what did sullivan et al 2000 do
meta analysed twin studies and found 37% heritability
found two or threefold increase in depression risk in first degree offspring
systematic review of 141 studies investigating candidate genes for depression
what did norkeviciene et al 2020 do
systematic review of 141 studies investigating candidate genes for depression
insufficient data on links between genes and depression
what is monoamine theory
also called catecholamine and serotonin-dysregulation hypothesis
what is the evidence for monoamine hypothesis
drug research suggests link between serotonin and mood 1950s
Strawbridge et al 2023 = review - reserpine (blood pressure drug) has depressive effects - depleted stores of monoamines including serotonin
iproniazad - anti-tuberculosis drug shown to enhance mood - inhibited monoamine oxidase
antidepressant medications increase levels of serotonin in brain - monoamine oxidase inhibitors inhibit enzyme that breaks down serotonin
tricyclics and SSRIs block reuptake of serotonin
what is evidence against monoamine hypothesis
antidepressant drugs dont work immediately even though serotonin levels altered within minutes/hours
Bell et al 2001 = ‘tryptophan depletion’ (reduces serotonin) only reliably induces depressed mood in those with existing vulnerability
Harmer et al 2017 = antidepressants may act on cognitive processes in brain and negative attentional biases
THE SEROTONIN THEORY OF DEPRESSION: A SYSTEMATIC UMBRELLA REVIEW OF EVIDENCE 2022 - massive blow up after this article that questions serotonins role in depression
what is the basic principles of cognitive model
event - cognition - emotion
what is the cognitive model of depression
beck 1970
faulty info processing about self and situations
negative cognitive biases
negative interpretations of self/world/future
“negative automatic thoughts” believed to be accurate representations of reality
driven by cognitive structures/core beliefs (schema)
what are common unhelpful processes in cognitive model of depression
all-or-nothing thinking
overgeneralisation
personalisation (what did I do to cause this?)
mental filtering (pick out neg detail of situation)
jumping to conclusions
rumination (recurrent neg thinking about urself)
catastrophising (exaggerating importance of specific events)
minimising
disqualifying the positive
attentional biases towards negative material
what are cognitive factors in depression
neg triad (world/self/future)
neg cognitions fuel neg emotions
what is evidence for the cognitive model
mezulis 2004 = cross-cultural support for neg thinking biases in depressed patients
wenze et al 2007 = neg thinking predicts onset, relapse and recurrence of depression
mcleod 2002 = inducing bias to increase attention towards neg info increases depression and anxiety in controls
what studies support role of stressful life events in depression
marital problems and divorce = Kendler et al 1999
financial problems and unemployment = Paul and Moser 2009
sexual and physical abuse = Browne and Finkelhor 1986
accidents ie road traffic collisions = joormann et al 2022
Paykel 1969 (another flashcard)
what did paykel 1969 do
retrospective interviews with depressed patients (4 months was median duration) and controls
2x more life events 6 months prior to depressive episode in depressed patients than controls
what did kierman et al 1984 propose about depression
depression exacerbates/creates new interpersonal problems which maintain depression
BUT ALSO depression is a response to an adverse event
interpersonal issues and depression are in a reinforcing cycle
Kohler et al 2018
umbrella review of 70 meta-analyses found risk factors for depression of:
widowhood
physical abuse during childhood
obesity
sexual dysfunction
job strain
what is evidence against life events causing depression
not everyone with negative life events becomes depressed
what are the recommended treatments for depression in UK
least intrusive/most effective offered first
THEN stepped up to more intensive treatments
also accounts for patient differences
LESS SEVERE:
CBT-based: guided selfhelp, group CBT or group behavioural action (BA), CBT or BA
group exercise
group mindfulness
interpersonal psychotherapy
SSRIs
counselling/psychodynamic psychotherapy
SEVERE:
CBT/BA and antidepressants
problem solving
counselling
short-term psychodynamic psychotherapy or interpersonal psychotherapy
guided self-help or group exercise
ECT if other treatments unsuccessful
how do antidepressants work
daily
1-2 weeks to start having an effect
taken for at least 6 months
types of antidepressants
SSRIs
SNRIs
tricyclics
monoamine oxidase inhibitors (MAOs)
what is the hot cross bun model for CBT
Padesky and Greenberger 1995
neg automatic thoughts, emotions, behaviours and sensations feed one another
what is the basic CBT approach for depression
16-20 sessions
behavioural activation (increasing daily activities to reduce withdrawal)
cognitive restructuring (aware of and evaluating and testing neg thoughts)
relapse prevention
how does interpersonal psychotherapy work
16-20 weekly 1:1 sessions over 20 weeks
target key interpersonal problem/s thought to be maintaining depression
increasingly led by patient rather than therapist (structured but less than CBT)
opening sessions: collect info and create an interpersonal inventory where relationships are grouped according to four main problem areas
middle sessions: improve chosen problem areas
final sessions: deal with sense of loss associated with end of therapy
explore and address (normalise/alternative responses/new relationships) interpersonal problems
what did Cuijpers et al 2011 find about treatment for depression
meta-analysed research
243 RCTs examined psychological treatments for depression and pharmacotherapy
147 psychotherapy vs control
similar effects for psychotherapies
SSRIs marginally better than psychotherapy BUT higher drop out so about as effective if you take that into account
combined treatment (pharmacotherapy and psychotherapy) most effective
what are limitations to current research into treatments of depression
Cuijpers et al 2011
studies short-term treatment only
effect of psychotherapy likely to be overestimated
many poor quality studies
risk of publication bias
what did Cuijpers et al 2013 find about the long term effects of CBT vs pharmacotherapy
9 RCTs (N=506 patients)
follow up period of 12 months
no difference between acute CBT and continued pharmacotherapy
CBT found superior to acute pharmacotherapy
combined treatment more effective than pharmacotherapy alone
