Psychological Causes of Depression - Essay Example

?Some young people are diagnosed with depression. Outline and discuss some possible psychological causes and also identify a range of suppport and interventions that may be used to treat them Depression is a very common disease and it is estimated that about 121 million people worldwide suffer from some form of depression. Depression is considered to be one of the most important causes of disability in the world. Based on the data from the world health organization depression is the most important cause of disability worldwide measured by DALYs (Disability-adjusted life year), which is a measure introduced by WHO to demonstrate the different reasons for years of productive life lost due to disability. It is estimated that about 5.8 % of males and 9.5 % of females in the world experience a depressive episode every year (WHO 2001). Depression is a condition that should be differentiated from the normal feeling of sadness and decreased mood that is normal event in everyday’s life. There are several psychiatric conditions classified by the diagnostic and statistical manual of mental disorders (DSM IV TR) that are characterized by depressed mood also called mood disorders. All of them can be characterized in two broader groups depending if person had manic episodes which are major depressive disorder and bipolar disorder. There are many subtypes of these conditions, but they are all characterized with episodes of depressed mood, diminished sense of pleasure and interest, feelings of guilt and low self esteem, feeling of low energy and worthlessness, insomnia, changes in appetite with weight loss or weight gain and other symptoms that can be a major cause of disability in the normal functioning of one person and other symptoms (Sadock et al 2002). Most commonly the term depression is used for the major depressive disorder which is defined as presence of at least 5 characteristic symptoms during a 2 weeks of period of time, where at least one of the first 2 symptoms must be present (Kendler and Gardner 1998). The symptoms are: - Depressed mood - Diminished interest or pleasure - Significant weight loss or gain - Insomnia or hypersomnia - Psychomotor agitation or retardation - Fatigue or loss of energy - Feelings of worthlessness -Diminished ability to think or concentrate; indecisiveness - Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide (Kendler and Gardner 1998). Major depressive disorder is a condition without exact known pathopfisiology. Based on some clinical and pre - clinical trials it is suggested that disbalance of the serotonin, norepinefrine, dopamine and other neurotransmitters is the major etiological factor for depression. These conclusions are based mainly on the efficacy of serotonin reuptake inhibitors (SSRI’s) and other specific antidepressants in treating the symptoms of major depression (Nutt 2008). The mechanism of action of these drugs is more complex than simply elevating the levels of serotonin for example, because other substances like cocaine for example that cause only short elevation of the neurotransmitter levels are not effective in controlling the symptoms of depression on a longer terms and can even cause depressive episodes (Viggiano et al. 2004). Also it is known that several weeks of treatment with antidepressive drugs are necessary in order to achieve changes in the symptoms (Quitkin et al. 1996). This suggest that the mechanism of action of antidepressants is more complex where antidepressants after the initial effect on neurotransmission trigger subsequent neuroplstic changes in the brain that will result in a longer-term in the psychologic behavior of the individual. This only suggest that other factors than serotonin levels, like social, psychological, environmental and other are important in the development and treatment of depression (Robert and Frazer 2002). Other theory that tries to implement more integrative approach in understanding the etiology of depression is Diathesis-stress model that concludes that depression is a result of preexisting susceptibility or vulnerability to depression that in some individuals is activated by some trigger stressful factors. This theory implies that depression is a condition that has genetic predisposition, but is also affected by social, environmental and other factors (Caspi et al. 2003) (Marya et al. 2008). There are studies that show that variations of the serotonin transporter gene (5-HTT) affect how every individual reacts on very stressful life-events, where it is found that individuals with one or two shorter alleles of this gene are more prone to develop major depression after highly stressful events (Caspi et al. 2003). Biopsychosocaial theory states that biological, social and personal psychological factors play a role in the development of depression (Howard et al. 1999). However we can conclude that depression has a complex pathophysiology that is not fully understand and additional research and investigation is needed to fully understand the causative agents that result in depression in one individual. Depression is an increasing problem in the younger population. This is a major concern because of several reasons. In some countries, like the United Kingdom for example the most common cause of death in the population between age 25 and 34 is suicide (Agerbo 2002). In a study that was conducted using so called “psychological autopsy” on these young people that committed