Etiology and Treatment of Depression

Psychoanalytical Theory of Depression:

During the oral period, a child’s needs may be insufficiently or over sufficiently
gratified, causing the person to become fixated in this stage and dependent on the
instinctual gratification particular to it. With this arrest in psychosexual maturation, this
fixation at the oral stage, the person may develop a tendency to be excessively dependent
on other people for the maintenance of self-esteem.

Freud hypothesized that after the loss of a loved one, whether by death or most
commonly for a child, separation or withdrawal of affection, the mourner first introjects,
or incorporates, the lost person, he or she identifies with the lost one, perhaps in a fruitless
attempt to undo the loss. Because, Freud asserted, we unconsciously harbor negative
feelings towards those we love, the mourner then becomes the object of his or her own hate
and anger. In addition the mourner resents being deserted and feel guilt for real or imagined
sins against the lost person.

According to the theory, the mourner’s anger towards the lost one continues to be
directed inward, developing into an ongoing process of self-blame, self-abuse, and
depression. Overly dependent individuals are believed to be particularly susceptible to this
process. This theory is the basis for the widespread psychodynamic view of depression as
anger turned against oneself.

It is stated that some depressed people are high in dependency and prone to become
depressed following a rejection. Some researchers have analyzed dreams and projective
tests of depressed individuals, reasoning that they should be means of expressing
unconscious needs and fears.

Beck Theory of Depression:

The most important contemporary theory that regards thought processes as

causative factors in depression is that of Aaron Beck. His central thesis is that depressed
individuals feel as they do because their thinking is biased towards negative interpretations.

According to Beck, in childhood and adolescence depressed individuals acquired a

negative schema----a tendency to see the world negatively---through loss of parent,
succession of tragedies, the social rejection of peers, the criticism of teachers, or the
depressive attitude of parents.

The negative schemata acquired by depressed persons are activated whenever they
encounter new situations that resemble in some way, perhaps only remotely, the conditions
in which the schemata were learned. Moreover, the negative schemata of depressed people
fuel and are fueled by certain cognitive biases, which lead these people to misperceive
reality. Thus, an ineptness schema can make depressed individuals expect to fail most of
the time, a self-blame schema burdens them with responsibility for all misfortunes, and a
negative self-evaluation schema constantly reminds them of their worthlessness.
 Negative schemata, together with cognitive biases or distortions, maintain what
Beck called the negative triad: far reaching negative views of the self, the world, and the
future. The “world” part of Beck’s depressive triad refers to the person’s judgment that he
or she cannot cope with the demands of the environment. It is highly personal----“I cannot
possibly cope with all these demands and responsibilities.”

Principal cognitive biases of depressed individuals:

 Arbitrary Inference: a conclusion drawn in the absence of sufficient evidence or of

any evidence at all. For example, a man concludes that he is worthless because it is
raining the day he is hosting an outdoor party.

 Selective abstraction: a conclusion drawn on the basis of but one of many elements
in a situation. A worker feels worthless when a product fails to function, even though
she is only one of many people who contributed to its production.

 Overgeneralization: an overall sweeping conclusion drawn on the basis of single

perhaps trivial event. A student regards his poor performance in a single class on one
particular day as final of his worthlessness and stupidity.

 Magnification and Minimization: exaggerations in evaluating performance. A man

believing that he has completely ruined his car (magnification) when he sees that there
is a slight scratch on the rear fender, regards himself as good- for-nothing. A woman
believes herself worthless in spite of a succession of praise worthy achievements.

Learned Helplessness Theory:

The basic premise of learned helplessness theory is that an individual’s passivity

and sense of being unable to act and to control his or her own life is acquired through
unpleasant experiences and traumas that the individual tried unsuccessfully to control,
bringing on a sense of the helplessness, which leads to depression.

Seligman conducted the study on animals and concluded that in learned

helplessness the animals appeared passive in the face of stress, failing to initiate action that
might allow them to cope. They had difficulty eating or retaining what they ate, and they
lost weight.

