Reviewing Some Depressive Disorders - Literature review Example

Reviewing Some Depressive Disorders It is believed that much can be said about how a person reacts to a situation. In times of successes and positivemoments, most people celebrate with joyous reactions. However, in troubled times, people react with different shades of negative emotions. Some spring back right away and take positive action while others dwell in doom and even fall into a dark depressive state. In this complicated world of ours, many people find it difficult to cope. When problems which they cannot handle beset them, emotions run low. Such downward spirally of emotions usually come with a host of symptoms that affect physical and mental functioning. For these people, how do they find their way back to the light? Depression is usually manifested with negative behaviors stemming from negative emotions. Sometimes, the person experiencing it is not even aware that he is undergoing depression. Unipolar Depression Depression as a psychological disorder comes in many forms. One is Unipolar Depression which is characterized by severe and debilitating depressive episodes of Clinical Depression or Major Depression. Compared to Bipolar Depression which has manic and depressive states, Unipolar depression only shows symptoms on one end of the spectrum (the low end). People suffering from Unipolar Depression experience inability to go on with work, establish harmonious relationships in their social and family life. They become withdrawn, and cease to enjoy things they have enjoyed before and eventually becomes hopeless. Causes for Unipolar Disorder may be linked to organic neurological causes such as disruption in neural circuits and neurochemicals in the brain. It may also be genetically predisposed in the patient or caused by post-traumatic stress disorder, social anxiety disorder, panic disorder or generalized anxiety disorder (www.bipolarcenteral.com/otherillnesses/unipolar_disorder.asp). Symptoms of unipolar depression include: the inability to concentrate or make decisions; being apathetic or neutralized emotional behavior; irritability, nervousness and anxiety; lowered energy and complaints of consistent fatigue; feelings of sadness, hopelessness, low self-esteem, worthlessness; withdrawal from social and family activities; decreased sexual desire and activity; suicidal tendencies and disturbance in eating and sleep patterns. Diagnosis of this disorder includes physical and mental evaluations to rule out the presence of other diseases or illnesses. The patient exhibits most, if not all of the symptoms for a prolonged period of time. Treatment may include Psychotherapy; Electroconvulsive Therapy in severe cases; pharmacotherapy with antidepressants such as selective serotonin reuptake inhibitors (SSRIs)-the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs-and other newer medications that affect neurotransmitters such as dopamine or norepinephrine-generally have fewer side effects than tricyclics.; or hospitalization in severe cases. Brent and Birmaher (2002) noted that depression in both children and adolescents is not always featured by sadness, but rather takes the form of irritability, boredom, and the inability to find pleasure. Symptoms of depression may also vary depending upon the stage of adolescence. Younger adolescents may show more anxiety-related symptoms—clinging behaviors, unexplained fears, and physical symptoms—while older adolescents may experience a greater loss of interest and pleasure and also have more morbid thinking (Mondimore, 2002). Lewinsohn, Rhode, and Seeley (1998) found that nearly 89% of depressed adolescents reported disturbances in sleep. Other symptoms that were frequently reported included a disturbance in weight/appetite (79.5%) and anhedonia (77.3%). The average length of a depressive episode is about 6 months however, about 25% of patients have episodes of more than a year and about 10-20% develop it chronically. About 80% of patients with major depression will experience further episodes (http://www.depression-guide.com/unipolar-depression.htm) Dysthymic Disorder Another kind of depression is Dysthymic Disorder which is a less severe type of depression. It is a chronic condition characterized by depressive symptoms occurring for most of the day for at least 2 years. If the depression persists after two or more years, it is common to develop into a Major Depressive episode. This disorder has usually an early onset in childhood or adolescence. In adults, 75% of individuals with this disorder develops it into a Major Depressive Disorder within 5 years. Recovery rate is about 10%, which gets better with active treatment (http://www.psychologyinfo.com/depression/dysthymic.htm). Although it is much like Unipolar Depression, individuals with Dysthymic Disorder can still go about their daily routines and manage their lives although the symptoms are severe enough to cause distress and interference with important life role responsibilities. Psychotherapy is effective in reducing