suicide it was found that about 79 percents of them suffered from some form mental illness and approximately 56 percents of all suffered some form of depressive disorder (Houston et al. 2001). Depression disorders are very common among adolescents and young adults. Some studies suggest that about 25 percents of the young adults experience some form of major depressive disorder by the age 24. This is the highest age-related incidence of depression in any age group (Kessler and Walters 1998). Now even though these episodes of major depression can cause significant disability to work, impair social functioning, may increase the chances of substance abuse in these individuals, influence the psychological and social development of the young individual, it is estimated that less than 20 percents of these individuals receive appropriate, high quality treatment (Reinherz et al. 2000) (Young et al. 2001). This problem is partly caused by the fact that many young adults are avoiding to accept the presence of symptoms of depression and refuse to accept the treatment that is necessary for depression. This only adds and even more complexes the problem of depression in young adults because even though the problem is very serious they refuse to accept the presence of depression and refuse treatment (Benjamin et al. 2005). There are many suggested etiological factors that contribute to the high incidence of depressive disorders in young people. Some studies suggest that changes during adolescence have important role in increased incidences of depression during this period. It is found that females are twice more affected by depsression than males. A number of studies have shown that this is relevant observation and is not simply a result of women being more willing to talk about their depression (Piccinelli, Marco and Greg 2000). There are studies that suggest that reason for this is the cyclical rise and fall of levels of estrogen during menstrual cycles and this is the reason why depressive disorders are more common in women (Rubinow et al. 1998). It is found that before puberty boys have slightly greater incidence of depression compared to girls, but this is changed drastically after puberty, and the depression disorder dominates the women population until the period of menopause. But it is found that changes of sexual hormones levels are only one reason for this difference in depression incidences. Other factors like intensive changes in social environment and personal relationships stimulate development of affiliative needs. When these more developed affiliative needs in adolescent girls are stressed by social, psychological, environmental and other factors, along with drastic hormonal changes, they can react with personal and romantic disappointments that can progress in a major depressive episode (Brown, Harris, and Hepworth 1995) (Cyranowski et al. 2000). However there are studies that the severity of the condition is similar in both boys and girls. The both have similar symptoms that are characteristic for depression, however girls have more potentiated feeling of guilt, dissatisfaction with their body image, self blame and disappointment, difficulties of working, sleeping, concentration and other symptoms compared to boys (Bennett et al. 2005). On the other hand we must note that even though depression in adolescent and young people (males and females) carries increased risk of suicidal behavior, this risk is much more present in adolescent males compared to females, especially if depression is accompanied by alcohol or misuse of drugs or other substances (Shaffer et al. 1996) (Shaffer and Craft 1999). We must note here that substances abuse is an independent risk factor for developing depression in young people. In a study conducted for 5 years on 155 female adolescents it was found that substance abuse was significant factor for developing depressive disorder (Rao et al. 2000) (Wiesner et al. 2005). Alcohol abuse is the most common form of substance abuse in younger adults and it is found significant percentage of comorbidity between alcohol use and depression. Alcohol use is also a risk factor for developing depression at older age and also a risk factor for developing other substance abuse and alcohol dependence by age 27 (Brook et al. 2002). Another very common form of substance abuse in young people is marijuana. In a number of studies it was found that marijuana misuse is a significant risk factor for the mental health of young people, and in the same time young people that use marijuana reported more often that have suicidal thoughts and tendentious (Greenblatt 1998) (Fergusson et al. 2002). Substance abuse in general is associated with increased incidence of depression among young people but we must point the fact that young with substance abuse problems are less willing to accept their problem due to their altered mental state and cognition, which is a significant problem (Crome 2004). In another study it was found that depression is also a risk factor for future substance abuse. In a study conducted by Lewinson et al. 2000 they monitored the behavior of depressed adolescents until age of 24. It was found that 70 percents of patients had another major depressive disorder event until age 24, and from the remaining 30 percents about 77 percents developed some form of substance abuse. So we can conclude that substance abuse and depression are interconnected in younger individuals and younger patients should be monitored