DEPRESSION

Most people at some point in their life experience at least some degree of low mood. It is
generally felt as sadness that is a normal response to painful circumstances such as financial
losses, the break-up of a relationship or losing a job. However, sometimes the depressed mood
continues for a prolonged period of weeks or months. At this stage a psychiatrist might diagnose
a depressive disorder
Depression is a term used to describe a mood state in which the main symptoms or features
include prolonged feelings of sadness or emptiness and lack of interest in previously enjoyed
activities. This caused depressed people significant distress, since they lose motivation to
participate fully in their lives. Depressed people have difficulty spending time with other people
and might lose contact with friends and family, which could deprive them of essential support.
They might even lose their job because of poor work performance or attendance.

Depression can also result from medical conditions or other psychological disorders. For
example, people suffering from adrenal and thyroid dysfunction display depressive symptoms
due to their being either very over or underweight. Similarly, agoraphobics might become
depressed because their fear of being vulnerable in public places makes it difficult for them to
experience taking part in social activities. This prevents them from having essential, healthy
contact with other people. In this unit we will be dealing with depression, define and describe the
symptoms, discuss the different types of depression, causes of depression and then the treatment
of this disorder.
Although depression is often thought of being in an extreme state of sadness, there is a vast
difference between clinical depression and sadness. Sadness is a part of being human, a natural
reaction to painful circumstances. All of us will experience sadness at some point in our lives.
Depression, however, is a physical illness with many more symptoms than an unhappy mood.

The person with clinical depression finds that there is not always a logical reason for his dark
feelings. Exhortations from well meaning friends and family for him to “snap out of it” provide
only frustration, for he can no more “snap out of it” than a diabetic can will his pancreas to
produce more insulin.

Sadness is a transient feeling that passes as a person comes to term with his troubles. Depression
can linger for weeks, months or even years. The sad person feels bad, but continues to cope with
living. A person with clinical depression may feel overwhelmed and hopeless.

To clarify the differences between normal sadness and depression, there are specific, defined
criteria for the diagnosis of major depression:
A person who suffers from a major depressive disorder must either have a depressed mood or a
loss of interest or pleasure in daily activities consistently for at least a two week period. This
mood must represent a change from the person’s normal mood and impair his functioning in his
daily life
A depressed mood caused by substances such as drugs, alcohol, or medications is not considered
a major depressive disorder, nor is one that is caused by a general medical condition.

Signs and Symptoms of Depression – General Terms

• Loss of interest in formerly pleasurable activities

• Dissatisfaction with life

• Withdrawal from social activities

• Loss of energy

• Feeling useless or hopeless

• Irritability

• Great concern with health problems

• Sadness or crying

• Worry and/or self-criticism

• Difficulty concentrating and/or making decisions

• Loss of appetite and weight.

Psychological Symptoms: Feelings, Thoughts and

• Feeling sad, blue, depressed, or hopeless most of the day.

• Greatly reduced interest or pleasure in all or almost all activities;

• Feelings of excessive guilt or a feeling that one is a worthless person.

• Slowed or agitated movements (not in response to pain or discomfort)

Physical or Somatic Symptoms

• Significant, unintentional weight loss and decrease in appetite; or,

• Insomnia or excessive sleeping

• Fatigue and loss of energy

• A diminished ability to think, concentrate, or make decisions

• Physical symptoms of anxiety, including dry mouth, cramps, diarrhea, and sweating,
ideation, or suicide attempt or plan.

CAUSES OF DEPRESSION:

Interpersonal and social factors that might affect the development of depression
include social isolation and either separation from a partner or divorce.

Biological factors that might influence the development of depression include changes
in neurotransmitter levels within the brain. Neurotransmitters carry chemical messages
between neurons and can influence mood and behaviour. Three types of
neurotransmitters – serotonin, dopamine and norepinephrine assist in the regulation of
emotions including stress, sleep functions and appetite. All three are often found at
lower levels in depressed people than in nonsufferers.

