Clinical Psych - paper 1

Revision

What is statistical infrequency?

Statistical infrequency refers to behaviours or characteristics that are rare or uncommon within a given population. If someone exhibits a behaviour that is significantly different from the majority or 2 standard deviations from the mean, it may be considered statistically infrequent, helping to identify potential psychological disorders.

Example of statistical infrequency…

If someone has an IQ score below 70, where the average is 100, this is more than 2 standard deviations from the mean, which may indicate a developmental disorder.

A strength of using statistical infrequency?

-It provides an objective, data-driven criteria for identifying abnormal behaviour, reducing subjective bias in diagnosis.

-Uses non-subjective judgements, unlike other definitions, using measurable data, to highlight statistically rare behaviours.

-Most methods used to diagnose mental health, like the PHQ-9 for depression, rely on statistical cut-off scores. Even broader definitions, such as failure to function, involve rating scales.

-Helps to reduce bias in clinical practice.

Weakness of statistical infrequency…

• It has rigid cut-offs that can unfairly exclude people who genuinely need help.

• Although it relies on rare scores, that threshold may not reflect individual needs.

• For example, in the UK, many people are denied access to CMHT because their scores fall just below the threshold, even after being referred by a GP.

• Demonstrates how cut-offs can block support for those in need of care.

• Shows that although it seems objective, the cut-off point is ultimately subjective and can prevent people from receiving necessary support.

What is functional impairment?

Mental health professionals may decide someone needs help if their symptoms are affecting their ability to live a normal life.

Clinical psychologists assess failure to function using tools like what?

WHODAS 2.0

What 6 ideas does WHODAS focus on?

• Cognition- concentration, memory

• Mobility- being able to leave the house

• Self-care- washing, dressing, eating

• Getting along- with people

• Life activities- work, school

• Participation- social inclusion

A strength of failure to function adequately?

• Considers the individual’s perspective

• the person’s own report on how they cope with daily life

• Tools like WHODAS use self-report questions, making it more person-centred.

• makes this definition more relevant in clinical practice as it values personal experience.

Weakness of failure to function adequately?

• Involves subjective judgement

• Even though tools are used to provide structure, professionals still need to decide whether distress is severe enough to need intervention.

• As one psychologist may interpret someone’s difficulty attending work as serious, another may see it as manageable, depending on their judgment and experience.

• This lack of consistency can lead to differences in who gets support, making the definition less reliable when used alone.

Who proposed the criteria for ideal mental health?

Marie Jahoda (1958)

According to Jahoda, mental health is judged based on the presence of what 6 qualities?

P - positive attitude towards self

R - resistance to stress

A - accurate perception of reality

I - independent

S - self-actualisation

E - environmental mastery

Strength of ideal mental health?

• Takes a positive and holistic approach to understanding mental health.

• Rather than focusing on one symptom, Jahoda’s criteria outlines what good mental health looks like.

• Encourages a more complex view of a person’s wellbeing and identifies areas that need help as well as areas to promote recovery.

• Making it a valuable addition to the field of mental health as it shifts focus from just treating illness to supporting mental wellness.

Weakness of Jahoda’s definition of ideal mental health?

• Criticised for being culturally biased.

• Criteria reflect Western, individualistic values such as independence and autonomy, which are not valued in the same way in collectivist cultures.

• For instance, in some cultures, depending on others and prioritising community over personal achievement is seen as healthy, not a sign of poor mental health.

• Meaning that the definition may unfairly pathologise people from non-Western cultures and doesn’t reflect how mental health is understood globally.

What is deviation from social norms?

Mental health professionals may decide someone needs support if their behaviour is very different from what is generally expected or accepted within their community or culture.

Strength of deviation from social norms?

• Reflects real-world concern as people are often referred for help because others notice something unusual or socially inappropriate.

• For example, teachers, police officers or family members may raise concerns when someone’s behaviour violates social expectations.

• This can be a valuable starting point for identifying people who may be struggling and need mental health support.

• While not a complete definition, it has practical value as an early warning sign, helping professionals know when to carry out further assessments.

Weakness of deviation from social norms

• Norms differ between cultures.

• What is considered usual or acceptable in one culture may be seen as normal in another, meaning someone could be labelled as needing support in one cultural context but not another, raising ethical concerns about fairness and bias.

