TYPES, CHARACTERISTICS, EXAMPLES AND SEX DIFFERENCES
Abnormal affect refers to abnormal disorders related to moods and emotions. According to the DSM-IV, mood disorders are “mental disorders characterised by disturbances of mood that are intense and persistent enough to be clearly maladaptive”.
The two main mood disorders are unipolar depression and bipolar mania. “Unipolar” refers to mood disorders in which a person experiences only one type of episode, and depressive episodes are the most common. “Bipolar” refers to mood disorders in which a person experiences two different episodes, usually depression with mania.
Feeling depressed from time to time is pretty normal (particularly during the weeks without Castle), but clinical depression is something that will affect a person’s overall performance for a prolonged time. The DSM-IV states that the symptoms must be present daily for at least two weeks for a person to be diagnosed as depressed.
Symptoms of clinical depression:
- Emotional symptoms – intense sadness, guilt, worthlessness, lack of pleasure
- Motivational symptoms – passivity, social withdrawal, less interest
- Cognitive symptoms – negative thoughts, lack of concentration, low self-esteem, difficulty in decision-making
- Somatic symptoms – disturbances in weight, appetite, sex drive, sleep, energy
Bipolar disorders are characterised by alternating episodes of depression and mania, so this illness is also known as “manic depression”. Depression is intense sadness (look above) while mania is intense euphoria. There are two main sub-types of bipolar disorder: bipolar I and bipolar II. A person with bipolar I has manic episodes while a person with bipolar II has hypomanic (slightly more manic) episodes. The DSM-IV states that a person must experience an elevated or irritable mood with at least three additional symptoms lasting for one week.
Symptoms of mania:
- Emotional symptoms – increased pleasure in everything
- Motivation symptoms – increased interest goal-directed activities, unrealistic goals
- Cognitive symptoms – inflated self-esteem, overconfidence
- Somatic symptoms – decreased need for sleep, lots of energy, increased sex drive, hyperactivity
A major symptom in depression and bipolar disorder is suicidal thoughts or a fixation with death. Many patients of these two disorders have tried to commit suicide.
Causes and treatments for manic depression
The exact cause of manic depression has not yet been discovered.
Bipolar disorder seems to have some roots in our genes. Many studies have been conducted to determine the role of genes in this mental illness, and the following information has been collected:
- About 50% of bipolar patients have a family member with a similar mood disorder, like depression.
- A person with one bipolar parent also has a 15-25% chance of having the same condition.
- Dizygotic twins have a 25% chance of both being diagnosed with manic depression.
- Monozygotic twins are eight times more likely to both develop manic depression, compared to DZ twins.
Manic depression primarily occurs in a specific area of the brain and is thought to be due to the malfunctioning of neurotransmitters like serotonin. This mental illness may lie dormant (inactive) for a long period of time or it may become activated. It is also possible that the person is biochemically vulnerable to manic depression but does not experience it until it is triggered by another factor.
A certain life event may trigger the mood episode (depression or mania) in a person who has a genetic predisposition for bipolar disorder. Other things like alcoholism, drug abuse or hormonal imbalances may also act as triggers. Although substance abuse is not a cause of bipolar disorder, it can worsen the illness or heighten its symptoms. This mental illness is appearing in people at an increasingly early age; this may point to social or environmental factors that are related to this stage.
Treatments for manic depression:
Manic depression is a long-term and often chronic condition, however, there are still various methods of treatment available. Treatment can be divided into three broad categories:
- ACUTE treatment focuses on suppressing present symptoms and is continued until remission (when symptoms are diminishing).
- CONTINUATION treatment prevents symptoms of a specific manic or depressive episode from returning.
- MAINTENANCE treatment prevents symptoms from reoccurring.
Some common methods of treatment are:
- Mood stabilisers: Lithium is an older medication. It is reliable and generally well-tolerated by most patients. Other older medications are effective and accepted but they are slowly being replaced.
- Atypical antipsychotics: These are newer, expensive medications. They offer relief from many symptoms but their side effects can sometimes be concerning.
- Psychotherapy: Psychotherapies and similar strategies involving therapists can be very helpful in keeping a patient stable and helping them to avoid relapse.
