MDD 3A - Reagan Humanities

Group PowerPoint
 (Names on each slide)
Ellis (1962) suggests that psychological
disturbances often come from irrational
and illogical thinking.
Brown and Harris (1978) carried out a
study concerning the social origins of
depression in woman.
Major Depressive Disorder.
first bullet point is MDD with anxiety disorders & second point is
with MDD & affective disorders. Last point is the prevalence..
· Depression and Anxiety disorders are different but people who
suffer from depression often experience symptoms that are similar
to people who have an anxiety disorder. Some of these
symptoms are nervousness, irritability, and problems sleeping and
· Someone who suffers from Major Depressive Disorder with
affective disorder usually have symptoms that are feelings of guilt
and sadness; lack of enjoyment or pleasure in familiar activities.
· The Prevalence for MDD reported that the lifetime risk for the
disorder has varied from 10% to 25% for women and 5% to 12% for
men. The rates for MDD appear to be unrelated to education,
income, ethnicity, and marital status.
5-HTT gene shortage is
suggested(duenwald(2003)) may be
associated with a higher risk of depression.
The gene plays an important role in the
control of mood, emotions, aggression,
sleep, and anxiety.
 Deficiency in neurotransmitters and
 Catecholamine hypothesis- Depression is
associated with low levels of noradrenalin.
Since 5-HTT is important to controls the different
actions and feeling it is believe it can lead to
depression since those are the most abnormal
behaviors have when one is depressed.
another biological cause believe is a
deficiency in neurons and hormones
according to the neurobiological researchers.
Since the problem of noradrenalin is biological
and it can be cure with drugs then depression
should be the same way since its link with
noradrenalin .
Ellis(1962)-psychological disturbances
often come from irrational and illogical
 Negative cognitive
schemas(beck(1976)) are do to stressful
events and how they are dealt with.
 Not known if depressive thoughts lead to
depression or if their a cause of
Negative thoughts can lead to
depression when they are irrational and
illogical. A person might want something
that is exaggerated and blames himself
for any little thing that prevents him from
reaching his goal.
 Stress events can also lead to depression
since the person is constantly thinking of
the event and how it affected their live.
Life events can lead to depression .
 Marsella(1979) affective symptoms are
typical in individualistic cultures.
Depression is seen mostly in individualist
countries since society make the people
think they should be able to provide for
their families and them selves.
 When a person cannot meet society’s
expectations they start having depressive
thought and can up leading to depression.
 In collectivist countries it’s not seen as much
since the individual is part of the group and
the society as several resources to help the
individual. Being a collective society the
individual does not feel a lot pressure.
Brown and Harris (1978) conducted a study dealing with
the social origins of depression in women. The study
showed that 29 out of 38 women who became had
depression had experienced a severe life event. However,
78% of those who did experience a severe life event did
not suffer from depression. Brown and Harris found that life
events which resembled previous experiences were more
likely to lead to depression.
Brown suggested a Vulnerability Model of Depression, based
on a number of factors that could increase the likelihood
of depression. Factors included lacking employment away
from home, absence of social support, having several
young children at home, loss of mother at an early age, or
history of child abuse.
 The study directly correlates with the Diathesis-Stress
Model, which is an interactionist approach to explaining
psychological disorders. The model states depression
might be the cause of a hereditary predisposition, with
precipitating events in the environment
The World Health Organization (1983)
identified common symptoms of depression
in Iran, Canada, Switzerland, and Japan.
 The symptoms included: sad affect, loss of
enjoyment, anxiety, tension, lack of energy,
loss of interest, inability to concentrate, as
well as ideas of insufficiency, inadequacy,
and worthlessness.
 This study’s results are similar to another
study by Murphy et al.(1967), which
covered 30 other countries. Other
symptoms it found were loss of sex drive,
appetite loss, weight reduction, fatigue,
and self accusatory ideas.
Prince in 1968 said that there was no
depression in Africa and in parts of Asia.
