Depression Psychology

Depression Seligman (1973) referred to depression as the ‘common cold’ of psychiatry because of its frequency of diagnosis.  According to BPS figures a staggering 9 million people in Britain reported feelings of depression to their GP in 1998!  However to continue Seligman’s analogy, although this ‘cold’ may have reached epidemic proportions in the West it is certainly not pandemic since many cultures and areas of the World report little or no depression

Characteristics Depression is an affective disorder in that it is characterised by disturbances of affect (or mood).  During the course of any period of time it is not unusual for a person’s mood to alter.  However with affective disorders this variation is more marked and is accompanied by other symptoms. These symptoms of depression do vary; the DSM-IV recognise three main types of depression, only two of which will be mentioned here, and only one of which will be covered in detail. 

Emotional symptoms The symptoms we most associate with depression, those feelings of sadness, loss of mood and loss of pleasure from what were previously enjoyable activities.  Mood may also alter during the course of the day, typically being lowest in the morning and gradually showing improvement as the day progresses.  This may be associated with circadian rhythms

Physical symptoms Disturbances of sleep: patients sometimes report insomnia, but sleeping longer than before is also common, perhaps as patients attempt to escape their problems.  Appetite can also decrease or it may increase in the form of comfort eating.  Part of this may be due to boredom since typically depressed people tend to have lower activity levels.

Motivational symptoms Apathy and loss of drive are common.  Typically the depressed person will sit around waiting for things to happen, making no attempt to initiate activity or social contact.  This could be because they don’t want people to see them in a depressed state.

Cognitive Symptoms These can vary from negative self thoughts, loss of self esteem and self confidence, feelings of despair and hopelessness, inability to concentrate on tasks for any length of time to feelings of inadequacy and blaming themselves for their situation and on occasions and suicidal thoughts.  

Categories of Depression: Unipolar (major or clinical depression) This is what we normally consider to be depression and can comprise a combination of any of the symptoms mentioned above.  Minor depression occurs when the patient suffers the low mood but without any of the cognitive or other disturbances.

Dysthimic disorder (or chronic depression) DSM-IV-TR now recognises a milder form of depression with a lower level of diagnosis.  The patients only needs three of the symptoms rather than the usual five to be considered to be suffering from dysthimic disorder.  Note: dysthimic does not include suicidal thoughts!

Bipolar (manic depression) Involves bouts of clinically depressed symptoms that alternate with periods of near normal mood and/or elevated mood (mania).  Bipolar 1: usually consists of mania and depression but can on rare occasions be mania on its own Bipolar 2: major depression with hypomania (a less extreme form of mania)..

Differences between Unipolar Bipolar Persistent low mood Up to 3 times more common in Women Around 5% incidence in the general pop Swings between high and low moods Similar in both men and women Around 1% in the general population Far more common in creative people

Diagnosis These are the two most widely used and quoted methods of categorising mental illness.  DSM (Diagnostic and Statistical Manual) devised by the American Psychiatric Association in 1952.  Its last major revision was 1994 when DSM-IV was published.  DSM-V is currently under construction and is expected in 2013. ICD (International Statistical Classification of Diseases and Related Health Problems) devised by the World Health Organisation and categorises all illnesses.  Currenty we are on ICD-10 with ICD-11 due in 2015.

Endogenous or reactive depression This is a second way of distinguishing between depressions that relates more to causes rather than symptoms. Endogenous depression (as the name suggests) comes from within and is thought to be caused by chemical Reactive depression on the other hand is caused by external factors such as loss of job, death of relative etc. and is usually explained using psychological approaches such as behaviourist or cognitive models. Depression is also a major factor in a number of other related disorders such as Seasonal Affective Disorder (SAD), Premenstrual syndrome (PMS) and Postpartum depression (PPD).  The latter was formerly known as post natal depression

Depression and anxiety Generally speaking the general population are accepting of depression but tend to be more concerned about psychotic disorders such as schizophrenia.  Mood disorders, like anxiety disorders are not seen as threatening and are usually not too far removed from ‘normal’ or everyday behaviour.  They are also far more common than psychoses.  There tends to be lots of overlap between depression and anxiety, both in terms of symptoms and in terms of diagnosis.  It’s thought that as many as 90% of patients suffering from depression also exhibit symptoms of anxiety, such as interruptions of sleep, ability to concentrate and panic.  Some have even suggested a new category of ‘mixed anxiety depression’ with the unfortunate abbreviation ‘MAD.’  It’s also worth mentioning that stress can be a symptom of both, as well as a potential cause! 

Reliability and Validity of Beck’s Depression Inventory (BDI) The BDI is one of the most widely used tests for assessing the severity of depression.  When it was first published in 1961 it signalled a major shift in the view of depression which until that time had been viewed in psychodynamic terms.  Aaron Beck considered the cognitive symptoms of depression rather than seeing it as a self destructive and inwardly displaced anger.  The BDI consists of 21 item self-report questionnaire.  Each item is designed to test the severity of a specific symptom

Task Read through the BDI hand-out and feedback your thoughts on the reliability and validity