• For example, in the UK, people of African-Caribbean descent are diagnosed with schizophrenia 7 times more often than the general population (Gara et al.), as behaviours that can differ from dominant cultural norms can be misinterpreted as signs of mental illness.

• This highlights that the definition is culturally relative, making it less valid as a universal tool for identifying mental health needs.

What is a phobia?

• A phobia is a form of anxiety disorder characterised by an irrational and extreme fear of a specific object, situation or activity.

• The fear experienced is often disproportionate to the actual danger posed and leads to avoidant behaviour.

• This avoidance can become maladaptive, meaning it disrupts a person’s ability to function in everyday life.

What are the behavioural characteristics of a phobia?

• Avoidance

• Panic

• Endurance (remaining in the presence of the phobic stimulus but experiencing high anxiety)

What are the emotional characteristics of phobias?

• Anxiety

• Unreasonable emotional response

What are the cognitive characteristics of phobias?

• Selective attention (focusing on phobic stimulus)

• Irrational beliefs

• Cognitive distortions (perceiving the stimulus in an exaggerated way)

What is depression?

Depression is a mood-affecting disorder characterised by persistent low mood and a lack of interest or pleasure in usual activities.

What are the behavioural characteristics of depression?

• Activity levels (reduced energy, social withdrawal)

• Disruption to sleep or eating (insomnia/hypersomnia, appetite loss/increase)

What are the emotional characteristics of depression?

• Lowered mood

• Anger

• Low self-esteem

What are the cognitive characteristic of depression?

• Poor concentration

• Negative self-schemas

• Absolutist thinking (black and white thinking)

What does SADFACE, the acronym for depression, stand for?

S - Sleep and eating disruption

A - Activity level changes

D - Difficulty concentrating

F - Feelings of worthlessness

A - Anger

C - Cognitive distortions

E - Emotional low mood

What is OCD?

Obsessive-compulsive disorder is an anxiety disorder characterised by unwanted thoughts (obsessions) and repetitive behaviours (compulsions) performed to reduce anxiety.

What are the behavioural characteristics of OCD?

• Compulsions - repetitive behaviours to reduce anxiety

• Avoidance - avoiding situations that might trigger obsessions

What are the emotional characteristics of OCD?

• Anxiety and stress (from obsessions)

• Depression (common due to disruption of daily life)

What are the cognitive characteristics of OCD?

• Obsessive thoughts

• Cognitive strategies (mental acts used to manage compulsions)

• Insight into excessive anxiety (recognises that obsessions/compulsions are irrational)

• Hyper-vigilance (constantly alert and focus on potential danger/threat)

What is the behavioural approach to explaining phobias?

The two-process model - Mowrer (1947) proposed this model, which suggests that phobias are learned and assumes that phobias develop through an experience of a negative or traumatic event.

The two-process model suggests phobias are acquired through classical conditioning and are maintained through operant conditioning.

Who suggested the two-process model in explaining the behavioural approach to explaining phobias?

Mowrer (1947)

Who conducted the Little Albert study?

Watson and Rayner (1920)

What did the Little Albert study involve? (AO1)

Aim - To investigate whether a phobia could be created in an infant using classical conditioning

Method - The infant, known as Little Albert, was presented with a little white rat (neutral stimulus). He was curious and wanted to stroke and play with it. But then researchers paired the exposure of the rat with a loud noise.

Results - After pairing the frightening sound with the rat several times, the researchers found that Little Albert began to cry and crawl away every time the rat was brought over to him. The white rat was now the conditioned stimulus and his fear the conditioned response.

How are phobias maintained?

• Through operant conditioning.

• Avoidance of the feared stimulus reduces unpleasant feelings of fear/anxiety caused by the conditioned stimulus.

• This acts as negative reinforcement by removing something negative; you are rewarded by feeling less anxiety/fear, strengthening the avoidant behaviour, meaning that the phobia is maintained.

Outline the two-process model as an explanation for phobias…

• The two-process model suggests that phobias are acquired through classical conditioning and maintained through operant conditioning.

• Phobias are acquired by forming an association between an object or situation and something which causes a trigger response.

• For example, a person being bitten by a dog. The dog (initially the NS) would become associated with being bitten (the UCS), which leads to fear (UCR). This pairing leads to the dog becoming a CS, which then creates fear, the CR.

• Phobias are maintained through negative reinforcement. Those with a phobia will avoid the phobic stimulus, which reduces anxiety, acting as negative reinforcement.

