Explanations of depression

• Family studies - First degree relatives offspring, siblings, parents share 50% of their genes and second degree relatives have 25%. Studies compare rates of depression in relatives of diagnosed cases compared with relatives of controls to determine if those who are more genetically related with a depressed person have more of a chance of developing depression.
• Twin studies: compare the difference in likelihood of both twins being affeccted with depression concordance rates. For identical twins (MZ) and non-idential twins (DZ). MZ twins have identical genes, so if comapared to DZ twins there is a higher concordance rate for MZ then this indicates the imprortance of genetics in deremining the occurance of depression.
• Adoption studies: If depression has a genetic component, it should occur even if there is a change in environment as with being raised by non-biological parents.

Support:

• Family studies: Gershon (1990): 10 family studies. Depression rates in first degree relatives of depressed patients was found to reach 30%.
• Weissman et al. (1984): Relatives of those diagnosed before age 20 had an 8 times greater chance of being depressed.

• Twin studies:McGruffin (1996): study of 109 twin pairs. 46% concorane rate in MZ twins compared to 20% for DZ twins. 
• Bierut et al. (1999) 2662 twin pairs with concordance rate of around 40% in MZ twins.
• Adoption: Wender et al. (1986): biological relatives are 8 times more likely to have depression than adopted relatives.
  Opposition 
• Been said that family share same environment, therefore it may be learned.
• Concordance rate in twins is far from 100%. Genetics are only a risk factor, not clear how exactly genes play a role without knowing the specifc genes involved.
• Adoption - only certain aspects of depression may be genetic, symptoms are not likely to be related to genetics but the number of episodes was linked to life events 
  Biochemical explanations.
• Serotonin: Thase et al. (2002): Depression related to an overall imbalance between several different neurotransmitters including serotonin and noradrenaline.
• Mann et al. (1996) impaired transmission of serotonin in depressive patients.
• Amr et al. (1997) Frequency of depression higher in pesticide users. 15 year longitudinal study where pesticide users were compared against matched control. Pesticides were found to lower serotonin levels and increase depression 

Psychodynamic approach

• Seperation/loss of mother in early childhood could cause depression
• Hostile feelings towards parents = in childhood you eventually redirect feelings towards self.
• If parent mistreated the child then trauma may re-emerge as depression in later life.

Support:

• Hinde (1997) When infant rhesus monkeys are seperated from their mother they displayed depressive behaviour.
• Martin et al. (2004): From questionnaires it was found that depressed patients more often report having parents that are affectionless. 

Opposition

• Harris (2001): The social/financial circumstances are affected after the death of the parent, where the resulting lack of care & family discord could instead be the main factor for increasing the chances of them developing depression.
• Bonanno (2004): Major losses only lead to depression in less than 10% 

• Veisola et al. (1998): Gender differences from loss of parent: female becomes depressed where as males become anti-social and alcoholics.

Cognitive approaches

• Hopelessness: Attributions concerning expereiences of failure
• Internal: believe that they caused the failure.
• External: believe failure was out of their control.
• Stable: failures will occur over the long-term
• Unstable: failure may occur occasionally.
• Global: one failure indicates to them that they will fail @ everything.
• Specific: Failure is specific to the event.
• Cognitive triad: Beck (1976) Negative view about the self, world & future. 

Support

• Nolen-Hoeksema (1992): 5 year longitudinal study. There is a connection as children grow older between their attribution style & likelihood of developing depression.
• Seligman (1974): Studied college students that fialed an exam who were depressed. Those that made unstable & specific attributions were not depressed two days later.

Psychodynamic approach

• Seperation/loss of mother in early childhood could cause depression
• Hostile feelings towards parents = in childhood you eventually redirect feelings towards self.
• If parent mistreated the child then trauma may re-emerge as depression in later life.

Support:

• Hinde (1997) When infant rhesus monkeys are seperated from their mother they displayed depressive behaviour.
• Martin et al. (2004): From questionnaires it was found that depressed patients more often report having parents that are affectionless. 

Opposition

• Harris (2001): The social/financial circumstances are affected after the death of the parent, where the resulting lack of care & family discord could instead be the main factor for increasing the chances of them developing depression.
• Bonanno (2004): Major losses only lead to depression in less than 10% 

Cognitive triad - Evans et al. 2005:depressed people have been found to have maladaptive attitudes and beliefs. The more the have the more severe their depression.

