Week 5-Depression Flashcards
When does depression become clinically relevant?
-We all have periods of ‘depression’ or more specifically of sadness and low mood across our lives. These experiences are often understandable reactions to difficult circumstances
-These experiences become clinically relevant when depression becomes pervasive and long-lasting
-Suicide and injury with unknown intent are the leading causes of death in people aged 20-34 (Office for National Statistics, 2020)
What is Positivism?
-Positivism assumes depression is a ‘natural kind’ reflecting the natural world rather than human interest
-Sadness has been documented for as long as human records have existed (Cromby et al., 2013). Ancient Greeks and religious scriptures reference low mood and sadness
-The presence of sadness throughout human history does not mean that the experience has been unchanging. The word ‘depression’ has evolved to capture a cluster of phenomena around sadness (However, it ignores social and contextual influences)
What are the historical understandings of depression?
-Solanus, 1st Century AD: Melancholy, thought to be caused by an excess of black bile, centred on distress, silence, animosity, suspicion, crying and ‘occasional joviality’ (mood swings) (Melechi, 2003). More common in middle aged men (Cromby et al., 2013)
-“Depression refers to a wide range of mental health problems characterised by the absence of a positive affect (a loss of interest and enjoyment in ordinary things and experiences), low mood and a range of associated emotional, cognitive, physical and behavioural symptoms” NICE (2022) (This is a more modern definition of depression)
How does culture influence the classification of depression?
-Cultural variations exist around how much physical symptoms are deemed as part of depression (Cromby et al., 2013)
-The Western view of depression leads to assumptions that all Westerners experience the same pattern of symptoms. This gets compared to assumptions about Eastern differences rather than thinking about individual cultures (Kirmayer, 2001)
-West tends to separate mind and body (Jenkins et al., 1991) (We tend to heavily separate the mind and body in our model of mental health (which other cultures do account for))
Relates to individualistic culture (Cromby et al., 2013)
-Even within western cultures there are individual differences e.g., UK and France
How good is validity and reliability in depression diagnoses?
-Depression diagnoses are not distinct from one another. Co-occurrence is higher than chance levels (Andrews et al., 2008; Cromby et al., 2013)
-E.g., if someone has major depressive disorder, you wouldn’t expect them to also have a prevalence of pre-menstrual dysphoric disorder like the rest of the public BUT the prevalence of this happening is higher than it reliably should be.
-NICE (2007) - Depression is too heterogeneous and is limited in predictive validity for treatment plans
-Cromby et al (2013) - single symptom research might be better than research using psychiatric categories
What are some Physiological causes of depression?
-Vitamin D, B6 and B12 as well as folate have all been linked to depression (would the disorder be deficiency or depression?)
-Is depression a real reliability of a category? Or a cluster of symptoms?
-If depression is a symptom of deficiency, which is the natural kind? what if there’s a social cause of the symptoms? They tend to ask if you feel healthy, if the answer is yes they tend to just refer for treatment rather than doing blood tests for example
-Some research takes this to mean that supplements would prevent depression (Sangle et al., 2020)
-Not a single cause for depression so to say B12 causes all forms of depression e.g., it would be very inappropriate especially if their depression has a social cause
How are Neurotransmitters involved in depression?
-Monoamine hypothesis: Norepinephrine, dopamine and serotonin. All 3 are involved in sleep, appetite and emotion.
-Antidepressants work by increasing levels of one or more monoamines in the brain. Discovery worked backwards: found antidepressants impact NT function and influenced mood
-By discovery working backwards, they assumed that chemicals play a role in depression (but doesn’t mean drugs are good for them even if it influences mood)
What are Tricyclic antidepressants (TCAs)?
-Prevents serotonin reabsorption
-Impacts norepinephrine and to a lesser extent dopamine
What are Monoamine oxidase inhibitors (MAOIs)? (antidepressants)
-They break down the enzyme that breaks down serotonin, norepinephrine and dopamine
-Can impact blood pressure and risk of stroke
-MAOIs are used left often nowadays as risks may not be worth it most times
What are Selective-serotonin reuptake inhibitors (SSRIs)?
-Most popular option in the West
-Associated with fewer risks and side effects than TCAs and MAOIs
-Some risks exist, including a small but significant risk of suicidal feelings. SSRIs can affect heart rhythm and fatigue
-All these antidepressants can all counter feelings of low mood and sadness and are associated with feeling content
What’s the Serotonin Hypothesis?
-SSRIs (e.g., Prozac) slow down serotonin reuptake, gradually increasing serotonin levels
-No strong evidence for the serotonin or monoamine hypothesis. No evidence for what a typical balance should look like or why some people have an imbalance (Cromby et al., 2013)
-If we could support this hypothesis, should we diagnose depression or a serotonin deficiency/imbalance of some kind?
What’s Seasonal Affective Disorder?
ICD-11: Recurrent depression unspecified. DSM-5: Major depressive disorder with a seasonal pattern
-Linked to sunlight exposure: (1) reduced melatonin (which affects our sleep schedule), (2) lower levels of serotonin (3) circadian rhythm
-NHS acknowledge potential for a reverse pattern of depression over summer
-Treated with SAD light therapy: Efficacy uncertain (NICE, 2022). Review=46% still developed SAD, low quality evidence and there was a lack of studies comparing to alternative treatments (Dong et al., 2022; Nussbaumer et al., 2015)
Premenstrual Dysphoric Disorder
ICD-11: Mood, somatic or cognitive symptoms during the majority of menstrual cycles that are severe enough to cause significant distress or impairment in functioning
-Cause is unknown but is believed to be a sensitivity to normal hormonal changes associated with PMS. Causes of sensitivity point to (1) genetics, (2) smoking and (3) trauma and stress (Mind, 2023)
-Treatments include: SSRIs, combined oral contraception, painkillers, Gonadotropin releasing hormone (GnRH) analogue injections, therapy or surgery (Carlini et al., 2022)
-PMD hints to a significant impact on a person’s wellbeing e.g., suddenly feeling suicidal
What are some less common Biomedical Treatments used for depression?
-Benzodiazepines (e.g., Valium) - Increase GABA and inhibit neurotransmitter activity leading to calming effects. Linked to dependency and withdrawal.
Electro-convulsive therapy (ECT):
-Electrical currents passed through brain, now seen as a ‘last resort’
-started in 1930s - thought that schizophrenia and epilepsy were mutually exclusive. Began with drug injection, switched to electrocution after witnessing a pig in a slaughterhouse experience a seizure after electrocution
-On anaesthetics during ECT. NICE guidelines suggest ECT should be a last resort unless the patient REALLY wants to
What are the Modern ECT Guidelines for Depression?
NICE (2022) guidelines: Consider ECT if:
-Patient preference
-‘Rapid response needed. For example, if the depression is life-threatening because the person is not eating or drinking.’
-Other treatments unsuccessful
-Must be fully informed of risks -1 in 200 died as a result
-Still a listed option which is bizarre despite origins, issues and the key fact that schizophrenia tends to not be associated with epilepsy
-Risks include headaches and retrograde amnesia which can lead to longer term or permanent memory loss. Blood pressure changes and heart irregularities can result (Bregg, 1997). Reviews indicate a marked risk of death (Read, 2004)