the symptoms of depression and helping the person manage life better. The disorder also responds well to antidepressant medication in addition to psychotherapy. Cyclothymic Disorder Still another type of psychological disorder related to depression is Cyclothymic Disorder, which is a chronic condition characterized with episodes of hypomanic alternating with depressive symptoms for at least 2 years. Symptoms are very similar to Manic-Depressive or Bipolar Disorder, although less severe. If the Hypomanic Episodes intensify to meet the full criteria for a Manic Episode or a Mixed Episode; the diagnosis would be changed to Bipolar I Disorder. If the depressive symptoms intensify to meet the full criteria for a Major Depressive Episode; the diagnosis would be changed to Bipolar II Disorder (http://www.mentalhealth.com/dis/p20-md03.html). Like the previous disorders discussed, Cyclothymic Disorder may be treated with Psychotherapy. Medications that are effective in treating Bipolar I Disorder are usually effective also in Cyclothymic Disorder. Pharmacotherapeutic drugs include mood stabilizers such as lithium, carbamezepine and valproate. Antidepressant medication such as tricyclic antidepressant medication has likewise been shown to be effective in the treatment of this disorder. Psychotherapy Clients suffering from psychological problems are assumed to focus more on their flaws that pull them down than on their potentials that may spur them up to success. Aaron Beck, the founder of this psychological intervention called Cognitive Behaviour Therapy (CBT), agrees that much of our psychological problems are caused by “cognitive distortions” due to our acknowledged human fallibility. “ In depressed people, these belief systems, or assumptions, develop from negative early experiences such as the loss of a parent, rejection from peers, an unrelenting succession of tragedies, criticism from teachers, parents or peers, or even the depressed behaviour of a parent. These negative experiences lead to the development of dysfunctional beliefs about the world, which are triggered by critical incidents in the future.” (Field, 2000). Beck (1987) came up with the concept of “negative cognitive triad” that describes the pattern that triggers depression. In the first component of the triad, the client exhibits a negative view of himself. He is convinced that he is to blame for whatever pathetic state he is currently in because of his personal inadequacies. Secondly, the client shows negative view of the world, hence, a tendency to interpret experiences in a negative manner. He nurtures a subjective feeling of not able to cope with the demands of the environment. Third and lastly, the client projects a gloomy vision of the future. He can only anticipate failure in the future. Beck (1975) writes that, in the broadest sense, “cognitive therapy consists of all of the approaches that alleviate psychological distress through the medium of correcting faulty conceptions and self-signals” (p. 214). Once the negative schema is activated this leads to a stream of what Beck called negative automatic thoughts (NATs). Eventually, the person will have no voluntary control over such thoughts. These negative thoughts then become accepted as true, leading to other negative thoughts. It is this negative stream of consciousness that leads to depressive symptoms (Field, 2000). These distorted automatic thoughts, maladaptive assumptions and negative schemas. are what need to be corrected in the perspective of the client with the help of the therapist. The goal of therapy is to help the client realize that reorganizing the way they view situations will call for a corresponding reorganization in behavior. The therapist uses a variety of therapeutic strategies depending on what he decides will work on his particular client. He also delegates responsibility to his client by expecting him to do homework outside the therapy sessions. Usually, depressed individuals feel overwhelmed with all their responsibilities and their inability to attend to all the details of their lives lead them to be depressed. A supportive therapist usually needs to take the lead in helping these young people make a list of their responsibilities, set priorities and develop a realistic plan of action. If they can learn to combat their self-doubts in the self-help group sessions, they may be able to apply their newly acquired cognitive and behavioral skills in real-life situations (Corey, 2005). After undergoing a successful health intervention programme that includes intensive CBT, relapse prevention is essential. All throughout the programme, the patients are encouraged to integrate the techniques they have learned in the sessions in their daily lives with the goal of keeping CBT effective even when the programme ends (Roth, Eng and Heimberg, 2002). However, the concerned individuals are also warned that they might still encounter difficult times in the future even after successful treatment but their newly acquired skills at dispelling negative thoughts and