mood disorders

• When analysing markets, a range of assumptions are made about the rationality of economic agents involved in the transactions
• The Wealth of Nations was written

  1776
• Rational


  (in classical economic theory) economic agents are able to consider the outcome of their choices and recognise the net benefits of each one
• Rational agents will select the choice which presents the highest benefits
• Consumers act rationally by


  Maximising their utility
• Producers act rationally by


  Selling goods/services in a way that maximises their profits
• Workers act rationally by


  Balancing welfare at work with consideration of both pay and benefits
• Governments act rationally by


  Placing the interests of the people they serve first in order to maximise their welfare
• Rationality in classical economic theory is a flawed assumption as people usually don't act rationally
• Marginal utility


  The additional utility (satisfaction) gained from the consumption of an additional product
• If you add up marginal utility for each unit you get total utility
• Learned helplessness


  An individual feels they do not have control over a situation because they have had negative experiences of that situation in the past, giving them a sense of helplessness that can lead to depression
• Beck Depression Inventory (BDI)

  A 21-item multiple choice questionnaire that measures the severity of depression. Patients read statements and answer how much each applies to them on a 0-3 scale over the past two weeks. The higher the score, the more depressed the person is deemed to be.
• Scoring ranges for the Beck Depression Inventory:
• Explanations of depression


  • Biological (genetic and neurochemical)
  • Cognitive (Beck's cognitive triad)
  • Learned helplessness/attributional style (Seligman)
• Biological explanation (Oruc et al., 1997)

  • Depression has a genetic basis, with polymorphisms in serotonin receptors and transporters increasing risk, especially in females
• Cognitive explanation (Beck, 1979)


  • Depression is due to faulty processing of information, with a negative cognitive triad of views about the world, self, and future
• Learned helplessness/attributional style explanation (Seligman, 1988)

  • Depression results from an individual perceiving negative events as internal, global and stable, leading to a sense of helplessness
• Increased risk of developing bipolar disorder just with the females in the sample
• Cognitive (Beck 1979)


  Depression due to faulty processing of information. Created the cognitive triad (negative views about the world, negative views about oneself and negative views about the future) which all influence each other and can lead the depressed individual to spiral into lowering moods.
• Learned helplessness/attributional style (Seligman, 1988)

  Attributional Style Questionnaire given to 39 unipolar depressed patients at the beginning and end of cognitive therapy and also after a one year follow-up. Also gave this to 12 bipolar patients during a depressed episode. Found a pessimistic explanatory style for bad events correlated with severity of depression. As therapy progressed depression reduced as the explanatory style became less pessimistic. This continued to remain improved at the one-year follow-up.
• Learned helplessness


  The depressed person has learned they are helpless in the unpleasant situation they are currently living in and they no longer try to make their life/mood better.
• Unipolar depression is an affective disorder characterised by persistent low mood, lack of energy, and hopelessness. Low mood is long term and periods of mania are not experienced.
• Drug treatments for depression

  • Tricyclics
  • MAOI
  • SSRI
• Tricyclics


  Increasing the brain's supply of norepinephrine and serotonin levels
• MAOI


  Slowing the natural breakdown of norepinephrine, serotonin and dopamine
• SSRI


  Act on the levels of the neurotransmitter serotonin at the synapse, preventing its breakdown and reuptake
• Similarity between depressive disorder (unipolar) and bipolar disorder

  Both have depressive symptoms such as social withdrawal and changes in appetite, sleep patterns
• Difference between depressive disorder (unipolar) and bipolar disorder

  Bipolar has mania episodes while unipolar doesn't have mania episodes
• Similarity between drug treatments for depression and cognitive restructuring treatment for depression


  • Both require professional (doctor to prescribe and psychologist to 'teach' CBT)
  • Both have research support for their success
  • Both take some time to be effective (usually 4 weeks for SSRI)
• Difference between drug treatments for depression and cognitive restructuring treatment for depression

  • Individual needs to be motivated (and of certain personality type/insight) for cognitive treatment, whereas individual needs relatively little motivation to take drug
  • Drugs have side effects including dizziness, nausea, insomnia, constipation. No side effects with cognitive treatment
  • Patient more actively involved in cognitive restructuring but passive in drug therapy
• Treatments and management of depression

  • Biological: chemical/drugs (MAO, SSRIs)
  • Cognitive restructuring (Beck, 1979)
  • Rational emotive behaviour therapy (Ellis, 1962)
• MAOI


  Older antidepressants not frequently used today. Inhibit monoamine oxidase which is responsible for breaking down norepinephrine, serotonin and dopamine
• SSRIs


  Can help improve depression by increasing the levels of serotonin in the brain. This can occur by increasing the amount of serotonin in the blood stream as well as preventing it being reabsorbed and broken down once it crosses a synapse in the brain
• Cognitive restructuring (Beck, 1979)


  The patient participates in a number of therapy sessions over weeks and/or months to alleviate their symptoms of depression. The therapist helps the patient to identify their faulty thinking and then correct these thinking patterns to more helpful ways of viewing themselves, the world and the future.
• Rational emotive behaviour therapy (Ellis, 1962)

  Follows the ABC model: Activating agent - what is the behaviour and/or attitude of the patient towards events in their lives, Beliefs - what is the belief of the patient toward the event, Cognitive - what types of thoughts does the patient have with regard to the event. The goal of therapy is to identify the unhelpful thoughts and replace them with more rational and constructive thoughts.
• Bipolar disorder


  Two strongly contrasting phases of mood. Periods of severely elevated mood followed by periods of very low mood lasting for several weeks or months.
• Cognitive restructuring (Beck 1979) as a treatment for depression


  The patient participates in a number of therapy sessions over weeks and/or months to alleviate their symptoms of depression. The therapist helps the patient to identify their faulty thinking and then correct these thinking patterns to more helpful ways of viewing themselves, the world and the future. The patient then goes away between sessions and practices these alternative thoughts which should then lead to more helpful behaviours.
• Strength of cognitive restructuring as a treatment for depression


  • Effectiveness of treatments - shown to be as effective as SSRIs for treating depression and give a toolkit for patients to use in the future if the depressive symptoms return
  • Treatment does not have any side effects like medication and the patient has learned techniques to help with depression should they relapse in the future
  • Can be inexpensive for the patient as could be offered for free in some countries
  • Fairly quick compared to other therapies as around 6-8 sessions. Psychotherapy can take over a year
  • Empowering the patient - their free will is acknowledged and the patient is actively involved in their treatment
• Weakness of cognitive restructuring as a treatment for depression

  • Appropriateness of treatments as some patients will not want to discuss their personal problems with a therapist. OR some patients may be so severely depressed they cannot engage with the therapy
  • Cost of treatment. Therapist's time must be paid for either by the patient or by the health service. Therapists can charge £50-100 for a 50 minute session. This could lead to the patient feeling more depressed if they suffer financial hardship paying for the treatment
  • Time consuming. Takes 6-8 sessions but can be offered up to 12. Some therapists will have two weeks between treatments so it could take almost six months to finish the therapy. For someone who is very depressed and might engage in self-injurious behaviour waiting for the therapy to get to the point where it is helpful might be dangerous
  • Lots of effort/motivation required from the patient
  • Patients may feel uncomfortable discussing their problems and may not be completely honest about their thoughts and experiences