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 concentrating. · 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 hormones. 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 thinking. 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 depression. 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 culture. 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 disorders. 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 depression Examine each thought and decide whether or not it can be supported Replace these thoughts with realistic interpretations of each situation 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 sessions. Assessments at start, 16 weeks, and 18 months. 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 patients. 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 malfunctions Biomedical treatments aim to restore the chemical imbalance in neurotransmission 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 patients. 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. Conclusion:TO BE CONTINUED 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 themselves) 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.