reactions must be at their disposal to use whenever they would need them and maintain the belief that a single difficult event is not a failure on their part. Pace and Dixon (1993) have done a study to confirm that brief individual cognitive therapy, as compared with a no-treatment control condition, was effective in reducing depressive symptoms and the number of negative self-referent judgments. for mildly and moderately depressed college students. Depressed people appear to be more likely than non-depressed people to actively distort information about the self in negative ways that are consistent with the depressive features of their self-schemata (Haaga et al., 1991). However, no matter how effective Cognitive therapy seems to be, it should be noted that it s not a psychotherapeutic panacea for depression. It may suit some clients and not others, so appropriateness for each particular case needs to be evaluated well (Dobson, 1989). For example, for depressed geriatric patients, pharmacotherapy, or the use of anti-depressants to treat their depression may be more effective “because the nature of their symptomatology is often characterized by the so-called vegetative, or physical, signs” (Bielski & Friedel, 1976 as mentioned in Dobson, 1989, p.418). “Although the use of CBT as the sole treatment for unipolar depression has certainly been advocated, CBT is viewed as an adjunct to pharmacotherapy in the treatment of bipolar disorder.” (Roth, Eng & Heimberg, 2002, p.455) Beck’s Cognitive Therapy has been criticized for focusing too much thinking positively; being too superficial and simplistic and not putting enough emphasis on the client’s past. It is also criticized for being too technique-oriented, thereby not maximizing the therapeutic relationship between client and therapist. It was claimed to work only on eliminating symptoms but not entirely exploring the root causes of the client’s difficulties. Ignoring the role of the unconscious factors and neglecting the role of feelings are likewise criticisms of this therapeutic approach (Corey, 2005). Cognitive therapy practitioners are quick to defend that although they are straightforward in their approach and seek simpler instead of more complicated solutions does not imply that the practice of cognitive therapy is simplistic. They also argue that they do not explore the unconscious or underlying conflicts but work with the clients’ present circumstances to be able to bring about the necessary schematic changes. They also deny that they do not give importance to the clients’ past, as most of their issues spring from earlier experiences. (Corey, 2005) Cognitive Behavior Therapists admit that Cognitive Behavior Therapy places central emphasis on the client’s cognition and behavior, but does not ignore emotions in the therapy process, rather, it is considered a by-product of cognition and behavior (Corey, 2005). Like other therapeutic models, Beck’s Cognitive Behavior Therapy has its limitations, but nevertheless proves to be effective in most cases of depression. Its premise of changing the way one thinks about things brings about changes in behavior and feelings is one simple but wise advice worth following. . References Beck, A.T. (1975) Depresseion: Cause & Treatment. Philadelphia: University of Pennsylvania, Press. Beck, A. T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy: An International Quarterly, 1, 5-57. Bielski, R. J., & Friedel, R. Q (1976). Prediction of tricyclic anti-depressant Response: A critical review. Archives of General Psychiatry, 33, 1479-1489. Brent, A., & Birmaher, B. (2002, August 29). Adolescent depression. The New England Journal of Medicine, 347, 667–671. Corey, G. (2005) Theory and Practice of Counseling and Psychotherapy, 7th ed. Brooks/Cole, a division of Thomson Learning Inc. Dobson, K.S.,(1989) “A Meta-Analysis of the Efficacy of Cognitive Therapy for Depression” Journal of Consulting and Clinical Psychology 1989, Vol. 57, No. 3,414-419 Field, A. (2000) Cognitive Therapy, retrieved on April 25, 2009, from http://www.sussex.ac.uk/Users/andyf/depression.pdf Haaga, D. A., Dyck, M. J., & Ernst, D. (1991). Empirical status of cognitive theory of depression. Psychological Bulletin, 110, 214- 236. http://www.bipolarcenteral.com/otherillnesses/unipolar_disorder.asp http://www.depression-guide.com/unipolar-depression.htm hhttp://www.mentalhealth.com/dis/p20-md03.html http://www.psychologyinfo.com/depression/dysthymic.htm Lewinsohn, P. M., Rhode, P., Seely, J. R. (1998). Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications. Clinical Psychology Review, 18, 765–794. Mondimore, F. M. (2002). Adolescent depression: A guide for parents. Baltimore, MD: The John Hopkins University Press. Pace, T.M. & Dixon, D.N. (1993) “Changes in Depressive Self-Schemata and Depressive Symptoms Following Cognitive Therapy”, Journal of Counseling Psychology, Vol. 40 No. 3, 288-294 Roth, D.A., Eng, W. & Heimberg, R.G., (2002) Cognitive Behavior Therapy, Encyclopedia of Psychotherapy Vol. 1 Elsevier Science (USA). Read More