- Combination therapy: This refers to a combination of medications that work together to treat symptoms more effectively.
Sex differences in depression
From adolescence to adulthood, women are twice as likely as men to experience depression. There have been numerous attempts to explain this prevalence in females but the debate continues. Several risk factors have been identified and studied, namely: hormones, socialisation, coping strategies, social roles, cultural influence and reaction to stress.
The peak of the onset of depression in women coincides with their ‘reproductive years’. This suggests that hormones may have a role in this process. 20% of women report feeling depressed after giving birth while 43% of women say that they have experienced depressive symptoms during their menstrual cycle. Oestrogen and progesterone have been seen to have effects on the brain’s neurotransmitters, thus leading to a chemical imbalance.
As society pumps our boys to be independent and strong-willed, girls are still led towards sensitivity and dependence. This doesn’t just happen in Asian countries, it takes place everywhere. In the West, where women are plastered over billboards in little clothing and encouraged to “do this, do that” to “please their men”, women would also experience negative emotions. Many women are stuck seeking validation from others, sometimes creating a bubble of hopelessness which results in depression. Some researchers also think that housewives and mothers may feel devalued or unimportant in society while career-oriented women face discrimination and inequality, as well as conflicting feelings of guilt if they are working mothers.
Some studies have also shown that women’s coping styles are focused on emotions and reflection while men prefer problem-solving and distractions. Some researchers have theorised that this coping style leads to longer and more severe depressive episodes for women.
Evidence also suggests that women experience relatively more stressful events in life, compared to most men. This is obviously debatable. Studies have shown that adult women are more likely than adult men to have experienced a stressful event around six months before having a major depressive episode.
Finally, some psychologists have suggested that there is no significant sex difference with regards to depression. They suggest that the difference may simply come from most men’s reluctance to seek help for their depression, making them less diagnosed than women.
EXPLANATIONS OF DEPRESSION
Martin Seligman actually referred to depression as the “common cold” of psychological disorders because of how frequently it is diagnosed in the population. Different schools in psychology have put forward their explanations for the occurrence and characteristics of this mental illness.
Depression can be described as “hereditary” because it seems to run in families. Paul Wender (1986) found that the biological parents of adopted children who had experienced depression were eight times more likely to have also experienced major depression and 15 times more likely to have attempted suicide than the adopted parents.
Peter McGuffin found that monozygotic twins have a 46% chance of being concordant for depression while dizygotic twins have a 20% concordance rate. Martin Allen (1976) also conducted a study and concluded concordance rates for depression of 40% for MZ twins and 11% for DZ twins.
Myrna Weissman (1987) looked at the frequency of mood disorders in general and found that family members with a parent or sibling who suffered from a mood disorder were ten times more likely to suffer from one too. Elliot Gershon (1990) conducted a study and found that the incidence of depression is three times higher in families with a history of the disorder, compared to the general population.
Genes that are thought to be associated with depression include the ones involved in the synthesis and transmission of serotonin.
Initially, it was thought that low levels of norepinephrine or serotonin had an impact on moods. Recent data shows that moods seem to be the result of interactions between both serotonin and norepinephrine systems.
Joseph Schildkraut (1965) also found that high levels of noradrenaline led to mania but low levels led to depression. Since noradrenaline is chemically very similar to adrenaline, this makes sense. Think about how adrenaline can pump you up and make you feel much more active and how the opposite of this feeling is just lethargy. Schildkraut believed that serotonin would behave in the same way but more recent data disproved this theory.
Leonard Rampello (2002) claimed that moods are the result of an imbalance of certain neurotransmitters, like serotonin; serotonin may provide top-level control over various brain systems and so low levels of it would disrupt brain activities and result in a depressive episode.
Beck’s cognitive theory:
According to Aaron Beck, an American psychiatrist, depression is the result of faulty cognitive processes and a set of negative schemas. His theory states that depressed people are unrealistically and illogically negative about three things:
- Themselves (e.g. “I am a terrible human being.”)
- Their experiences (e.g. “My life is just horrible.”)
- Their future (e.g. “My life will remain horrible forever.”)
This is called Beck’s cognitive triad.