Attribution and Learned Helplessness:

Abramson, Seligman and Teasdale (1978) proposed a revised version of learned

helplessness. The essence of the revised theory lies in the concept of attribution----the
explanation a person has for his or her behavior. For example, the individual has
experienced failure and he or she will attribute the failure to some cause.

People became depressed when they attribute negative life events to stable and
global causes. Whether self-esteem also collapses depends on whether they blame the bad
outcome on their own inadequacies. The individual prone to depression is thought to show
a depressive attributional style, a tendency to attribute bad outcomes to personal, global,
stable. When persons with this style have unhappy, adverse experiences, they become
depressed.
Hopelessness Theory:

Some forms of depression (hopelessness depressions) are now regarded as caused

by a state of hopelessness, an expectation that desirable outcomes will not occur or that
undesirable ones will occur and that the person has no responses available to change this
situation.

Interpersonal Theory of Depression:

Depressed individuals tend to have sparse social networks and to regard them as
providing little support. Reduced social support may lessen an individual’s ability to handle
negative life events and make him or her vulnerable to depression. This deficiency in social
support is likely because depressed people elicit negative reactions from others.

Depression and marital or family discord frequently co-occur, and the interactions
of depressed people and their spouses are characterized by hostility on both sides.

Several studies have demonstrated that the nonverbal behavior of depressed people
may play an important role. For example, others may find aversive such things as the
following: very slow speech, with silences and hesitations, negative self-disclosures, more
negative affect, poor maintenance of eye contact, and fewer expressions as well as more
negative facial expressions.

Perhaps as a result of being reared in a cold and rejecting environment, depressed

people seek reassurance that others truly care, but even when reassured, they are only
temporarily satisfied. Their negative self-concept causes them to doubt the truth of the
positive feedback they have received, and their constant efforts to be reassured come to
irritate others. Later, they actually seek out negative feedback, which, in a sense, validates
their negative self-concept. Rejection ultimately occurs because of the depressed person’s
inconsistent behavior.

Social world of depressed people are more complex, more difficult to manage, and
more effortful than those of people without depression.

Interpersonal difficulties and deficits may be a cause of depression as well as

consequence of it. For example, low social competence predicted the onset of depression
among elementary school children, poor interpersonal problem solving skills predicted
increase in depression in adolescents and marital discord predicted the onset of depression
in a community sample.

Biological Theories:

Genetic Data:

Research on genetic factors have used the family, twin and adoption methods.
Among the first degree relatives there are more cases of unipolar depression. Early onset
of depression, the presence of delusions, and comorbidity with an anxiety disorder, or
alcoholism confer the greater risk on relatives.
 Twin studies of unipolar depression consistently report higher concordances in
monozygotic than in dizygotic twins, with some suggestions that genetics may play a
stronger role in women than in men. Several small scale adoption studies have also
supported the idea that unipolar depression has a modest heritable component.

The Monoamine Hypothesis:

It suggests that depressive disorder is due to an abnormality in a monoamine

neurotransmitter system at one or more sites in the brain. Three monoamine transmitters
have been implicated: serotonin, nor adrenaline, and dopamine. The latter two
neurotransmitters are called catecholamines.

Endocrine abnormalities:

Abnormalities in endocrine function may be important in etiology for three reasons:

 Some disorders of endocrine function are followed by depressive disorders more

often than would be expressed by chance, suggesting a causative relationship.

 Endocrine abnormalities found in depressive disorder indicate that there may be a

disorder of the hypothalamic centers controlling the endocrine system.

 Hormones modulate the activity of monoamine neurotransmitters and could play a

part in producing some of the changes in monoamine function found in depressed
patients.

Treatment of Depression:

 Tricyclics such as imipramine (tofranil) and amitriptyline (Elavil)

 Selective serotonin reuptake inhibitors such as fluoxetine (Prozac) and sertraline

(zoloft)

 Monoamine oxidase inhibitors, such as tranylcypromine (parnate)

 Electroconvulsive therapy

 Relaxation Exercises

 Supportive therapy

 Cognitive therapy

 Family therapy

 Social skills training

 Assertiveness training