AQA A2 Psychology Unit 4 - Depression

Depression is a mood affective disoder, which effects all physical, mental, emotional and behavioural experiences. Long term depression can cause severe damage and effect everyday functioning

Major Depressive Dissorder (MDD)

• Experience depressive episodes
• Also known as Unipolar Depression

Bi- Polar 

• Experience both depressive moods and manic episodes
• Can cause hallucinations and delusions 

Diagnosis 

• Must last over 2 weeks
• Must display - Depressive mood, diminished interest, weight loss or gain or insomnia 
• May also have fatigue, worthlessness, lack of concentration and thoughts of death 

Feelings of social impairment, berevement and physiological effects are not depression 

Reliability

Consistency of measurements 

• Test-retest reliability - Same doctor, same person on diagnosis
• Inter rater reliability - Same person, different doctor on diagnosis

Enfield et al - Inter rater reliability - skilled practitioners had a high level of agreement (Reliable)

Barca-Garcia et al - Reliability over 2,300 patients diagnosed at least 10 times each. Consistentcy in diagnosis poor (Un-reliable) 

Evaluations 

• Diagnosis is not always reliable
• Mainly use symptoms not physical signs - rely on patient 
• Level of depression - interpreted differently causes inconsistency 
• Jurges - Underestimating ratings of health

Validity - How meaningful and useful the diagnosis is

• Predictive validity - If diagnosis lead to successful treatment
• Descriptive validity - Diagnosis should be subjective per disorder
• Aetiological validity - All patients diagnosed should have similar symptoms

Sanchez-Villegas et al - 74.2% diagnosed with depression had been valid in the interview group (valid in diagnosis)

Ziger & Phillips - Descriptive validity - Symptoms of depression overlap with bipolar and 25% of schizophrenia patients (Low validity in diagnostic)

Van Weel-Baumgarten - 99 particiapants, 33 with depression. 28 correctly diagnosed (High but not perfect) - DSM-V is good but not perfect, not completely valid 

Evaluations 

• Common language used when diagnosing depression (no misinterpretation)
• Burrows et al - Healthcare underdiagnosed by 56% in nursing homes 
• Not all diagnosing scales are valid 

First Degree Relatives

Gershon - Rates of MDD in 1st degree relatives are between 7%-30% - Young people diagnosed more likely that a relative also has it

Weissman et al - Relatives of people diagnosed before 20 had a greater change of being diagnosed with depression, than those without. - Not sure if its the genetic influence or shared envrioment 

Twin Studies

McGuffin et al - 46% of identical twins had depression is the other did compared to 20% in non-identical - does not take into account shared enviroment or is it genentic

Evaluations 

• Vunerability!
• Cause and effect 
• Ethical 
• Reductionist - doesn't take into account other factors

Amine Hypothesis  - Caused by a low activity of certain neurotrasmitters 

• Noradrenaline - Excited
• Serotonin - Happy
• Dopamine - woooo
• - The work by sending chemical messages in the NS and active parts of the hypothalamus that deals with reward and punishment 

Evidence 

• Anti-depressants increase the amount of noradrenaline and 5HT in brain - Effective when stopping depressive symptoms
• Mann et al - Transmissions of serotonin were impaired, depression increased

Evaluations

• Cannot establish cause and effect of low levels of serotonin to depression (Anti-depressants don't just target neuro-transmitters but other this to) 
• Deterministic - Doesn't take into account lifestyle or neuroanatomy 

HPA is very important in the reaction of stress. Consistent findings between depressed and non-depressed patients and the differences in the function of the HPA

Cortisol is created in stress reactions - Cortisol elevated in depressed people, decreases when episode is over 

Carroll (1982) - Successful in depressed patients when cortisol is suppressed

When Noradrenaline is low, the hypothalamus loses its ability to regulate levels. High levels of cortisol are seen in both depressed and high anxiety patients - Cause and Effect

• Post Natal Depression
• Imbalances of oestrogen and progesterone, increases during pregnancy then rapidly drops
• Pre-Menstral Dysphoric Disorder 
• D'Alton - Oestrogen too high, Progesterone too low

Evaluations 

• Clare (1975) - Hormone imbalance studies are inconclusive - social change
• Not all suffer from it - Natural sensitivity to hormonal changes 
• Genetic pre-disprosistion - Madden et al - reaction is genetics (Imbalances) 

Head injury or Strokes in frontal lobe = likelyhood of depression

Starkstien & Robinson (1991) - Post stroke depressives, lesions in frontal lobe = stroke damages amine pathway = depression

Powell and Miklowitz (1994) - Structual abnormalities in individuals with MDD 

Nemeroff et al (1992) - Adrenal glands bigger in MDD patients 

Evaluations

•  Not all individuals with depression have brain abnormalities
• Ranges of scanning contradict when diagnosing - methological or medication?