• For example, if a person with a dog phobia sees one whilst out, they might avoid it by crossing the road. Therefore, reducing their anxiety and so negatively reinforces their avoidance behaviour, making the person more likely to continue avoiding dogs, thus maintaining their phobia.

What is a strength of the behavioural approach in explaining phobias?

• Strong research evidence supports the claim that phobias can be acquired through classical conditioning.

• Watson and Rayner (1920) demonstrated this in their Little Albert study.

• +Explain study

• This shows how a neutral object can become a source of fear through association with an unpleasant experience, supporting the role of classical conditioning in the development of phobias.

• However, because this study only explains how phobias are acquired and not how they are maintained, it provides limited support for the two-process model.

What is a weakness of the behavioural approach to explaining phobias?

• There are alternative explanations for how phobias may develop, not just from a negative experience.

• Instead, these phobias (such as heights, snakes or insects) can be explained using Seligman’s biological preparedness theory, which argues that humans are evolutionarily predisposed to fear certain things that posed a threat to survival in the past.

• For instance, people who were naturally more cautious of dangerous animals or risky situations were more likely to survive and pass on their genes.

• This inherited fear response helps explain why many people have these phobias without any personal trauma linked to them.

• This challenges the completeness of the two-process model of phobias, as it does not fully account for phobias that arise without a learned experience.

What is systematic desensitisation?

• Systematic desensitisation is a treatment based on classical conditioning that helps people gradually overcome their phobias by learning to associate the phobic object with relaxation instead of fear (counterconditioning).

• It’s based on the idea that we can’t be scared and relaxed at the same time, so one emotion cancels out the other, known as reciprocal inhibition.

What are the two types of exposure in systematic desensitisation?

• In vivo - facing your fear in real life (e.g. seeing a real spider)

• In vitro - imagining the feared situation (e.g. thinking about holding a spider)

How does systematic desensitisation work? What are the three steps?

• Anxiety/fear hierarchy - You work with your therapist to create a list of situations involving the phobia, ranked from least to most scary.

• Relaxation training - You learn ways to relax before facing your fear. (Deep breathing, visualisation, progressive muscle relaxation).

• Gradual exposure - You slowly work through your anxiety hierarchy, using your relaxation techniques at each step. Over time, your fear is replaced with calmness (counterconditioning)

Outline systematic desensitisation as a treatment for phobias

• Systematic desensitisation uses principles of classical conditioning to create a relaxation response to the phobic stimulus instead of fear, known as counterconditioning.

• A patient works with a therapist to create an anxiety hierarchy, ranking the phobic situation from most to least anxiety-inducing.

• They are taught relaxation techniques to help them remain calm when exposed to their fear.

• They begin at the bottom of the hierarchy and end at the top.

• The therapist will encourage them to use relaxation techniques and will not move on until their anxiety levels are reduced. This process will be repeated at each step of the hierarchy.

• The treatment is considered effective when they can remain relaxed in situations at the top of the hierarchy.

• Systematic desensitisation works on the assumption that two emotional states cannot exist at the same time, a theory known as reciprocal inhibition, and eventually relaxation will replace fear.

What is flooding?

Flooding is a behavioural therapy which involves immediate and direct exposure to the phobic stimulus.

How does flooding work?

• The person is unable to avoid the feared object or situation.

• This means avoidance is prevented.

• Although anxiety is very high at first, it cannot stay that intense forever.

• Over time, the person learns that nothing bad happens, and the fear response gradually fades. This is known as extinction.

Strengths of flooding and systematic desensitisation?

• Evidence supports the effectiveness of both systematic desensitisation and flooding in treating phobias.

• Gilroy et al. (2003) found that participants who received 3 sessions of SD for a spider phobia showed significantly less fear than a control group who only received relaxation, with this effect lasting up to 33 months.

• This suggests that the gradual exposure of SD is important in reducing phobic symptoms and that the treatment has long-term benefits.

• Kaplan and Tolin (2011) found that 61% of people treated with just one session of flooding no longer showed symptoms of specific phobia even four years later.

• This provides strong support for flooding as an effective long-term treatment. However, not all participants were cured, suggesting flooding may not be appropriate for all, possibly due to its intensity.

• Overall, these findings support the use of behavioural therapies such as flooding and SD as an effective form of treatment for phobias, although individual differences may affect how successful each method is.

Negative of systematic desensitisation and flooding?

