Depression, often referred to as the ‘common cold of mental illness’, is diagnosed through clinical observations of characteristic symptoms present in the individual. Although a mental illness, it is normal behaviour up to a certain point, at which it could then be categorised as abnormal. Depression is put into two categories, unipolar which is mainly having a constant low mood, and bipolar having both low and high moods (or mania) which is more common in the diagnosis of a manic depressive. This essay addresses the causes of depression and how its diagnosis and will then go on to describe the treatments of cognitive-behavioural therapy and anti-depressant drugs for unipolar depression. Upon outlining both perspectives, it will then evaluate the research and evidence of these effective treatments.
Unipolar depression is usually diagnosed by the assessment of the individuals’ experiences of five symptoms within the criterion and their duration, according to the DSM-1V criteria. These symptoms could be for example; persistent sadness, sleep problems, feeling worthless and guilty, confusion and poor concentration and thoughts or attempts of suicide. For a diagnosis of unipolar depression, the duration of these symptoms must have been present for more than two weeks and one symptom would usually consist of a feeling of low mood or the loss of interest in all activities nearly every day.
As the unipolar type is one of major depression, it is essential that the correct diagnosis made in order to ascertain the treatment required and most suited. However, what are the causes of unipolar depression? No conclusive evidence exists to say what exactly causes depression and many studies carried out suggest that the causes are a combination of differing factors. The effects and responses to these factors would also differ between individuals. These causal factors range from genetics, biological, personal life events, society, and the environment.
Evidence has shown that one main factor is that of a particular loss within the events of life (Eysenck, 2000: 683). Although everyone may be vulnerable to depression, it can differ in the onset and severity between individuals. For example, two people can experience the same devastating life event such as the loss of a loved one or being unsuccessful gaining promotion in the working environment, but one may be able to cope with this knock back and the other may become depressed.
Notably, the depression starts with feelings of low mood or sadness generally triggered by the loss that then has an effect on the individuals’ behaviour. Looking at this from a behavioural viewpoint, Lewinsohn (1974) offered the explanation that certain loss events influence the onset of depression due to a reduction of reinforcement. His theory defined by Gross et al, (2000: 715), suggests in the first instance, the depressive receives immense focused attention and concern from close friends or relatives that Lewinsohn argued reinforces the continuation of the depressed state. When the attention diminishes, the depression intensifies putting the depressive in a situation that is difficult to escape.
Psychotherapy, usually offered to the depressed individual, varies in treatment. The most commonly used treatment is cognitive-behavioural therapy and is recognised as a safe and effective technique. It is not concerned with analysing the causes of depression but more focused upon the thoughts and emotions the patient is experiencing and what they can do to change these feelings. In cognitive-behavioural terms, it is defined as the negative triad; negative views of the self, environment and the future and is based on what a person thinks determines the way they feel. Negative thoughts seem to impact on the behaviour of the depressive so the triad plays an important part in encouraging the depressive to recognise how they are feeling now.
Once recognised, the therapy process then enables the depressed individual to challenge these thoughts and emotions and decide how to change them for a better solution. For example, by facing up to the particular loss that caused the feelings and made them behave in a certain way, they are taught to look at the situation from a different perspective such as; if loss of promotion, which areas of improvement need focusing on so the same mistake is not made. A sense of achievement by goal setting often lifts a low mood, as the future seems brighter. Cognitive therapy therefore concentrates on conditioning the thoughts of an individual to look at their behaviours and the changes needed to prevent a possible reoccurrence of depression.
An alternative treatment is that of antidepressant drugs. They act by increasing the brain chemicals that influence how we feel. The chemical changes that occur within the brain of an individual with unipolar depression are usually a decrease or increase in serotonin, noradrenaline, and dopamine. The antidepressants purpose therefore is to target these areas and correct the balance of the levels to a more normal state. There are three types of these drugs and are classified as MAOI’s; monoamine oxidase inhibitors, TCA’s; tricyclic antidepressants and SSRI’s; selective serotonin re-uptake inhibitors. MOAI’s, not commonly used, suggest the patient follow a particular diet and are deemed affective.
The use of this antidepressant if the correct diet is not followed can prove fatal if the MAO inhibitors are combined with cheese, alcohol, and pickled herring (Rosenhan and Seligman, 1989). TCA’s, are known to induce side effects in some depressed individuals such as weight gain, drowsiness, vision problems, and dry mouth. This type of antidepressant is not suitable to a depressive with suicidal thoughts (Depression Website). SRI’s are the most commonly used, are effective, and concentrate mainly on the levels of serotonin to create a better mood. They do have some side effects such as headaches, dry mouth, and can influence nervousness. Barlow and Durand, (1995) argue that the SSRI drug Prozac can generate obsessive thoughts of suicide or violent acts (Eynsenck, 2000).
Patient who have agreed to the treatment of antidepressants are made aware that the drug may not begin to work immediately and usually takes around two weeks before they will notice the effects. It is also important that a review takes place so the clinician can be sure the particular drug prescribed is suitable to that patient. If not suited, another antidepressant is usually prescribed and could be of a different classification, for example, if a drug of the TCA type is used first and is not suitable, the doctor may then prescribe one of the SSRI type. Whichever drug is taken by the depressive, it is also important that they do not just suddenly stop taking their dosage as this can also be dangerous to their health. After a period of time they would normally be advised to reduce the dosage by taking a tablet once every two days for a certain period to one every three days and so on until such time it is safe not to take any.
Both of the treatments described here have their benefits to certain individuals and are used due to the contribution of various studies and experiments carried out by psychologists and biologists. The main aim for studies and research for psychologists and biologists on the subject of depression is to discover the causes, which has inevitably led to criticisms of each other. This is because they all have different theories as to whether it is due to biological or environmental matters.
Beck (1988) most famous for his studies in cognitive therapy, argues that the development of depression is due to an individuals cognitions being negative. Clarke and Beck (1988) offer their depressive schema as, ‘a negative cognitive trait is evident in the depressed individuals view of the self, world, and future’ (Clarke and Beck, 1988: 683). Hence, these three negative views form the triad used in cognitive-behavioural therapy. However, there is still no conclusive evidence as to whether negative thoughts influence the onset of depression or if the depression causes negative thoughts. Despite this, the therapy is known to have a high success rate.
Biologists have explained depression as caused by biochemical processes and have the evidence to support their theories in that the chemical imbalances in certain areas of the brain have been improved by antidepressant drugs. Schildkraut (1965) discovered that a reduction in noradrenaline caused low mood. Non-human subjects given drugs that reduce the levels of noradrenaline, caused them to become sluggish and inactive, two symptoms of depression (Schildkraut, 2000: 717).
Based on these two theories and treatments alone, it still raises the question of what causes depression and what treatments to give to individuals depending on the severity of the mental disorder. It is reasonable to suggest that depression occurs through a combination of biochemical and environmental factors, both having an influence on the other.