Genetic Factors

Researches indicate that people are between one and a half and three times more likely
to develop depression if one of their parents or brothers or sisters has the disorder.
Twin studies also have shown that if one identical twin develops depression, the
chances of the other twin developing the disorder can be as high as 75%. This provides
the evidence of the role of genetics in the development of the disorder.

Researchers also considered the possibility that the combination of genes might be
involved in the development of a vulnerability to depression, which increases a
person’s chances of developing depression. Vulnerability to depression does not mean
that they will develop the disorder but it means that they develop depression if other
factors or situations also occur. Examples include growing up with parents who are
overly critical or rejecting, losing friends or jobs or being placed in stressful or
traumatic situations.
PSYCHOLGICAL FACTORS
Factors which influence the possibility of developing depression include medical illnesses,
traumatic experiences such as abuse, war or accidents, job stress, substance abuse and the
adjustment required following serious injury
Psychological theories of depression consider these factors as important in the development of
the disorder. They focus on sufferer’s subjective experiences and how they interpret the vents
that occur in their lives. The three main theories are psychoanalytic, interpersonal and cognitive.
Psychoanalytical Theories

Sigmund Freud suggested that depression occurs as a result of anger being turned inward,
especially after the loss of a valued family member or friend. This loss can be either real such as
after the end of a relationship or imagined, for example, people who feel that they will never be
loved again.

Freud stated that this internally directed anger leads to self-criticism and blame and that the aim
of this treatment is to release this anger. A consistent feature of major depression can be
irritability often directed toward family members or close friends.

The criticism levelled against this view is that depression can affect people who have not
suffered the loss of a loved one. Freud’s theory that depressed people have internalised anger is
also not supported by dream analysis research.

Some of the latest psychoanalytic theories of depression have tried to address these limitations.
They proposed that depression develops when people believe they have not reached their true
potential such as achieving good grades in school or gaining promotion or a pay raise at work.
The effects of recognising and accepting that they have not reached heir expected goals affects
their ego. The result is a general feeling of helplessness and low self-esteem that leads to
depression.

Interpersonal Theories

Theories suggest that depressed people have poorer social skills than people not experiencing
depression. Social skills include the ability to relate to other people by making appropriate eye
contact, being able to communicate clearly, being able to show empathy and having a positive
regard for others. People experiencing depression have also been observed to have poor problem
solving skills and make poor day –day decisions. It is also found that people who experience
recurrent depression make poor decisions between depressive episodes.

Depressed people are more likely to be rejected by their friends or peers as they have an aversive
interpersonal style.

Cognitive Theories

According to these theories depression is caused by the misinterpretations or errors people make
about themselves, their world and the future. These errors are negatively focussed. For example,
sufferers might see themselves as useless, the world as uncaring and the future as hopeless
despite being successful in their jobs and having devoted families.

Beck’s Cognitive Triad

He observed that depressed people tend to make specific errors in their thinking. For example,
deciding that they are stupid simply because they make one mistake in a test. He suggested that
depressed people develop specific beliefs with strong
negative elements based on these thought errors. A number of factors might lead to the
development of these beliefs, including critical parents or rejection by friends.

Cognitive Errors or Biases in Depression

1) Arbitrary inference – Drawing a conclusion from an event or situation when

Situation: Waiters in a restaurant forget to take your dinner order.

Thought: They are ignoring me. I am obviously not worth their time.

2) Black and white thinking – Taking an extreme view of a situation.

3) Magnification/ minimisation – Exaggerating or ignoring a particular aspect of a

Thought: They obviously don’t like me anymore. I must be a bad person.

4) Overgeneralisation – A gross generalisation based on a single event.

Helplessness Theories

These theories explore the specific thoughts of an individual when depressed. The concept of
learned helplessness was demonstrated by Seligman. He believed that sufferers believe or find
that they have little control over their lives and become passive. Theories also use the concept of
attribution. Attribution refers to people’s explanation of a particular event and their response to
it. For example, depressed people might attribute failure to themselves when faced with a
situation they have difficulty controlling such as a difficult science test.