Opposition

• Ford & Neale (1985)  college students that were depressed didn't underestimate their level of control regarding internal/external attributions.
• Beyer (1988): found that women are more likely to attribute their failures to incompetence & successes to luck.
• Segal & ingram (1994): compared non-depressed & depressed individuals: no differences in cognitive vulnerability. Negative thinking is a concequence of depression rather than the cause.

Drug therapy 

• SSRIs: these drugs prevent the reuptake of serotonin, which results in a higher availability of it.
• Serotonin: found mainly in the synapses of regions of brain that are related to mood.

Support:

• Kirsch et al. (2008) Meta-analysis where SSRIs were compared with placebo. SSRI was more advantageous for severe depression but not for more moderate depression.

Opposition 

• Barbui (2003): suicide risk depends on age. Meta-analysis. SSRIs increased suicide risk among adolecents. However,there is a decreased suicide risk for adults & those aged 65. The appropriatness of the drug is questioned.
• Ryan (1992)The differenes in effectiveness concerning drug treatments may vary because of different in brain neurochemistry during development (appropriateness)
• Benek-Higgens et al. (2008):Elderly may be misdiagnosed as not being depressed due to life style changes. Therefore, no antidepressant medication provided when they need it. Additionally, elderly are less likely to seek drug therapy because of stigma.

Electroconvulsive therapy

• Firstly, muscle relxants are used to paralyse the patient. Short-acting anaesthetic makes them unconcious. These prevent the patient from moving and disrupting the procedure.
• Unilateral appliaction of a 70-130 volt current.
• Shock lasts for 5 seconds causing a seizure that lasts nearly a minute. The seizure enhancs transmission of neurochemicals & improves blood flow to brain to reduce symptoms of depression.
• 6 sessions carried out over a few weeks.

Support

• Richard & Lyness (2006): ECT improves 60-70% of those with severe depression.
• Scott (2004):Meta-analysis of 18 studies including 1144 patients. It was found that ECT was mmore effective than drug therapy for short-term treatments of depression.

Opposition

• Sackheim et al. (2001): 53% of patients who responded to ECT relapsed. 
• Department of health report (2007) 30% reported permanent fear & anxiety after ECT treatment. 

Psychodynamic therapy

• Catharsis: Emotional release after the psychoanalyst helps the patient uncover unconscious conflicts and anxieties. Encourages patient to have power over their behaviour. Traumatic childhood experiences can be better understood with adult knowledge.7
• Free association: Patient says out loud everything that comes to mind.
• Word association: Patient is given words and has to express the first word that they can think of which is interpreted by the psychoanalyst. 
• Dream analysis: Patient talks about their dreams, which are interepreted by the psychoanalyst. 

Support

• Corsini and Wedding (1995): those who were psychoanalysed, 30-60% were cured.

Opposition:

• Bolger (1989): the idea of being cured is based on the medical model which may not reflect complete recovery. Psychological disorders may not follow a course similar to that of a physical disorder.
• Eysenck (1952):66% of the control group recovered spontaneously. Only 44% of psychoanalysed group recovered. Participants may have been to passive to participate in the therapy.
• Stiles et al. (1991):Meta-analysis of 19 studies and found there was no difference between psychoanalysed and those without treatment after ayear. 

Cognitive behavioural therapy

• Cognitive part: Developing awareness of their beliefs and setting goals.
• Behavioural part: role-playing their beliefs.

Beck (1976)

• Carried out over 20 weeks:
• 1. schedule of activites is provided to help them become more active and confident.
• 2. patient records negative thoughts and acts out those thoughts.
• 3. Therapist helps client recognise the underlying illogical thinking processes. The patient is provided with homework assignments.
• The therapist helps the patient change their maladaptive attitudes. The patient is tested to see if they can adapt to real-life situations and then encouraged in pleasureable activities.

Support

• Brent et al. (1997): 107 adolescents diagnosed with major depression. CBT was the most effective treatment. Provided rapid respone and was effective for suicidial adolescents.

• March et al. (2007): At the start, 30% of the teenagers experiences suicidal thoughts, but this was reduced to 6% by the end of CBT.

Opposition

• Elkin et al. (1985): CBT less suitable for beliefs that are difficult to change.
• Simons et al. (1995): CBT less suitable where the source of stress can't be removed easily e.g debt and divorce.
• Hunt and Andrews (2007):5 meta-analyses. The median dropout rate was 8%. Patients may have dropped out if they felt therapy wasn't helping. The remaining patients were positive indibviduals who skewed the results.