Study Notes on Psychological Problems and Unipolar Depression

Psychological Problems: Understanding Unipolar Depression

Key Terms

  • Unipolar depression: A type of mood disorder causing periods of feeling sad and lacking motivation for everyday activities.

  • Mental health problem: A form of psychological issue characterized by symptoms affecting mind and behavior, impacting thoughts, feelings, behaviors, and interpersonal relationships.

Learning Objectives

  • Understand the symptoms and features that diagnose unipolar depression as a mental health problem.

  • Learn about the changing incidence rates of unipolar depression over time.

  • Explore how unipolar depression affects individuals and society.

Overview of Unipolar Depression

  • Definition: Unipolar depression is characterized by periods of feelings of being 'down'. The term 'unipolar' refers to a mood that is pulled in one direction, as opposed to bipolar depression which includes mood swings from very low (sad) to very high (manic happiness).

Symptoms of Unipolar Depression

  • According to the International Classification of Diseases version 10 (ICD-10), unipolar depression is referred to as 'depressive episodes', characterized by mood disorders. Symptoms can be classified as follows:

    • Main Symptoms:

    • Lowering of mood: Feelings of extreme sadness or upset.

    • Lack of energy: Feeling fatigued even after resting.

    • Lack of motivation: Difficulty initiating activities.

    • Additional Symptoms:

    • Feelings of guilt or self-blame.

    • Suicidal thoughts or attempts.

    • Lack of self-esteem.

    • Diminished enjoyment in previously liked activities.

    • Changes in appetite (either increase or decrease).

    • Sleep disturbances (difficulty falling asleep or waking up early).

    • Chronic tiredness not alleviated by sleep.

Diagnostic Criteria According to ICD-10

  • At least one of the main symptoms should be present most of the time for a duration of two weeks.

  • An additional symptom from the list should be present during that time.

Features of Unipolar Depression

  • Incidence: About 1 in 15 people will experience serious depression annually, with reports indicating that females are affected twice as often as males, and they experience depression for longer durations.

  • Severity Classification:

    • Mild: 4 symptoms present with minor disruption to daily life.

    • Moderate: 5-6 symptoms leading to considerable difficulty in daily functioning.

    • Severe: 7 or more symptoms, including pervasive feelings of worthlessness and potential for self-harm or suicidal thoughts.

Case Study Example

  • Marzia: Demonstrates the psychiatric symptoms of unipolar depression through missed school, excessive sleeping, social withdrawal, and persistent sadness, leading to an eventual doctor visit where she is diagnosed with depression.

Incidence Over Time

  • Historical comparisons show that diagnoses of depression have increased significantly (10x more in the 1980s compared to the 1940s).

  • According to The King's Fund (2008), it is estimated that by 2026, there will be 1.45 million diagnosed cases of depression in the UK compared to 1.24 million in 2007. This increase may result from greater awareness of symptoms and increased life stresses (e.g. social isolation).

  • Youth Trends: Research indicates higher depression rates in teenagers and young adults than in 1938, which suggests modern stresses significantly impact this age group, including links to social media usage and depression (Liu yi Lin et al., 2016).

Effects of Unipolar Depression on Individuals and Society

  • Individual Impact: Depression can increase the risk of suicide, with studies indicating that 10-15% of patients with severe depression may commit suicide.

  • Society Impact: The economic burden includes productivity losses; 9.9 million workdays were missed due to stress, depression, or anxiety in 2014-15. In the UK, treatment costs for depression via the NHS amount to an estimated £1.7 billion in 2007.

Genetic Explanation of Unipolar Depression

Understanding Genetic Influence

  • Evidence suggests higher risks of depression among individuals with a family history, implying a genetic link. Craig Hyde et al. (2016) identified 17 genetic variations associated with depression.

Twin Studies Findings

  • Monozygotic Twins: 46% chance of shared depression if one twin is diagnosed.

  • Dizygotic Twins: Only a 20% chance.

Environmental Triggers

  • Use of the diathesis-stress model to explain that genetic predisposition may require environmental triggers for activation (Caspi et al, 2003).

Ethical Implications of Genetic Determinism

  • Strengths: More acceptance and less stigma towards mental health disorders if genetic causes are understood.

  • Weaknesses: Deterministic views may overlook individual agency and environmental influences.

Cognitive Theories of Depression

Cognitive Theory Explanation

  • Proposes that negative thought patterns about self, future, and world contribute to depression. This is further conceptualized in Beck's cognitive triad and Ellis's ABC model.

  • The therapy approach addresses cognitive errors and reframes negative beliefs as part of treatment.

Applications and Considerations

  • Strengths: Accepts real-life events as triggers, making it actionable for therapy, demonstrated through Cognitive Behavioral Therapy (CBT).

  • Weaknesses: Thought changes may not relate directly to underlying biological or hormonal changes, making some cases of depression challenging to treat with cognitive approaches alone.

Cognitive Behavioral Therapy (CBT) as Treatment for Depression

Overview of CBT

  • It focuses on changing thought processes to improve emotions and behaviors related to depression. Research has shown that CBT can be effective and provide lasting benefits.

Process of CBT

  1. Understanding and discussing symptoms.

  2. Challenging irrational thoughts and beliefs, fostering rational thinking.

  3. Homework and practice outside of sessions enhances treatment benefits.

Evidence Supporting CBT

  • Studies show that patients receiving CBT often experience lower symptoms compared to those on drugs alone.

Strengths and Weaknesses of CBT

  • Strengths: Addresses real-life factors and teaches coping skills for long-term management of depressive symptoms.

  • Weaknesses: Requires patient commitment and effort, which can be difficult when motivation is low; also, the subjective nature of mental states can make measuring success challenging.

Drug Therapy as a Treatment for Depression

Overview of Antidepressants

  • Different types of antidepressants (SSRIs, SNRIs, MAOIs, and TCAs) aim to influence neurotransmitter activity, specifically serotonin and noradrenaline.

Treatment Considerations

  • The effectiveness of drugs can significantly improve mood and motivation, allowing patients to engage in other therapeutic modalities.

  • However, drug treatments can lead to side effects and dependency issues, with some studies indicating mixed results for long-term outcomes.

Economic Implications of Treatment Cost

  • The financial burden of treating depression highlights the importance of effective interventions given the significant costs involved in healthcare and societal impacts.

Conclusion

  • Understanding unipolar depression from multiple angles—genetic, cognitive, and societal—is crucial for developing comprehensive treatments and reducing the stigma associated with mental health disorders. Explorations of nature versus nurture continue to highlight the complexities involved in diagnosing, treating, and supporting individuals with psychological problems.