• Evidence suggests that SD is particularly useful for specific phobias because it targets the learned association between the phobic object and anxiety.

• However, for social phobias, cognitive factors like irrational thoughts often play a larger role. In these cases, cognitive behavioural therapy may be more effective.

• Flooding, although effective in treating specific phobias, may be less suitable for social phobias due to its lack of focus on the cognitive aspects of fear. For example, individuals may have persistent negative beliefs about how they are perceived by others, which flooding does not address.

• This means that both SD and flooding may have limited effectiveness depending on the type of phobia and highlights the importance of choosing treatment approaches based on the nature of the phobia.

What are the two cognitive explanations for depression?

• Beck’s negative triad

• Ellis’ ABC model

What are the three schemas in Beck’s negative triad?

• The self - individual sees themselves as worthless, hopeless and inadequate

• The world - individual has the impression that there is no hope anywhere

• The future - individual has a pessimistic view of the future

This triad is maintained by…

• Negative self-schemas

• Cognitive biases

Example of negative self-schemas include…

• Self-blame schema (the belief that you are responsible for all misfortunes).

• Ineptness schema (the expectation that you will always fail or are incapable of success)

Examples of cognitive biases may include…

• Overgeneralisation (drawing broad conclusions from a single event).

• Catastrophising (expecting the worst possible outcome)

• (These biased ways of thinking help to maintain the negative triad and are central to Beck’s explanation of depression.)

What does ABC stand for in Ellis’ model?

A - activating event (negative or stressful event)

B - belief (triggers irrational beliefs)

C - consequence (emotional and behavioural consequences - symptoms often associated with depression)

A strength of Beck’s cognitive theory of depression?

• Supported by research evidence

• Cohen et al. (2019) conducted a prospective (tracking the adolescents over time) longitudinal study to investigate whether cognitive vulnerability predicted later development of depression.

• They found that adolescents who showed cognitive vulnerabilities (such as negative thinking patterns) were significantly more likely to later experience depressive symptoms.

• This supports Beck’s theory, particularly the idea that cognitive distortions and negative schemas are not just present during depression, but contribute to its development, increasing the predictive validity of Beck’s theory.

Weakness of Beck’s cognitive theory of explaining depression?

• One weakness of Beck's cognitive theory of explaining depression is that it may not account for the full complexity of the disorder.

• Critics argue that while cognitive factors, such as negative thought patterns and cognitive distortions, play a significant role in the development and maintenance of depression, there are also biological, situational, and environmental factors that contribute.

• Additionally, Beck's theory primarily focuses on the individual’s internal thought processes, potentially neglecting the broader context of a person's life and experiences, such as trauma or significant life stressors.

• This narrow focus might limit the understanding and treatment of depression, which may require a more holistic approach.

What is cognitive behaviour therapy?

• Cognitive behaviour therapy (CBT) is the most widely used treatment for depression.

• It focuses on the cognitive explanation of depression, suggesting that negative thinking causes depressive symptoms, and focuses on identifying and challenging irrational or unhelpful thoughts.

CBT is a broad term that includes various therapies. What is REBT?

• REBT stands for Rational Emotive Behaviour Therapy.

• This was theorised by Ellis as well.

• It builds on the ABC model by adding two extras

• A - activating event, B - beliefs about the event, C - consequences (emotional and behavioural), D - dispute (challenging irrational beliefs), E - effect or exchange (replacing irrational beliefs with rational ones)

In REBT, what are the two common methods of dispute?

• Empirical dispute - asking for evidence to support negative thought.

• Logical dispute - questioning whether the belief is logically true.

What is Beck’s CBT?

• Beck’s version of CBT also aims to identify thoughts that cause depression.

• Once the schemas, that make up the negative triad, are identified, the thoughts are challenged.

• Patients are encouraged to put a particular thought on trial and look for evidence to support or contradict it.

• Patients are asked to record positive events, collecting evidence that can later be used to contradict negative thoughts.

• Patients also engage in behavioural activation to encourage depressed patients to engage in enjoyable activities to collect more evidence to challenge irrational negative beliefs.

Strength of the cognitive approach to treating depression?

• Strong supporting evidence of its effectiveness in treating depression.

• March et al. (2007) investigated 327 adolescents diagnosed with depression and compared the outcomes of CBT, antidepressant medication (SSRI’s) and a combination of both.