Beck also claimed that the life of a depressed person is dominated by a set of beliefs that end up shaping their conscious thoughts. Their assumptions are basically derived from other people in society. For example: “I must be valued by others and others must consider me important, or I have no value at all and I am unimportant.”
This theory also discusses how depressed individuals are likely to misinterpret external information. They are pessimistic and self-blaming, thus leading to their depression. Their negative schemas completely affect their life. They may deem themselves unfit for university simply because they failed an English exam, or declare themselves useless just because it rained on the day of their picnic.
So, basically, Beck’s theory had three main points:
- A cognitive triad
- Random, silent assumptions
- Faulty information processing
Behavioural explanations of depression typically focus on the operant conditioning process. Operant conditioning is when behaviour is positively reinforced with rewards or negatively reinforced by punishments. Peter Lewinsohn suggested that depression is caused by low levels of positive social reinforcement.
Learned helplessness/attributional style:
The most common theory is Martin Seligman’s “learned helplessness”. This refers to a person becoming so accustomed to (used to) negative situations that eventually they become passive and do not attempt to escape or avoid negativity, even when the opportunity to avoid it is present.
Seligman and Maier (1967) conducted a study involving dogs and electric shocks “to the feet” (cause that’s like, so much more humane). They used two conditions: one condition in which dogs could jump and escape the shocks, and one condition in which the shocks were inescapable. After putting the dogs through all this, they conducted a follow-up study to re-test the dogs. They found that the dogs who were forced to endure electric shocks did not even bother trying to escape from shocks even when given an opportunity to jump away. They had developed a “learned helplessness”.
If you are good at A-level psychology, you may be wondering: “Yeah alright then mate, but what would humans do?” Well… Donald Hiroto (1974) got human participants to endure an inescapable loud noise. In the follow-up experiment, participants were given a handle to turn the sound off. However, they still sat back and endured the noise… weird.
Seligman compared this to some symptoms of depression, such as passivity. Their research was also supported by tests that showed a reduced amount of serotonin and noradrenalin in rats who had also become helpless in this way. It was suggested that depression results from learning that your physical or social environment is uncontrollable. A person believes they were unable to control unpleasant experiences in the past, so they meet future unpleasant experiences with passivity and develop a depression.
However, this theory is not applicable to everybody; many depressed patients blame only themselves and, furthermore, many people do not become helpless in such situations. This distinction between people who adapt and people who break down under long-term psychological stress was studied. It led to the emergence of the attribution theory of depression. This theory states that people may experience similar or identical negative events, but the chances of developing learned helplessness and depression depends on how the person interprets that event. So, depression basically results from the person’s cognitive interpretations of the experience.
It is evident that regardless of attributional styles, people who go through uncontrollable events (e.g. accidents and assults) will suffer physically or mentally to some degree. However, evidence shows us that people with negative attributional styles or pessimistic explanatory styles are more likely to develop a learned helplessness that ends in depression. Some research shows that the more people see events to be uncontrollable and unpredictable, the more stressful their life seems and the more hopeless they feel.
TREATMENTS FOR DEPRESSION
Since the biological explanation for depression looks at faulty neurotransmitters and chemical imbalance, the treatment also addresses these factors.
Antidepressants are very common when treating depression and they are of four types: atypical antidepressants, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs).
- Atypical antidepressants – Some newer atypical antidepressants target neurotransmitters alone or along with serotonin. Side effects do vary, but the most common include: fatigue, weight gain, blurred vision, nausea and sleepiness. Wellbutrin, Effexor, Remeron and Desyrel are some examples.
- Tricyclic antidepressants – These are one of the oldest antidepressants and get their name from their three-carbon ring structure. They inhibit the brain’s reuptake of serotonin and norepinephrine. They also partially inhibit the brain from reabsorbing dopamine. They take about two weeks to provide symptom relief and are known to have the most side effects, including: weight gain, blurred vision, nausea, increased heart rate, dry mouth, sexual performance problems, abnormal heart rhythm and constipation. More seriously, they can be lethal (cause death) in extreme circumstances. Elavil, Anafranil, Tofranil and Vivactil are some examples.
