Etiologies - Biological Biochemical - Neurotransmi
1.Norepinephrine (NE)- Schildkraut(1965) to much=mania, too little=depression. Depleted levels=decrease in activity, pleasure, motivation. Caused by it being reabsorbed or broken down by Monoamine Oxidase Enzymes(MAO) to much.
2.Serotonin - low levels=depression, seems to act as a controller in the brain. Evidence shows drugs that increase serotonin improve mood. Suicide victims-low levels of it.
Hormones - high levels of cortisol in depressed ppl. Changes in oestrogen & progesterone could account for premenstrual/post-natal/menopausal depression + why more women diagnosed as depressed.
Evaluation - Teuting(1981) found that byproducts of NE/serotonin were lower in depressed ppl. urine, suggests they have abnormally low levels of it. Ogilvie(1996) ppl with depression have a genetic flaw in how they produce serotonin. Don't know if low serotonin/NE are a cause or symptom of depression. When ppl take anti-depressants effect at synapse is immediate but takes a while to improve mood-could depression be a habit/behaviour? Low levels of serotonin have been found in manic patients to. Thase (2002) found depressed ppl had MORE NE-opposite of other studies. Not all sufferers helped by serotonin drugs-other causes. Some ppl low neurotransmitter levels but not depressed. Ignores things like learning and experience-reductionist. Not all depressed ppl abnormal levels of cortisol.
Etiologies - Biological
Correlational studies shown that more likely to get depression if a close relative has it-suggests genetic link.
Family studies-Gershon(1990) reviewed 10 studies rates of depression in 1st degree relatives 7-30% higher than general pop. Egeland(1987) studied Amish found genetic markers on sufferers, however findings never been replicated.
Twin studies-McGuffin(1996) concordance rates of 46% for MZ twins & 20% for DZ twins. Allen(1976) found 40% for MZ & 11% for DZ.
Adoption studies-Wender(1986) compared relatives of adopted ppl with depression-biological relatives 8 times more likely to have depression than adopted relatives.
Evaluation-Many studies correlational-can't infer cause & effect. Families share a similar environment, kids could learn depressive behaviour, living with depressed ppl is depressing, other things like poverty affect whole family, completely genetic concordance rates for MZ twins would be 100%-environment MUST play a role. Don't know the actual way in which the genes cause depression.
Etiologies - Cognitive
Learned helplessness-Seligman & Maier(1967) dogs given inescapable shocks learned to be helpless even when they could escape didn't try. Hiroto(1974) pps. endure a loud noise when they had chance to turn it off endured it-learned to be helpless. Evaluation-Can't necessarily apply results to humans. Ethical issues with study. Not everyone becomes helpless. Feeling out of control is common yet rarely leads to depression. Doesn't account for the somatic symptoms. Could be an effect rather than a cause.
Attribution Theory-Abramson(1978) depressed ppl tend to explain -ve events in internal, stable & global ways & +ve events in external, transient & specific ways. Evaluation-can't say if attribuitions are the cause or arise from depression. Rose (1994) said it comes from abuse etc. but generally can't say how negative attributional style develops. Much of the research questionnaire based-problems of demand characteristics, response bias/acquiescence.
Beck's Cognitive Triad and errors in logic-unrealistically negative views about self, the world & the future.Depressed ppl make 5 diff. logical errors, arbitary influence, selective abstraction, overgeneralization, magnification & minimisation, personalization.Beck believes that depressed ppl cognitive life dominated by the triad of negative thought & logical errors-these maintain the depression & make them resistant to help. Evaluation-lots of evidence to support it. Therapies based on its theories. Still a question of cause & effect, could be bi-directional.
Etiologies - Sociocultural
Stressful life events-Ppl. suffering from depression experience an above average number of these.
Brown & Harris(1978)-interview study-61% of depressed women at least 1 event 8months before the interview, 19% non-depressed women. Also found vulnerability factors increased risk of developing depression.
Brown(1994) 404 single working class mothers-early life experience strong predictor of adult depression.
Bifulco(1998) 105 working class mothers with vulnerability factors but not depression. Over 14months 37% became depressed and 66% of these had experienced childhood neglect or abuse.