He found that rates of reported
depression rose with westernization in
former colonial countries. Modern
researchers argued that depression in
non-modernized settings tends to be
expressed differently and may escape
the attention of a person from another
According to statistical evidence, women are two to three
times more likely to become clinically depressed than men.
Women are also more likely to experience several episodes
of depression.
Most researchers do not believe that depression in women
is mainly due to hormonal fluctuations or other biological
reasons. Rather they believe it is due to more social causes.
This was the Brown and Harris (1978) study.
Brown and Harris studied a sample 458 women from a general
population. They found on average that 82 percent of those who
become depressed had recently experienced at least one severe life
event or major difficulty, compared to 33% of those in non-depression
groups. They also found findings of a pronounced social class effect. Of
the working class women in a general population 23% had been
depressed within the past year compared to 3% of middle class women.
For working class women, those who had 1 or more kids were at a higher
risk for depression. Was a strong association with risk and marital status.
Women who were divorced, widowed, or separated had relatively high
rates of depression. Although a strong overall association between
depression and the experience of stressful life events, only a
minority(20%) of the women who had experienced severe difficulties
became seriously depressed. This suggested Vulnerability Factors: lack of
confidence, early loss of mother(before age 11) and being
unemployed. The best way to prevent depression was found to be the
presence of a partner.
The previous study has established that
social stress plays a role in triggering
several depressive episodes. It also
demonstrated that social factors may
increase an individual’s vulnerability of
depression. It also confirms that social
support may offer protection against the
effects of potentially stressful events.
For short-term depression , generally
antidepressant drugs are an effective
way to treat this disorder. This approach
helps 60-80 percent of people.
(Bernstein et al. 1994)
 However, it is still proven that other
modern drugs provide effective longterm control for this depression & mood
One of the symptoms of depression is distorted
cognitions, or self-defeating thoughts. Aaron
Beck is a pioneer in cognitive therapy. His
theory developed in 1960 is based on the idea
of cognitive restructuring. The principles of his
approach are to:
Identify these self-critical thoughts
 Evaluate the connection between these thoughts and
 Examine each thought and decide whether or not it can be
 Replace these thoughts with realistic interpretations of each
Group therapy is a common method. Most
group therapy is actually “couples’
therapy”. This is due to the strong link
between depression and marital problems.
This type of therapy focuses on teaching
couples to problem-solve and
communicate more effectively. Jacobsen
et al. (1989) have found that this form of
treatment is just as effective as other forms.
Drug Therapy
› Drug therapy is effective for 60-80 percent of
people (Bernstein et al. 1994).
› Kirsch and Sapirstein (1998) found through
analyzing 19 studies, with 2318 patients who
were treated with antidepressant Prozac,
were only 25 percent more effective than
placebos and no more effective then other
drugs, including tranquilizers.
Drug therapy is effective in the long-term
and can help prevent suicide.
 Blumenthal et al. (1999) found that
exercise was just as effective as SSRIs in
treating depression with elderly patients.
Elkin et al. (1989) conducted an experiment
in collaboration with the National Institute
of Mental Health which included 28
clinicians with 280 patients. There were four
groups: Antidepressant (imipramine),
interpersonal therapy (IPT), cognitivebehavioral therapy (CBT), and a control
group using a placebo and weekly therapy
 Assessments at start, 16 weeks, and 18
Just over 50 percent of patients recovered
in each group, except the placebo group
which only 29 percent recovered.
 The drug group recovered faster then the
rest of the groups but the effectiveness of
all except the placebo were equal.
 Elkin et al. (1989) showed that the treatment
does not matter because the results are the
same for antidepressants, CBT, and IPT.
Siporin (1986) reviewed 74 studies
comparing individual and group treatment.
Group therapy was as effective as the
individual therapy in 75 percent of the
cases and more effective in the other 25
percent. Group treatment was costeffective in 31 percent of the studies.
 Group therapy is more effective then
individual however it is more costly to the
There are positives and negatives to
each treatment; effectiveness and cost
being the main ones.
 The treatment of major depressive
disorder must be personalized to the
individual patient as different treatments
will work for different patients as well as
are readily available to some patients
then others in regards to cost.