• After 36 weeks of treatment, 81% of those receiving CBT and 81% of those taking antidepressants showed significant signs of improvement.

• Supports the validity of CBT as it highlights its value as a non-biological alternative, especially for those who don’t want to rely on medication.

• However, March found that the combination groups showed the highest improvement rate at 86%, suggesting that CBT may be most effective when used as part of an integrated treatment approach rather than a stand-alone therapy.

Weakness of the cognitive approach to treating depression?

• May not be suitable for patients with severe depression as it requires a high level of motivation and engagement.

• Severely depressed patients often lack energy and motivation to attend sessions or engage in CBT tasks. In these cases, antidepressants, which require less effort, may be more suitable initially.

• This suggests CBT is most effective when used alongside medication for those who suffer from severe depression, allowing patients to stabilise before fully engaging in therapy.

• Also, CBT success often relies on the therapist-client relationship.

• CBT may be best used as part of a combined treatment, limiting its effectiveness as a stand-alone approach for severe depression.

What is the genetic explanation of OCD?

• The genetic explanation of obsessive-compulsive disorder (OCD) suggests that the disorder has a hereditary component, meaning it can run in families.

• Twin studies have shown that if one twin has OCD, the other twin is more likely to develop the disorder, indicating a genetic predisposition.

What did Nestadt et al. (2000) find about OCD in family studies?

• OCD prevalence was 11.7% in people with a first-degree relative with OCD compared to 2.7% in those without.

• His research shows that individuals may inherit a biological vulnerability to the disorder.

• The higher prevalence amongst first-degree relatives (who share about 50% of their genes) indicates that OCD may run in families due to shared genetic factors.

What about in twin studies?

• Nestadt found that monozygotic twins, who share 100% of their genes, had a much higher concordance rate than dizygotic twins, who share only 50% of their genes, indicating that genes play a significant role in the development of OCD.

What were the concordance rates for MZ and DZ twins, and who found this?

• Gottesman and Carey (1981)

• Found 87% concordance rate for OCD in MZ twins

• Found 47% concordance rate for OCD in DZ twins.

• This supports the claim that there is a genetic component.

OCD is not caused by a single gene but many; what is this referred to as?

Polygenic

Who found that OCD was polygenic?

• Taylor (2003)

• Up to 230 genes are involved.

• Different combinations of genes may lead to different forms of OCD.

What is the neural explanation of OCD?

• Neural explanations focus on neurotransmitters and the structure and function of the brain.

What are the roles of serotonin and dopamine in OCD?

• Serotonin - a neurotransmitter responsible for regulating mood and emotional responses. In people with OCD, low levels of serotonin may lead to obsessive thoughts and increased anxiety.

• Dopamine - plays a key role in reward-seeking behaviour, motivation and movement. Research suggests that high levels of dopamine may contribute to compulsive behaviours in OCD, such as checking or repetitive cleaning.

What are candidate genes?

• Candidate genes are specific genes thought to be involved in OCD.

• These genes are studied because they influence biological processes, such as neurotransmitter levels, that are thought to contribute to the symptoms of OCD.

• COMT and SERT genes.

What role does the COMT gene play?

• The COMT gene is involved in the breakdown of dopamine in the prefrontal cortex, which is important for regulating mood and behaviour.

• Variations in this gene can lead to lower enzyme activity, meaning dopamine does not break down efficiently, resulting in higher levels of dopamine.

• Higher dopamine levels may overstimulate the brain areas involved in reward and habit information, reinforcing compulsive behaviours in OCD.

What role does the SERT gene play?

• The SERT gene (serotonin transporter gene) regulates the reuptake of serotonin in the brain, influencing mood and behaviour.

• Variations in this gene can lead to reduced serotonin activity because it leads to faster reuptake of serotonin in the brain.

• Having this gene makes individuals have lower serotonin levels and, therefore, can be more vulnerable to obsessive thoughts and increased anxiety.

What is the worry circuit?

The neural explanation of OCD suggests that the disorder is caused by abnormalities in specific areas of the brain. Key regions include the orbitofrontal cortex (OFC), caudate nucleus (located in the basal ganglia) and thalamus.

What is the function of the OFC?

• Processes sensory information from the environment (senses).

• Evaluates input and turns it into thoughts and behavioural impulses, especially if it detects something potentially harmful.

What is the function of the caudate nucleus?

• Filters out unnecessary or minor worry signals, preventing overreaction to harmless stimuli.