MAOIs

• Block the action of the enzyme that breaks the noradrenaline and serotonin 

TCA's

• Mildest anti-depressants, slower acting, fewer side effects. Reduces the level of serotonin and noradrenaline. 10 days to work 
• Montgomery et al - 50% of users relaped if they stopped taking them too soon

SSRI's

• Increase serotonin and noradrenaline =. Can lead to high severe side effects - dizzyness and headaches

Evaluations

• Effective in reducing symptoms 
• 75% are effective compared to 33% of placebo effect
• Jarret - MAOI's are more effect than TCA's - Milder cases
• Clears symptoms not the cause of depression = Psychological and Biological needed

Proceedure of Electroconvulsive therapy

• Patient given muscle relaxent
• Electrodes placed on their head
• Given electric shock between 70v - 130v between 1/2 - 5 seconds
• Convulsion
• Patients wakes with no recolation of treatment
• 6 session needed over a number of weeks

Effectiveness

•  Richards et al - 70% with severe depression improves
• Sackeim - Depressed again the following year
• Heather - Don't understand the precise mechanism

Side effects  - memory loss, confusion, no evidence of brain change 

Appropriateness

Mental health act - only appropriate for those at risk of suicide and drugs dont work 

Freud 1917 - Relationship with Parents

• Birbings - Relationships - Depression is a result of low self esteem by harsh parenting
• Bifileo - Seperation and loss - Depression occurs due to a loss of a parent
• Supported - Hinde - Reeces Monkeys seperated from mothers = depressive symptoms

Individual may have hostile feelings towards the parents, repressing these feelings = self loathing = depression

• Freud - Lossing someone through grieveing process never goes away - Symbolic Loss
• Bempoarad - Individuals who have experienced loss in first 18months - search for love and approval - if they don't = depression 

Evaluations

• Difficult to test - Based of falsifyability
• Findings are inconsistent
• Some evidence on childhood loss and later life depression - enviromental factors = vunerability
• Harris - Family discord - Lack of adaqute care = depression even without seperation 

Aim - Ensure individuals cope with inner emotional conflicts

Purpose - Uncover unconcious conflicts and anxieties 

Techniques - Free association, Word association, Dream analysis, Transference, Projective test

De Clerq - Must be delieved by skilled practitioner

Burnard - Effective when combined with anti-depressants

Effective for elderly over 2 year treatment

Evaluations

• Expensive
• Not appropriate for those passive and withdrawn ( May drop out due to demand)
• Not appropriate for those who are suicidal
• Emotional harm
• Eyserick - Only works on 44% of patients 

Learning Theory 

•  Social reinforcement - Lewinsohn 1974
• Reduction in positive reinforcement maybe positively reinforced through sympathy 
• However this does not explain depressive symptoms after sympathy has stopped

Learned Helplessness - Seligman

•  Inescapable and unavoidable situation - lose motivation to find an escape (learn to fail)
• Maier and Seligman. Placed particiapnts in places of intense noise and shock with no escape, when escape was possible, they failed

Evaluations

• Does not take into account the congitive approach
• Gender difference - females = depression, males = anger
• Hoplessness theory of depression - Beck, negative expectancies of the future using hopless scale 
• Cause and effect (Hopeless a cause of depression or an effect)
• Nolen - Hoeksema - No connection between attributes and depression in youth (Later life)

Behavioural Activation Therapy (BAT)

• Maladaptive beahviour stopped through learning experiences and allows adaptiveness
• Depression is learnt and through operant conditioning and reinforcement can be changed to positive behaviour, Helps depressives as it gives them a route to cope

Social Skills Trainning (SST)

• Depressive patients lack social skills. Taught to build social skills and improve self esteem
• Improves patients ability to function in situations

Research 

• Houghten et al - BAT effective with low drop out rate (Motivated)
• Herson - SST is more effective than psychotherapy
• De Jong Meyer - BAT compared to Anti-depressants worked for longer

Evalutions

• BAT simple and works better than CBT
• SST slower process = Depressives can't deal with change well 
• SST hard to generalise to real life situations as not highly motivated

Hopelessness theory of depression - Beck et al

• Depressive attriutes - Internal/Global/Stable 
• Non depressive - External/Specific/unstable (Catastrophizing in their head)

 Negative Cognitive Triad = Self - hopeless, World - Barrier, Future - Will never improve

Abramsom et al : Hopelessness Theory

• Negative event + with a negative schema = stable/global atrtiubtes = hopeless future

Research 

• Boury - Misinterpretation of experiences  - failed exams = failed life in depressives
• Mcintosh - Negative self schema in depressives which occured through parental criticism

Evaluations 

• Evans  = Depressive people have maladaptive thinking
• Cause and effect cannot be established
• Beck - individual differences effect self esteem and its effects on the person 

Alter maladaptive thinking to be more positive and to challenge irrational thoughts

Cognitive - Client is aware of their beliefs though the Activation, Beliefs, Consequences model

Behavioural - Apply positive consequences to real life situtation, makes them more realistic

Research

• Whitfield & Williams - CBT is highly effective (Self help)
• National Institution of mental health - Less effective than anti-depressants
• Flanagan - Post stroke depression - CBT worked well

Evaluations

• Sets clear goals for the client
• Doesn't take into account unconcious (Psychodynamic)
• No side effects
• Brent et al - Less relapses than behavioural therapy
• Hard to concentrate ( Depressive patients find this hard)

Stressful events 

• Bervement, unemployment and divorce (Brown & Harris)

Gender Differences 

• Males see marriage as a safety net, females see it as a cage
•  Females are more biologically vunerable
• Women who are abused = depressed / Males = Antisocial or alcoholism

Culture

• Parker et al - Lock and Key model - Early experiences = activiated by mior problems
• Based on western DSM - V

Research 

• Bifulco et al - Working class mothers = 57% became depressed

Evaluations

• Doesn't explain why patients don't report critical life events