Evaluation-methodological problems with an interview-might not be honest. Biased sample. What counts as stressful? Many people who are depressed don't report stressfl life events at onset of depression. Many ppl suffer stressful life events & don't get depression.
Treatment-Biomedical Drug Therapies
Tricyclic anti-depressants-block the reuptake of neurotransmitters-relief in 75% of cases after 2-3wks-weight gain, drowsiness & constipation.
MAO inhibitors-increase amount of NE avalible less effective than Tricyclic, lethal if combined with certain foods.
SSRI's-increase amount of serotonin gd as the others relativly free of side effects
Lithium Carbonate-reduces mania & depression 80% full/partial recovery decreases relapses close medical supervision required
Evaluation-Bernstein(1994) generally effective in short term 60-80% cases. Reduced no. of hospital in patients (but there have been changes in hospitalization) Elkin(1989) drug treatment works faster but no better. Kirsch & Sopinstein(1998) only 25% more affective than placebos & no better than tranquilizers. Blumenthal found exercise just as gd as SSRI's. Leuchter & Witte(2002) improved just as well as those on a placebo. Kirsch(2008) found antidepressants & medical treatment not more effective than a placebo-only in extreme cases
Treatment-Biomedical Psychosurgery & ECT
Psychosurgery (Lobotomy)-severing the connection between the frontal lobes of the brain & deeper structures. Only used as last resort for severe depression or OCD. National Commission review in USA (1976). Side effects include changes in personality, motivation & cognitive abilities (Barahal, 1958) Also suffered seizures & 1-4% likelihood of death.
Electroconvulsive Therapy-electric shock of approx. 100 volts, repeated 6times over 3-4wks. Only used for severe cases of depression if drug treatment has failed & high suicide risk. Effective in 60-80% of cases. Unknown why it works. Replaced insulin coma therapy as more controllable & less risky. causes memory loss & mortality in 3 in 10,000. Ethical issues.
Beck's Cognitive resructuring therapy-identification & restructuring of faulty thinking-therapist gently pintos out errors in their thinking. Beck's six patterns of faulty thinking
Ellis's rational emotive behavour therapy-forcibly persuading the client to change their beliefs
Effectiveness-better than no treatment or a placebo. Elkin(1989) found no difference between CBT and other forms of therapy, it was better than a placebo but slightly less effective than drugs. Riggs(2007) found that CBT & SSRI's is effective (76% improved) but CBT & placebo was almost as gd (67%). Cost effective-don't involve prolonged treatment. Quite effective for milder depression. No negative effects. Criticised for focusing on symptoms not causes.
Treatment - Group Therapy
Group of clients meet with 1+ therapists. Evaluation-proven useful for specific groups to come together, healing process, therapist can counsel +1 at a time. Some individuals might not want to tell problems. Promlems with confidentiality. Group dynamics-some ppl might feel they're not being heard or not the therapists priority.
Group therapy & depression
Jacobsen(1989) just as effective at treating the symptoms, most sucessful treating women with marital problems.Toseland & Siporin(1986) group vs. inividual-just as effective 75%, more effective in 25%. Group therapy more cost effective in 31%McDermot(2001)-43/48 studies statistically significant reduction in depressive symptoms. 9 no diff. between group/individual. 8 CBT more effective. Difficult to obtain data more variables ina group than individual.
Factors to consider-Group cohesion, exclusion, confidentiality, relationship with the therapist.
Recognizes the strengths & limitations of diff. therapies-tailors sessions to meet indivdual/group needs.
E.g. Depressive suicide patient-drugs to lesson symptoms then use CBT
Research shows drugs alone have significant relapse rates.
Rush(1977) higher relapse rate for drugs is because in therapy learn coping strategies
Hollon & Beck(1990) therapy more effective than drugs alone at preventing relapse unless drugs taken long term.
Klerman(1994) combination of psychotherapy & drugs moderately more successful than either alone.
Relationship between etiology & treatment
Historically diff. views oncauses of psychological disorders->influenced by knowledge & belief at time.
No matter approach treatment has generally been linked to what was thought to be the etiology.
Contemporary approaches to treatment depending on the disorder.
General belief that multifaceted approach is best
Today person is considered a "client" not a "patient".