel very low. The duration that the episodes occur can be classed as ‘mild’ ‘moderate or ‘severe.

Question 2

what are the symptoms of unipolar depression

Answer 2

C L G A S P D I E
c- concentration loss
l- low self esteem 
g- guilt
a- appetite changes 
s- sleep disturbances
p- psychomotor changes (physical behaviour has slowed down e.g feeling lethargic or speed up eg anxious e.g shaking) 
d- death (ideas, thoughts or attempts at suicide)
i- interest loss 
e- energy decrease

Question 3

how long should the symptoms be present until a diagnosis?

Answer 3

at least one of the symptoms should be present most of the time on most days for at least 2 weeks along with another symptom which should also be present at some point during that time.

Question 4

what are the different episodes in unipolar depression?

Answer 4

mild, moderate and severe

Question 5

what are the amount of symptoms required for each episode?

Answer 5

for mild - 4 symptoms must be displayed
for moderate - 5 or 6 symptoms must be displayed
for severe - 7 or more symptoms + feelings of worthlessness

Question 6

what are the features of each episode?

Answer 6

mild- a patient might find that their symptoms are upsetting but they are still able to continue with most of their day to day activities

moderate - a patient might have serious problems doing their usual activities like going to work or school.

severe- a patient might have suicidal thoughts or opt to self-harm to cope with their feelings.

Question 7

how have the incidences of depression changed over time?

Answer 7

more people are diagnosed with depression nowadays than in the past.

reasons:

• this could be because more people are aware of the symptoms of depression.
• modern life is more stressful and includes more risk factors for depression such as sleep deprivation, poor diet and increased social isolation.
• stigma reduced
• more people are able to afford diagnosis or appointments with doctors.

Question 8

how does depression affect individuals and society?

Answer 8

individual:
one major affect is increasing the risk of suicide. The overwhelming feelings of sadness and worthlessness can make people feel as if they need a ‘way out. 10-15% of patients with severe depression will commit suicide.

society:
missing work, 9.9 million days of work were missed because of stress, depression or anxiety. People with depression lack motivation which in turn may make getting up for work difficult . This leads the company employing them to cover their work load.

cost of treatment. more people are being diagnosed with depression meaning that more people require treatment. Anti-depressant drugs can be used to treat depression but they are expensive to prescribe. other alternatives are therapy which requires trained therapists.

Question 9

what study is used in the genetic explanation of depression?

Answer 9

twin studies

Question 10

why are twin studies useful in looking at the genetic explanation of depression?

Answer 10

because monozygotic twins (mz) share 100% of the same genes while dizygotic twins (dz) share 50% of the same gene ( the same as normal siblings).

If one of the monozygotic twins are diagnosed with depression then the other has a 46% chance of getting depression as well. If one dizygotic twin is diagnosed with depression there is a 20% chances that the other twin would also develop depression.

Question 11

how does the twin study show that depression might be genetic?

Answer 11

because monozygotic twins who share more genes have a greater risk of both getting depression that the dizygotic twins who share less genes.

Question 12

what are the strengths of the twin study?

Answer 12

one strength is that if we can explain that depression is inherited through genes it will take away the stigma of being diagnosed with depression.

another strength os that there are lots of research evidence which supports the idea that some people are more prone to depression that others. Caspi et al (2003( found that people with a variation of serotonin which is a neurotransmitter for controlling moods were more likely to react negatively to stressful life events and develop depression.

Question 13

what are the weaknesses of the twin study?

Answer 13

one weakness is the genetic theory of depression is very deterministic meaning that our actions come from what we are born with and what we experience because it assumes that if you have certain genes you are more likely to be depressed and you have no way to change that. This may not be the case as some people believe that you have a certain amount of free will to choose whether or not you ‘let yourself’ become depressed.

another weakness is that the genetic explanation of depression is reductionist because it fails to take into account other factors which could explain why someone would develop depression. It is too simple to assume that it is just a gene that make someone depressed.

Question 14

what are the different cognitive theories as an explanation of depression?

Answer 14

Becks cognitive/negative triad and Ellis’s ABC model

Question 15

what is becks cognitive triad?

Answer 15

Aaron Beck thought that depression could be explained through negative thought patterns about ones self, the future and the world.

Question 16

what is in becks cognitive triad? and describe the way of thinking?

Answer 16

Ones self, the future and the world.

All of these are examples of cognitive bias meaning the way people think. Things are viewed negatively and the person cannot see the positive aspects of the situations they find themselves in. They see everything in a negative way.

Question 17

according to beck how did the negative triad form?

Answer 17

Beck felt that the negative triad developed through bad experiences in someones past. Once they have a negative way of thinking, they are more likely to perceive things that happen to them in an abnormal way. This leads to negative self-schema where a persons whole belief system about themselves is covered negatively. This might lead to them being prone to magnification which is when they see their problems far worse that what they actually are.