- SSRIs – These are the most commonly prescribed antidepressants. They act on serotonin by inhibiting its uptake, and they have relatively less severe side effects. It is also practically impossible to overdose on them. Their side effects include: fatigue, weight loss or gain, insomnia, nausea, tremors, sweating, dizziness, headaches and restlessness. However, cases of extreme violence and suicide have been associated with these antidepressants. Prozac, Zoloft, Paxil and Luvoc are some examples.
- MAOIs – These are the oldest available antidepressants. They have drastic reactions with certain things like yeast, bananas and fish. They basically inhibit the actions of monoamine oxidase, resulting in higher levels of serotonin and noradrenaline in the synapse. MAOIs are seen as the least effective antidepressants. Some of their common side effects include: weight gain, insomnia, dizziness, headaches and daytime sleepiness. Marplan, Emsam and Parnate are some examples.
ECT was introduced by Ugo Cerletti and Lucio Bini in the mid-1930s. It has been used for various disorders in the past, including alcoholism and eating disorders. In modern times, it is used very rarely and is often a last resort in cases where absolutely nothing else is working, like for major depression. This is mostly because successful drug therapy, cognitive treatments and psychotherapies have been introduced. People believe these kinds of treatments are more humane and that ECT is more like kicking a computer to make it work normally. It is not yet clear exactly what ECT does to a person, meaning that doctors are even more reluctant to use it.
In ECT, an electrical current is passed through a patient’s brain for a few seconds, resulting in a seizure (fit). The body goes into convulsions but the patient is given a muscle relaxant which relatively soothes this. A mouth gag and other precautions are taken to prevent the patient from accidentally hurting themselves. The side effects include short-term memory loss, dizziness and confusion. The patient is also given oxygen after the procedure because the muscle relaxant can affect their breathing.
In the past, when ECT was first introduced, many patients died because of heart problems. Now all patients’ medical records are thoroughly checked before even considering this treatment.
One problem with drug therapy is careless diagnoses. In 2004, a survey of general practitioners in England found that 80% of them admitted to prescribing Prozac or Seroxat when their patient may have simply just needed somebody to discuss their problems with.
Also, drugs aren’t really a cure for depression. They are palliative, meaning that they may numb the symptoms or make the individual feel better but it is a temporary state. One study showed that patients who received cognitive therapy instead of drug therapy had a much smaller relapse rate than patients who were just given drug therapy. These significant relapse rates show that once patients are taken off a drug, their symptoms eventually return, meaning that the cause of depression was not really treated.
Aaron Beck was behind the emergence of cognitive therapy in the 1960s. In the cognitive-based treatment for depression, the cognitive restructuring technique is used to fix harmful, negative thoughts and introduce a logical, adaptive thinking style. This technique uses reason and evidence instead of unlikely optimism when replacing distorted thought patterns with realistic and effective cognitions.
The process has two steps:
- Identify the thoughts/beliefs that influence disturbing emotions
- Evaluate their accuracy and usefulness with logic and evidence
If needed, the damaging cognitions are modified or replaced.
A patient of depression who uses this cognitive restructuring technique would be guided by their therapist. Therapy encourages patients to be aware of their own cognitions and evaluate them appropriately. Like this, the patient learns to distinguish between faulty cognitions and healthy cognitions. The therapist’s job is to guide the patient towards making their own conclusions, not pointing everything out themselves.
Patients with depression may have “automatic thoughts” in response to some situations. Automatic refers to the spontaneous thoughts that encourage negativity and illogicality. They are described as follows:
- Always believing the worst will happen (e.g. “My boss didn’t talk to me today… I must be about to lose my job!”)
- Always blaming oneself (e.g. “Why isn’t Emma Watson picking up the phone? I must be really unlikeable.”)
- Always exaggerating negativity instead of positivity (e.g. “I got a bonus but my colleague got a higher bonus… I must be totally incompetent and talentless.”)
Rational emotive therapy (Ellis, 1962):
RET is a type of cognitive therapy, developed by Albert Ellis in the 1950s. The crux of this therapy is that all individuals have strict, irrational and rigid beliefs that result in unhealthy thinking patterns and mental disturbances. RET involves a therapist encouraging their patient to recognise such beliefs and replace them with logical, flexible patterns. This occurs after a period of self-analysis. The patient is given daily re-learning exercises during which they can practice their newly improved, healthier cognitive styles.