unipolar depression

• what is unipolar depression

  major depressive disorder

  characterised by a persistent low mood aswell as other symptoms

  it can be reactive, a response to adverse life events or it can rise for no reason
• unipolar depression- facts


  5% of adults globally suffer from unipolar depression

  5.7% of older adults above age of 60 years will develop depression
• unipolar depression- feature


  depression twice as common in women than men

  rates of suicide for unipolar dperessuon lower than biopolar depression

  over life time- 10-25% of women and 5-12% of men will get major depression

  young et al- concluded that symptoms were similar in both genders
• unipolar depression- symptoms


  psychological- continuous low mood and sad, feeling helpless, low self esteem, no enjoyment in life

  physical- slow movements, aches and pains eg headaches

  social- having problems at work, avoids socialising
• monoamine hypothesis


  monoamines include serotonin, noradrenaline and dopamine

  serotonin regulates other monoamines- without this regulation then erractic brain functioning occurs

  low levels of seretonin- low levels of noradrenaline which is used for alertness

  antidepressants target seretonin as lack of seretonin- depression
• antidepressants- SSRIS


  SSRIS- selective reuptake inhibitors

  underlining the idea that serotonergic transmiss has a role in depression

  prevents the reuptake of serotonin in the presynaptic neuron- help with depression

  • helps to increase serotonin synapse
• evidence for monoamine hypothesis

  Reboxetine- works by increasing the action of noradrenaline

  Reserpine- used for treatment of hypertension- which also lowers seretonin and noradrenaline induced symptoms of depression
• strengths of monoamine hypothesis


  lots of evidence

  • Krishnam and Nestler- did review of neurobiology of depression
• weaknesses of monoamine hypothesis

  SSRIS do not work on everyone

  • Hease and Brown(2015) which suggests that lack of seretonin is not complete explanation
  • Delagado- evidence for there being deficiencies in a specific monoamine system in a depression not found difficulties to measure monoamines
• cognitive triad


  beck suggested that people with depression have 3 negative thinking patterns

  • negative automatic thinking (cognitive traid)
  • selective attention to the negative
  • negative schemas- Beck said it could be developed through parents
• becks negative triad


  experiences- the self-the future

  faulty thinking- selective thinking to negative aspects of situations

  selective abstraction- focus on negative aspects of situations

  arbitrary inference- drawing inference/ conclusion with no evidence
• learned helplessness- seligman


  people learn to give up trying to put things right because they have only ever experienced failure

  CBT example of cognitive therapy

  cognitive therapies focus on looking at unhelpful thinking to re-evaluate

  • looking at evidence and uncovering core beliefs that guide thoughts and the schemas that go with it
• strengths- cognitive triad


  Alloy and abramision(1999) under took longitudinal study of those with depression to evaluate Becks schema theory and idea of helplessness

  researchers found that students with negative thoughts were at risk
• weaknesses- cognitive triad


  hard to find evidence for the cognitive models claim that negative thinking rather than just being in those with depression
• Cognitive behavioural therapy


  aims

  1. re establish previous levels of activity
  2. re establish social life
  3. challenge patterns of negative thinking
  4. to challenge and learn to spot
  5. early signs of reoccuring depression
• CBT- steps takens

  • explaining ideas and purpose of cbt
  • frame reference is set so that client can talk about themselves
  • specifying lost of problems
  • identify the negative automatic thoughts
  • think of a new way of thinking
• evidence for effectiveness of CBT

  Stiles et al- carried out study that looked at effectiveness of CBT as compared to person-centred and psychodynamic therapies

  concluded that theoritcally different approaches had similar outcomes

  Farrer et al- considered the reduction of depression in people with mental health disorders using ICBT

  found that depression was lower in those who used ICBT compared to in person
• strengths of CBT


  backed by government funding- improves access

  evidence based- Kuyken suggested 1/4 of CBT was more effective than use of antidepressants
• weaknesses of CBT


  include self report data

  CBT depends on its efficacy on the idea that depression comes from negative thinking
• appropriateness and practicality of CBT

  appropriateness- doesnt know if faulty thinking caused the disorder or is the product of it because they have not seen before their illness

  practicality- quick and cheap and a lot of studies only look at short term effects
• SSRIS- drug treatment


  selective seretonin reuptake inhibitors

  examples- fluxetine

  they increase seretonin levels in the brain

  SSRIs work by blocking reuptake meaning more seretonin is available to pass further messages between nearby nerve cells

  side effects- nausea, dizziness
• drug treatment- tricyclic antidepressants

  inhibit reuptake of serotonin and noradrenaline and to an extent dopamine
• drug treatment- atypical antidepressants


  new drugs which also target other neurotransmitters like serotonin

  Affecting the chemical messengers used to communicate between brain cells
• evaluation of drug treatment- strengths

  1. researchers seek for more effective antidepressants with fewer side effects
  2. they can be prescribed to boost mood so that other therpies like CBT can be used
• evaluation of drug therapy- weaknesses

  1. Government study showed that fewer than 50% of those with depression who take antidepressants become symptom free
  2. antidepressants resolve symptoms but do not cure depression- therapy is better to reduce relapse
• evidence for drug treatment as 'best' treatment

  WHO 2000s published most effective way

  the report points out to a large number of studies show that antidepressants are effective

  the report also gave conclusions about specific drug
• evidenc against drug treatment being the best treatment

  Muller(2013)- is critical of the way drugs for depression are prescribed without sufficient attention to individuals past

  WHO reported that 5-10% of western europe population show that clinical education is needed