Question 18

what are the examples in becks cognitive triad of ones self, future and the world?

Answer 18

self = i am worthless 
future = i am never going to achieve anything in life
world = no one likes me.

Question 19

what is Ellis’s ABC model?

Answer 19

Albert Ellis had a slightly different view to what caused depression. Ellis suggested that there are 3 stages which might cause a person to develop negative though processes which can ultimately lead to depression.

Question 20

what does ABC stand for in Ellis’s ABC model?

Answer 20

A- activation
B- belief
C- consequence

Question 21

in the ABC model what does A mean? define it etc

Answer 21

activation. This is something that happens to a person that makes them feel unsettled.

Question 22

in the ABC model what does B mean? define it etc

Answer 22

belief. this is the thoughts that the person associates with the event such as why it happened. it can be rational (healthy thoughts) or irrational (unhealthy thoughts)

Question 23

in the ABC model what does C mean? define it etc

Answer 23

consequence. it is split into 2. so the rational and irrational thoughts both lead to different outcomes.

if the person had a rational thought about the event that occurred such as they failed an exam because they didn’t try then they will have a positive emotional consequence and they won’t become depressed.

if the person had an irrational thought about the event that occurred such as they failed the exam because they went to a party 2 weeks before even if they revised everyday until the exam, then they will have a negative emotional consequence meaning they might become depressed.

Question 24

what are the strengths of the cognitive theory as an explanation of depression?

Answer 24

one strength is that it takes into account the events of the persons life. It recognises that these events could explain why the person became depressed. Unlike the genetic explanation which claims that some people are naturally likely to become more depressed, this theory shows that there is often an event which could trigger depression. It is a combination of both nature and nurture factors which make people depressed.

Question 25

what are the weaknesses of the cognitive theory as an explanation of depression?

Answer 25

another weakness of the theory is that although some cases of depression can be caused by activating events such as a death of a family member, other types of depression cannot be so easily explained through thought processes such as post-natal depression. Post-natal depression may have a lot to do with varying hormone levels after birth rather than thoughts and it may be more biological factors.

Question 26

what is the cognitive behavioural therapy as a treatment for depression? what does it do?

Answer 26

The CBT is based on the understanding that the way we think affects how we feel and how we feel influences how we behave. If the person changes the way they think then everything else will change as well. In this case, if the patient changes their negative thoughts that make them feel depressed then the symptoms of depression should improve.

The main aims are to:

• help patients change the way they think (cognitive part of the therapy)
• help the patient change the way they act to improve the symptoms they are having (behavioural part of the therapy)

Question 27

what is the first stage of using the cognitive behavioural therapy as a treatment for depression?

Answer 27

the patient will first discuss all their symptoms with the therapist and explain how they feel and what makes them feel this way (activation and belief)

Question 28

what is the second stage of using the cognitive behavioural therapy as a treatment for depression?

Answer 28

this involves challenging the irrational thoughts and ways of thinking. When a patient can recognise thoughts that are irrational or negative they should try to replace them with more rational and positive ways of thinking.

Question 29

what would normally be the homework for the patient using the cognitive behavioural therapy as a treatment for depression? and what must they do?

Answer 29

normally the homework would be to write in a journal and diary. In this they try to change the way they think about a certain situation bu writing down how they feel. Once they can see their thoughts written down it can encourage more rational thought processes.

Question 30

what are the strengths of the cognitive behavioural therapy as a treatment for depression?

Answer 30

one strength of the CBT as a treatment for depression is that there is evidence to suggest that it is effective. Matthijs Beltman et al (2010) found that depressed patients that were treated through CBT improved more than those who were still waiting for treatment or not receiving any treatment. This suggest that it does help reduce the patients symptoms.

another strength is it is a longer lasting solution/ treatment to the patients depression. For example, the CBt is teaching patients how to control their negative thoughts and reflect on their irrational thoughts. This has more of a positive impact ad the patient learns new skills rather than becoming dependent to drugs and eventually having to increase dosage until the drug stops working.

another strength is it makes patients feel better as they are taught to manage their own symptoms. The feelings of hopelessness or worthlessness associated with depression are reduced because the patient has the power to manage their thoughts and avoid the irrational thought process.

Question 31

what are the weaknesses of using the cognitive behavioural therapy as a treatment for depression?

Answer 31

one weakness is the CBT therapy relies on the patients wanting to change their behaviour and the ability to recognise that their thoughts are irrational and need help managing their thought process. A symptom of depression is loss of interest or loss of motivation and if the patient is suffering with that symptom they might be unable to reach out for help or if they did, then they would be unable to complete their homework. For this reason patients opt for drug therapy.

another weakness is that the CBT might not be ethical This is due to the therapist or counsellor convincing the patient that their thoughts are the problem which is causing them to be depressed and they should think in a different way. This could cause the patient to act differently to others as they are told to believe that the way they think and act are wrong.