This treatment is based on assumption
that the patient has biomedical
 Biomedical treatments aim to restore the
chemical imbalance in
 Most of the drugs work by increasing or
decreasing neurotransmitters such as
Dopamine, Serotonin, or Noradrenalin.
National Institute of Mental Health Treatment of Depression
Collaborative Research Program: General Effectiveness of Treatments
Researcher: Elkin et al. (1989)
Aim: To determine if different forms of therapy and drug treatment have
varying levels of effectiveness in combating major depression in
Research method: laboratory experiment
Procedure: This study included 28 clinicians who worked with 280
patients diagnosed with having Major Depressive Disorder. Individuals
were randomly assigned to treatment using either an antidepressant
drug (imipramine), interpersonal therapy (IPT), or cognitive-behavioral
therapy (CBT).
In addition, a control group was given a placebo pill. Together they had
weekly therapy sessions. The placebo group was conducted as a
double-blind design, so that neither the patients nor the doctors knew
which was which. All patients were assessed at the start, after 16 weeks
of treatment, and again after 18 months using the Hamilton Rating Scale
for Depression
Findings: Just over 50% recovered in each of the CBT and IPT groups, as
well as in the drug group. Only 29% recovered in the placebo group.
Causes can come from combinations of
several different factors…
 intrapsychic (inside the mind)
 Environmental Causes
 And Biological causes
Early conflicts during childhood
 Internalization of negative events
(Treatment assumes that people’s
interpretation of situations around them are
responsible for the development of
depression rather than the events
 Self-blame/guilt
 “learned helplessness” long-term
experiences of helplessness can cause a
person to not even try anymore
External events trigger depression
 Unfortunate circumstances that are
difficult to change (range from
environmental disasters or personal losses
to socioeconomic status,
oppression/discrimination because of
one’s sex or race, unpleasant or
frustrating relationships)
Abnormal chemical imbalances (body
fluids, hormones, neurotransmitters, etc.)
 Differences in anatomical structure
(brain- prefrontal cortex)
 Genetics
Therapy: Cognitive therapists help patients identify the
automatic thoughts that lead them to anticipate poor
outcomes or to interpret neutral events in negative ways.
The patient is also encouraged to challenge negative
thoughts by comparing his or her expectations of events
with actual outcomes.
Social Skills Training: patients are trained to recognize
actions and attitudes that annoy or distance other
people, and to replace these behaviors with more
appropriate ones.
Psychodynamic psychotherapy: effective in treating
patients with MDD whose depression is related to
unresolved issues from the past. The growth of insight into
one's emotional patterns, as well as the supportive aspects
of this form of therapy, offers relief from emotional pain.
Medication: antidepressants. Hormones etc.
Electroconvulsive therapy: used for patients that don’t
respond to other treatments.
Treatment used to be all medical until
recently. Now therapy is also a common
method. A more holistic and multifaceted
approach to treatment is seen to be most
effective. The person is not considered as a
sick patient, but as a person who suffers
from illness. Different treatment methods
don’t mean that it deals with that specific
type of cause, but it deals with that type of
cause, as well as others.
Therapy can be used for many causes of
MDD. It is used for most of the
intrapsychic and environmental causes.
Therapy can be one on one or group
oriented and aims at getting the
participant to talk about why they are
acting strange or what they think could
help with their problem.
Social skills training is more oriented
towards interaction with others. Because
people suffer from illnesses that make
interacting with society difficult, skills
training can help these individuals rethink
how they interact with others.
Medication is more focused on the
biological causes. Abnormal levels of
chemicals, hormones, or body fluids can
be regulated by pills and injections.
Antidepressants help with any cause.
 Electroconvulsive therapy is only used in
extreme cases where individuals show no
signs of improvement from other
treatment methods.
It is important for clinicians to take the
time to find the appropriate type of
treatment and change treatment if it
does not seem to have positive effects.
 Basically the etiology of the disorder has
a major influence of what treatment is
given to the patient, although other
possible treatments and causes are kept
in mind.

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