Psychological Problems - Depression
Unipolar depression: the type of depression most people are familiar with, where we suffer periods of ‘feeling down’.
Symptoms of unipolar depression
- Depressive episodes
- Feeling suicidal
- Not enjoying activities they used to like doing
- Poor sleep, finding it difficult to fall asleep, waking up early even when still tired
- Extreme tiredness not relieved by sleep
- Poor appetite or an increase in normal appetite
- Lack of self esteem
- Feelings of guilt or blaming themselves for problems
- Acting nervously or feeling like their general behaviour has slowed down more than usual
Main symptoms:
- Lowering of mood so feeling very sad or upset
- Lack of energy even after resting for a long time
- Lack of motivation to do things
Features of unipolar depression
- According to the World Health Organisation, 1 in 15 people will suffer from an episode of serious depression every year.
- Affects twice as many women as men.
| Episode | Symptoms | Features |
| Mild | 4 symptoms displayed | Patients might find their symptoms upsetting but will be able to carry out most day-to-day activities. |
| Moderate | 5-6 symptoms displayed | Patients might have serious problems doing day-to-day activities such as going to work or to school. |
| Severe | Seven+ symptoms displayed | Patients may have suicidal thoughts or self harm to cope with feelings. |
Incidence of depression over time
More people are diagnosed with depression nowadays than in the past.
Teenagers and adults have had a sharp increase in depression diagnosis.
How depression affects individuals and society?
- Increasing risk of suicide. The feelings of helplessness, worthless make people feel like they need a way out. They might think that people around them won’t care if they’re gone. 10-15% of patients with severe depression will commit suicide.
- Amount of time missed from work by patients. The health and safety executive estimated that in 2014-15, 9.9 million days of work were missed because of stress, depression and anxiety. They lack motivation and may get behind on work, feeling guilty and increasing depression. The company also has to cover their workload.
- Cost of treatment for patients. Antidepressant drugs are expensive to prescribe. Counselling requires training of therapists.
- 2007: depression cost the NHS 1.7 billion. This could put a strain on services provided by the NHS.
Genetic explanation of unipolar depression
Twin studies
- Identical (monozygotic) twins share 100% of the same genes, while non-identical (dizygotic) share only 50%.
- McGuffin et al 1996 found that if one monozygotic twin had depression, there was a 46% chance the other twin would too.
- This is only 20% for dizygotic twins.
Not everyone in a family becomes depressed though. This could be explained through genetic predisposition. This is a trigger from the environment to make this gene active.
Diathesis stress model: combination of a stressful life event and an inherited gene that increases risk of depression.
Strengths and weaknesses of genetic explanation
| Strengths | Weaknesses |
| If we can explain depression by looking at the genes people might inherit, we can take away the stigma of being diagnosed with depression.Society might be more accepting of patients as they can’t be blamed for depression. | Very deterministic because it assumes that if you have certain genes then you’re likely to become depressed and you have no way to change that. Some people argue you have free will to not let yourself get depressed. |
| Lots of research evidence supports it.E.g. Caspi et al (2003) found that people with a variation of the serotonin transporter gene were more likely to react negatively to stressful life events. | Reductionist Fails to take into account other factors that explain why someone might develop depression. |
Cognitive theory explanation of depression
- Cognitive theory claims that behaviour can be explained by looking at how the brain processes and thinks.
- Beck’s cognitive triad
- He argued that depression could be explained by a negative triad – this is a set of three thought patterns where people feed bad about themselves, the future and the world in general.
- They believe that problems are bigger than they actually are (magnification)
Ellis’s ABC model
Three stages that might cause depression
| Activating event Something bad happens. |
| Beliefs The thoughts associated with the event can be rational or irrational. |
| Consequences If they have an irrational belief, they will have negative emotional consequences and perhaps blame themselves for the event. |
Strengths and weaknesses of the cognitive theory explanation
| Strengths | Weaknesses |
| It takes into account a person’s life events which may trigger depression.It combines nature and nurture factors. | It is difficult to tell whether irrational thoughts are symptoms or causes of depression. |
| It has been applied to therapy.Cognitive Behavioural Therapy (CBT) is a leading treatment for depression. This helps change the way patients think. | Some cases of depression can be seen to follow obvious activating events such as a death in the family. Some cannot be explained by thought processes, there are biological factors like hormones. |
CBT treatment for depression
The main aims
- Help patients change the way they think.
- Help patient change the way they act to improve symptoms
If a patient changes the way they think, their behaviour should also change.
Stages of CBT
- Patient discusses all their symptoms with their therapist and explains how they feel.
- Challenging these irrational thoughts. Recognising these irrational thoughts and replacing them with positive ones.
- Between each session they might get homework such as writing in a diary.
Evidence from the NHS in 2012 shows that there is a significant improvement when patients with depression are given CBT alongside their previous treatment (drugs).
Strengths and weaknesses of CBT
| Strengths | Weaknesses |
| Evidence to show it is effective. Beltman et al found that depressed patients with CBT improved more. | Relies on patients wanting to change their behaviour. Lack of motivation would make this treatment ineffective. |
| It is a longer lasting treatment than using antidepressants. This allows them to change the way they control their symptoms and thought processes. | Ethical issues concerning CBT.Some argue that therapists are making patients believe that their thought process is an issue and they should think differently. This could change the way they interact with others. |
| Depressed patients will feel better because they learn how to deal with their own symptoms. Feeling helpless decreases because the patient believes that they can do something about their state. | The therapist may therefore be conditioning the patient to what behaviour they think is ‘normal’ and ‘appropriate’. |
Drug therapy as a treatment for depression
Antidepressant drugs work by raising the levels of neurotransmitters such as serotonin and noradrenaline which are thought to play a role in controlling our mood.
The drugs help make these neurotransmitter effects last longer or increase the amount.
| Types of antidepressants |
| Selective serotonin reuptake inhibitors (SSRIs) |
| Serotonin and noradrenaline reuptake inhibitors (SNRIs) |
| Monoamine oxidase inhibitors (MAOIs) |
| Tricyclics (TCAs) |
Strengths and weaknesses of drug therapy
| Strengths | Weaknesses |
| They can improve a patient’s symptoms enough to make it easier for them to access other psychological therapies.Drugs can improve mood and in turn, their motivation. | They can have unpleasant side effects.MAOIs require a specific diet because it can be dangerous when combined with certain foods. They can also make you drowsy, nauseous and dizzy. It can decrease quality of life rather than increase it because of the severity of side effects. |
| Royal college of psychiatrists reports that 50-65% patients with moderate to severe symptoms of depression show improvements when given antidepressants. This is compared to only 20-30% patients given a placebo. | Some argue that drugs don’t treat the disorder because they don’t tackle the cause of depression. Patients are more likely to relapse after treatment, become over reliant on the drugs and once they stop, the symptoms would return. |
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