Question 32

in the genetic explanation of depression, what is the diathesis stress model and what does it explain?

Answer 32

the diathesis stress model shows a model with the diathesis which is the change plus an uncomfortable situation causes depression. This goes against the genetic explanation of depression as it suggests people with the depression gene won’t be depressed unless they are put under a situation which can trigger their depression. for example. gene + stress = depression.

Question 33

what is the drug therapy as a treatment for depression used for or when is it used?

Answer 33

when the patient has a long lasting history of depression, suffering from moderate to severe episodes of depression that keeps coming back or their depressive symptoms have lasted for a long period of time they may be offered drug therapy to treat their depression. The drug will be a form of anti-depressant. The drugs may also be used for mild episodes of depression if the CBT is not proven effective.

Question 34

how do anti-depressants work? ( in drug therapy as a treatment for depression )

Answer 34

they work by raising the levels of neurotransmitters such as serotonin and noradrenaline which are thought to play a role by controlling our moods. The drugs will increase the amount of neurotransmitters or help the effects of the neurotransmitters last longer.

Question 35

what are the different types of antidepressants? name all in abbreviation and long names.

Answer 35

selective serotonin reuptake inhibitors (SSRIs)
serotonin and noradrenaline reuptake inhibitors (SNRIs)
monoamine oxidase inhibitors (MAOIs)
tricyclics (TCAs)

Question 36

what does the SSRI do? (selective serotonin reuptake inhibitors) in drug therapy as a treatment for depression

Answer 36

The SSRI will block the reuptake of the serotonin when it is released from the neuron. This means that the serotonin or neurotransmitter is available for longer. This allows more of an opportunity for the neurotransmitter receptors to absorb it which should help increase the levels of serotonin in the brain ultimately improving the patients mood.

Question 37

what does the SNRI do? (serotonin and noradrenaline reuptake inhibitors) in drug therapy as a treatment for depression?

Answer 37

this has a similar effect to the SSRI but it blocks the reuptake for both serotonin and noradrenaline. This again gives more of an opportunity for the receptors to take in the neurotransmitters, increasing the amount of serotonin and noradrenaline, improving the mood of the patient.

Question 38

what does the MAOI do? (monoamine oxidase inhibitors) in drug therapy as a treatment for depression?

Answer 38

this drug prevents the enzyme known as ‘monoamine oxidase’ from doing its job. the MO will break down some of the neurotransmitters serotonin and noradrenaline after they have been released from the neuron into the synapse. Through stopping the enzyme from breaking down the neurotransmitters it increases the amount of noradrenaline and serotonin, lifting the persons mood.

Question 39

what does the TCA do? (tricyclics) in drug therapy as a treatment for depression?

Answer 39

this is one of the oldest drugs used to treat depression. They work through boosting the effect of serotonin and noradrenaline in the brain by preventing the reabsorption of these neurotransmitters into the neuron. This means that there will be more neurotransmitters so it will lift the persons mood.

Question 40

what are the strengths of drug therapy as a treatment for depression?

Answer 40

one strength is that the drug therapy can be combined with the CBT. This is because if the patient is suffering from severe episodes of depression or any other episodes of depression where they lack motivation to attend therapies this drug can be used as a starting point to reduce their symptoms enough to improve their mood and once this is done they can benefit from the CBT and make it more effective for them.

another strength is that there is data which supports the use of anti-depressants helping patients. There is a report from ‘The Royal College of Psychiatrists which says 50 to 65% of patients with moderate to severe episodes of depression showed improvements when given antidepressants. This was compared to a placebo experiment where 25 to 30% of patients showed improvements. This suggests that there is strong evidence supporting that the anti-depressant drugs have a positive effect.

Question 41

what are the weaknesses of in drug therapy as a treatment for depression?

Answer 41

one of the weaknesses is the side-effects and dangers. Some of drugs cause dangerous side effects when combined with certain foods, so patients have the responsibility of following the guidelines given to them. Overall the antidepressants make the patients feel drowsy, nauseous and dizzy and in some cases cause disturbed sleep. The drugs can also cause diabetes and increase suicidal feelings. Some patients find that taking the drugs decrease their quality of life rather than improve it.

another weakness is the likeliness of relapse. People argue that the drugs improve the symptoms but they don’t treat the disorder because it doesn’t attack the cause of the patients depression. When anti-depressants are used more often, the long-term outcomes are negative. Patients will become more likely to relapse after treatment for depression, despite the fact that the amount of anti-depressants being prescribed is increasing. This suggest that the drugs are not treating the cause of depression itself but soothe the symptoms until the effect of the drug is done. Once the drug has left the patients body the patient will no longer have as much neurotransmitter signals being released from their brain, worsening their mood and as a result it can cause patients to relapse.