• In individuals with OCD, the caudate nucleus may not function properly, so irrational or exaggerated worry signals are not suppressed.

What is the function of the thalamus?

• It receives these unchecked signals and becomes overactive.

• Amplifies the worry, sending strong signals back to the OFC, creating a loop of repetitive thoughts and actions.

Strength of the biological approach as an explanation for OCD?

• Strong research evidence supports both the genetic and neural explanations of OCD, increasing the credibility of a biological basis for the disorder.

• Nestadt et al. (2010) reviewed previous twin studies and found that 68% of MZ twins both had OCD, compared to 31% in DZ twins.

• Since MZ twins share 100% of their genes, while DZ twins share only 50%, the higher concordance rate in MZ twins suggests that genetic factors play a significant role in the development of OCD.

• Additionally, Hu (2006) compared serotonin levels in 169 OCD sufferers and 253 non-sufferers and found that the OCD group had lower levels of serotonin. This supports the idea that abnormal functioning of the neurotransmitter serotonin is involved in OCD. Low serotonin may make it harder for the brain to manage intrusive thoughts, which could lead to obsessions and compulsions.

• This biological evidence increases support for the genetic explanation (by showing that people with a closer genetic link are more likely to share OCD) and the neural explanation (showing how chemical imbalances in the brain may contribute to the development of symptoms).

Weakness of the biological approach as an explanation of OCD?

• Biologically reductionist because they focus mainly on biological causes, like genes and neurotransmitters, while overlooking psychological and environmental factors.

• For example, genetic explanations focus on inherited vulnerability and neural explanations highlight serotonin and dopamine levels, but neither fully considers cognitive or social influences on OCD. This biological reductionist approach oversimplifies OCD.

• However, understanding these biological factors has been crucial in developing effective treatments. Genetic research into the SERT gene (linked to low levels of serotonin) has informed the use of SSRIs. The success of SSRIs, increasing serotonin levels and, in turn, reducing OCD symptoms (Soomro et al. 2009) supports the neural explanation.

• Therefore, while the genetic and neural explanations may be limited by biological reductionism, their contribution has directly led to useful drug therapies that improve patients’ lives.

What is the biological approach to treating OCD?

• Drug therapies such as SSRIs

How do SSRIs work?

• Normally, when serotonin is released into the synapse (the gap between neurons), it carries a signal to the post-synaptic neuron. Any serotonin that is not used is reabsorbed by the presynaptic neuron in a process known as reuptake.

• In people with OCD, low serotonin levels are linked to overactivity in the brain’s worry circuit, which contributes to obsessions and compulsions.

• SSRIs (e.g. fluoxetine) work by blocking the reuptake of serotonin into the presynaptic neuron. This means more serotonin remains in the synapse, increasing the chance it will bind to receptors on the postsynaptic neuron.

• This leads to greater serotonin activity, which has an inhibitory, calming effect on the brain. As a result, anxiety is reduced, and the intensity of obsessions and compulsions decreases.

• This helps to break the cycle of obsessive thinking and compulsive behaviour that characterises OCD.

Strength of the biological approach in treating OCD?

• Strong empirical support for their effectiveness, particularly SSRIs.

• For example, Soomro (2009) conducted a meta-analysis of 17 studies comparing SSRIs to placebos and found that SSRIs were significantly more effective at reducing OCD symptoms. They were especially effective between 6 and 13 weeks after starting treatment.

• Provides strong evidence that SSRIs can be effective short-term treatment for managing OCD symptoms, particularly when rapid symptom relief is needed.

• Therefore, this research supports the use of drug therapy as a reliable biological treatment for OCD, especially in cases where psychological therapies such as CBT may not be immediately accessible or suitable.

Weakness of the biological approach in treating OCD?

• Can produce unpleasant or even serious side effects, which may reduce their overall effectiveness.

• For example, while some patients may experience mild side effects such as headaches or indigestion, others may suffer from more severe issues such as raised blood pressure, sexual dysfunction, sleep disturbances or even hallucinations.

• These side effects can lead patients to discontinue the medication, making them more vulnerable to relapse. Additionally, SSRIs have been linked to an increased risk of suicidal thoughts, particularly in younger people and those with comorbid depression.

• This suggests that although SSRIs can be effective, they may not be suitable for all individuals, and treatment decisions must weigh the benefits against the potential risks, particularly for vulnerable groups.