Various Theories on Depression, and Respective Treatments
Depression is a complex mood disorder that is characterized by various emotions, including sadness, self-blame, absence of pleasure and an overall sense of worthlessness, and by physical responses relating to sleep, appetite and motor symptoms. According to statistics, one in four adults will suffer from a depressive episode at some point in life. With a quarter of the population affected by depression, it is no wonder that one sees so many advertisements both on television and on billboards relating to the disorder. It is also understandable that many intellectual fields of study would give an opinion on what depression truly means and how it can be treated. This paper will thus examine psychological, sociological, cultural and biological theories on depression and will describe various treatments that take into account expertise from these various areas of study to better understand this complex phenomenon. [1: Gray, P. (2007). Psychology. New York: Worth Publishers. ] [2: Puterbaugh, D.T. (2006). Communication Counseling as Part of a Treatment Plan for Depression. Retrieved from the Journal of Counseling and Development, 84(3), pp. 373-381. ]
The first theory attempting to explain what depression means that this work will describe is the psychological theory. This field of study differentiates between two main classes of depressive disorders: major depression and dysthymia. Major depression is exemplified by severe symptoms that can last for at least two weeks. Dysthymia lasts for a longer period, up to two years at least, but it is less severe in the symptomatic aspect. However, a person can experience both major depression and dysthymia concomitantly, and this is called double depression, though this is a much more rare form. [3: Gray, P. (2007). Psychology. New York: Worth Publishers. ] [4: Gray, P. (2007). Psychology. New York: Worth Publishers.]
Psychology also aims to find what the cause is for depressive episodes. Some believe that heredity and stressful experiences, also known as behavioral theory, are two main causes for depression. In a study conducted between 1995 and 1998 these two causes were combined in a study that included over 1000 women and their twin sisters. These individuals were identified and examined to see whether genetic predisposition could influence depression by influencing their response to stressful events. The study examined three elements:
1. whether a stressful event had been experienced recently by the woman,
2. whether a depressive period began within a short time (e.g. one month) after that event, and
3. whether the said person had a genetic predisposition for depression by studying the twin and whether she had a history as well.
The results of the study showed that within the group who had not experienced a stressful event, the incidence of depression was low "regardless of the level of genetic predisposition. However, in those women who had experienced a stressful life event, the incidence of depression "was strongly related to the level of genetic predisposition." [5: Gray, P. (2007). Psychology. New York: Worth Publishers.]
Other causes for depression include cognitive styles and other neural or evolutionary predispositions. From the cognitive perspective, depression may be brought on by negative patterns of thought and pessimistic ways of interpreting important occurrences. This theory, first observed by Aaron Beck, evolved from his "empirical observation of depressed patients' descriptions of their thought content through verbalization." Beck noticed that these people were extremely pessimistic and belittled the positive occurrences in their lives. Without professional help, these individuals were likely to believe wholeheartedly in the futility of their existence. [6: Gray, P. (2007). Psychology. New York: Worth Publishers. ] [7: Davidson, K.W., & Rickman, N., & Lesperance, F. (2004). Psychological Theories of Depression: Potential Application for the Prevention of Acute Coronary Syndrome Recurrence. Retrieved from Psychosomatic Medicine: Journal of Biobehaviaral Medicine, 66, pp. 165-173. Retrieved from http://www.psychosomaticmedicine.org/content/66/2/165.full#R16-1020.]
From the anatomical, most simple perspective, depression clearly stems from the brain. Most antidepressants therefore treat imbalances in the brain by increasing activity in either one of both of these neurotransmitters: serotonin and norepinephrine. Thus, some believe that depression is caused by some sort of imbalance in the brain and that the disorder is not based on personality, but simply based on anatomy. However, according to Gray, this theory has its pitfalls because it does not explain why drug treatment effectiveness is sometimes delayed and why most people who experience depression do not seem to have low levels of these two neurotransmitters. The most likely explanation, according to this author, is that when one experiences high levels of stress certain areas of the brain "take over," and thus the levels of these two neurotransmitters can fluctuate over extended periods of time. [8: Helpguide.org. (2011). Antidepressants: What you need to know about depression medication. Retrieved April 11, 2011, from http://helpguide.org/mental/medications_depression.htm.]
The last perspective is called the evolutionary basis for depression because it has been suggested that depression is a form of inability to adapt or a mirror of past routines. One such example is seasonal affective disorder, which simply means that, especially in winter, a person will experience changes in behavior that have been traditionally associated with our ancestors' need to adapt to the season (i.e. increased sleepiness to conserve energy and survive the cold). Another well-known example is the period of sadness experienced after a significant loss, which can be characterized by crying or other expression of sadness, according to Gray. [9: Gray, P. (2007). Psychology. New York: Worth Publishers. ]
Psychological theory thus posits two main kinds of depression, and explains at least five causes for depressive episodes. Some of these explanations have been tested by studies, such as the heredity and stress causes, which have been successfully shown to be a major cause of depression. However, explanations of the disorder, and causes, can be examined differently, as will be shown by the next few paragraphs.
Sociology, the study of groups, culture, social institutions and their effects on people, is different from psychology its approach to understanding depression. The sociology of depression encompasses "the cultural context in which people live, as well as the social stressors that people encounter as a part of life." This idea further continues by stating, "The sociological aspects of depression are both influenced by and also influence the other biological and psychological aspects of people's lives." Sociology does not attempt to define depression, but rather place it within cultural context and thereby extract various causal factors for different views on this disorder.
Within this field, culture and ethnicity are important all health-related aspects, but especially to mental illnesses. A culture's perception on a certain illness is also important because it can shape a person's own outlook on his or her condition. Until recently, it was believed that only "Western" nations fought with the problem of depression, but it has been proven that all humans can suffer from this disorder. Whereas in the West, depression is recognized as a disorder and there are steps one can take to treat it, in other parts of the world perception of this disorder does not necessarily give it a label or admit it exists. In India, for example, distress disorders are widely characterized as depressive, but in Japan, the idea of "mental illness" is not culturally acceptable, so few people will admit to any symptoms. [10: Nemade, R. & Staats-Reiss, N., & Dombeck, M. (2007). Sociology of Depression -- Effects of Culture. Retrieved April 11, 2011, from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13009. ] [11: Nemade, R. & Staats-Reiss, N., & Dombeck, M. (2007). Sociology of Depression -- Effects of Culture. Retrieved April 11, 2011, from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13009. ]
Another example is the individual vs. group theory, where it is posited that in group-oriented or family-oriented cultures, one will sacrifice happiness for the well-being of the group, whereas in autonomous or individualistic cultures, depression will be more easily classified or accepted. The group-oriented cultures often also take into account gender roles, so in this case, a male who is depressed is unacceptable to the well-being and good function of such a group. Such as male would know this, and would have shame in admitting there is a problem, thereby hiding his feelings. In some countries, hiding depression from oneself or from others can lead to drastic consequence, including death by suicide. The sociological aspects of depression are thus illuminating when placed in the group context, especially for their importance to the study of depression. [12: Scheff, T.J. (2000). Shame and Community: Social Components in Depression. Retrieved April 11, 2011, from http://www.soc.ucsb.edu/faculty/scheff/12.html. ]
Cultural theories for depression are similar to the above-described, group-based, sociological definitions. Cultural theory focuses on, again, understanding and finding a way to treat depression. Various differences in cultures around the world can and will impede detection of depression, however, in part due to some of the sociological factors described above. For example, in Arab cultures, guilt and suicide are rarely discussed. The word guilt has various negative connotations, including "sin" or anti-religious behavior. Suicide, which is strongly condemned in Islam, is also…
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