for both conditions. Another recognized factor in the etiology of depression in young population is neurotic disorder. Neuroticism in general is considered a risk factor for developing depressive disorder (Jeffrey et al. 2007). It is defined as a condition of susceptibility to nervous breakdown under more intensive stress (Tambs et al 1991). But neurotic disorder in a number of studies is shown to be linked with increased susceptibility to major depressive disorder and premorbid neuroticism is present in large percentages in young adults with depressive disorders (Jeffrey et al. 2007) (Roberts and Kendler 1999) (Krueger et al. 1996). The effect of neurotic disorder on increased susceptibility to developing depressive disorder is complex and involves genetic, social, environmental and other factors. Young people with significant neurotic disorder have increased susceptibility to develop depression under severe stress compared to general population, but number of other factors are also important (Farmer et al. 2002). Another important psychological factor that can be a significant risk for developing depressive disorder in adolescence and young adulthood is early childhood adversity. It is found that history of childhood adversity is associated with severe chronic major depressive disorder that is usually less responsive or unresponsive to antidepressive treatment (Klein et al. 2009). The importance of childhood molestation (physical, emotional, sexual) in developing signs of depression in adolescence and early adulthood is believed to be due to the fact that traumatic and stressful experiences can impair the normal development and the affected adolescents have difficulties to cope with the intensive and stressful process of maturation and introduction of adulthood (Brown et al. 1999). We must note that this susceptibility to developing depression is not absolute and not all adolescents subjected to early adversity will develop symptoms of depression. Other factors like genetics, environment, social, economical and other factors are also important (Silberg et al. 2001). Another recognized important factor for developing major depressive disorder in young people are stressful life events which have substantial causative relationship with increased susceptibility to depressive disorders, but nevertheless the relationship is not absolute because other predisposing factors like family history and genetic predisposition have also importance in the developing of symptoms of depression after a stressful life event (Kenneth et al. 1999). It must be noted that stressful life events have significance in developing the first episodes of depressive disorder and their significance is less important for the subsequent episodes of depression, which only implies the importance of other factors for developing depression later in the life of young people (Ghaziuddin et al. 1990). The importance of the effect of stressful life events to produce major depressive disorder is linked to genetic factor in more than one way. It is found that some people have sustained tendency to find themselves in a stressful situations and this tendency has some form of genetic predisposition but these same genetic factors are probably correlated with increased inherited susceptibility to developing depressive disorder (Kendler et al. 1993) (Kendler et al. 1997). Based on all examples above we can conclude that depressive disorders in young population have a complex etiological background and multiple factors lead to increased susceptibility to developing depression. When we analyze the etiology of one depressive disorder we must take into account the genetic predisposition and family history for depressive disorders, but also have to have in mind other factors like alcohol and substance abuse, previous neurotic disorders, stressful life events and a number of other factors. The effort to decrease the incidence of depression in young population must take into account all of the above mentioned factors and incorporate integrative approach in order to effectively treat the increasing prevalence of depressive disorders in young individuals (Kessler and Walters 1998). It is important to fight depression in young population because depression during adolescence is predictive event of increased chances for developing major depressive disorder later in life (Weissman et al. 1999). Children with a family history of depression have the highest risk of developing this disorder themselves. This is why measures to recognize this population and take preventive measures, like psychological monitoring may be important (Beardslee et al. 1997). Screening for alcohol and substance abuse, educative programs about the negative consequences of substance abuse is also important considering the importance of substance abuse in developing depressive disorders in young population. Talking about substance abuse we must also take into consideration the fact this population also avoids to accept their psychological problems related to substance abuse (Crome 2004). Fight against childhood molestation is also important factor in reducing the incidence of depression in adolescence and early adulthood because it may trigger the first episodes of depression. Having this in mind every case of depressive disorder in young individual should be explored for possible domestic violence and other forms of early adversity (Klein et al. 2009). 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