The authors aim is to produce a case study containing all information on the individual in question. Then to diagnose the illness and the long term effects and prognosis for them.
Depression is a major illness, however many people think it’s not a real illness because they cannot see it. It is a mood disorder that debilitates the suffer, as it affects the person as a whole: in body, moods and thoughts. It is so serious it can completely affect everyday life, such as: eating, sleeping and how you perceive things and feeling worthless. This is more than a passing mood especially with sign of extreme sadness, irritability or slow but these episodes lasts for weeks, months or years; not just a few days.(About.com, 2007). If it is left untreated, these will really impact on everyday routines.
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Depression is an illness that can affect anyone, at any age. This includes children. However, it is more likely to occur if there is a family history of depression. Also studies show woman are more likely to suffer from depression then men. Additionally, 2% of teens suffer from depression in the UK (NHS, 2009).
Types of Depression
Experts are unable to find the cause of depression, however, complex factors such as; physical, environmental and social factors have a part to play. Furthermore, chemical imbalance is thought to be a cause. Depression can range from mild to severe depression. Health professionals have different terms to describe it: depression, depressive illness and clinical depression. Someone who is severely depressed may also show signs of psychotic symptoms (NHS, 2009).
Major depression, is the most severe form which may occur as a single or reoccurring episode. Most of the symptoms will be present and this manifests with the individuals ability to carry on with a normal routine of eating, sleeping and working. With this they also lose interest in any activities they enjoyed doing and feel sad, worthless and hopeless (Psychology info.com, 2009).
Dysthymia is chronic depression, which is much milder form than major depression. The symptoms are the same but less severe. This type of depression go on for years without the suffer realising and being diagnosed. The sufferer would just carry on with their daily routine, all the while they may believe something is not as it should be (Psychology info.com, 2009).
Bipolar used to be known as manic depression. Emotional episodes of depression followed by episodes of high (mania) mood. These episodes can last many weeks. Changes in mood, behaviour and thoughts are the characteristics bipolar; however, suicide rates are high in suffers of manic depression (NHS, 2009).
Atypical depression is slightly different from major depression. The individual is able to experience temporarily happiness, whereas a major depressive will always feel low. This can last months or a lifetime. “People who suffer from atypical depression believe that outside events control their mood”(About.com, 2004).
Psychotic depression is where individuals hear and see imaginary things, none of which exist: Negative hallucinations. This is a classic symptom of schizophrenia. “The sufferer of psychotic depression imagines frightening and negative sounds and images” (About.com, 2004).
Postpartum depression affects 10-15% of women after childbirth (Women’s Health, 2010). The cause is not know, however it is suggested it is the hormonal change after birth. This can be severe or mild, in which case medication can be prescribed or a support network to help alleviate symptoms.
SAD (seasonal affective disorder) and PDD (premenstrual dysphonic disorder) are less serious forms of depression that can occur.
Symptoms
Symptoms of depression are varied depending on the depth and severity of the condition but also factors such as: physical, psychological and social. Each individual’s symptoms may be different to the next person. Depression changes an individual’s personality. It also causes changes in; thinking, feeling and behaviour. Physical symptoms can be: a change of appetitive/weight, lack of energy, insomnia and feeling or moving slow. Social symptoms can be: lack of interest in hobbies or past-times, home/family life traumas and isolation. Psychological symptoms can be: low self-esteem, guilty, irritable, worthlessness and hopelessness, no motivation, anxiety or stress and bad thoughts (NHS, 2009). Also constipation, slow speech and suicidal thoughts.
Diagnosis
Depression is very widespread and can affect men, women and children alike. When an individual thinks they are suffering from depression, they need to seek professional help from their GP. There is no clinical test to diagnose depression. However, the GP will talk symptoms through in an in depth interview to find your characteristic symptoms; listed on DSM-IV and ICD. These are classified systems put in place which have details of all recorded symptoms related to mental health. The GP may give you a questionnaire (BDI) to fill out along side the symptoms. After the GP has made the initial diagnosis, they will then advise on treatments for the condition. This could be anti-depressants, counselling or even further referral to specific professional (NHS, 2009).
Beck’s Depression Inventory (BDI) is a list of self reporting questions rated from 0 (symptoms not present) to 4 (severe symptoms). This system was developed by Aaron Beck in 1961 and revised after the introduction of DSM-IV, in 1996 (Statistic Solution, 2009)
Beck considered cognitive symptoms of depression rather than seeing it as a self destructive and inwardly displaced anger (psychology 4A).
Profile of Individual
Mary is a woman of 46 years who initially studied to be a secretary, but went on to study Fashion and interior design. Mary’s working history is not disclosed.
She was the eldest child of a dysfunctional family. Mary moved out at the age of 17 years, taking with her, all her siblings, thus becoming their support system.
Mary fears abandonment and this caused her to suffer deep anxieties in marriage and family commitments. However, she did have one close friend.
Mary displayed the following symptoms to the GP: low energy, heart palpitations, menstrual problems, shaking and trembling, constipation and insomnia. Mary had previously been treated with hormone therapy and antidepressants but she considered these treatments had made the condition worse and therefore felt more anxious and withdrawn. Furthermore, when Mary started therapy she displayed suicidal feelings and immense anger and resentment towards her mother, poor communication with her husband and anger and frustration towards her oldest daughter (DLCentre, 2008).
Family Profile and Social Networks
Mary came from a dysfunctional family. Her parents both had addictive personalities. Her father was an alcoholic and suffered from Casanova complex, thus having 23 children from nine different women, and had married five times. Furthermore, he was not married to her mother at the time Mary was born, but to someone else. His addiction to alcohol meant that he was verbally and physically abusive.
Mary’s parents did marry but also got divorced when she was six. Mary’s mother became a divorcee with illegitimate children and became an outsider in the small town they lived in, so they moved to London. This had a major affect on Mary’s mother who became angry and used extreme violence towards her children. Mary at seventeen could not take any more and decided to take her siblings and moved out, which made her the main support for her siblings.
Mary went on to marry a dentist who promised to stay with her for life, so she dedicated herself to her husband and two daughters. Mary only managed to have one close personal friend who she confided in but never disclosed details of her past (DLCentre, 2008).
Outline the Onset and Progression of the Condition
Previous to Mary visiting the GP, her condition was quite severe as she had no interest to do anything. Mary’s physical symptoms included; low energy, heart palpitations, menstrual problems, shaking and trembling, bad breath, constipation and insomnia. Mary also had a medical history of cysts in the pancreas, liver and intestines. With the commencement of therapy, Mary showed suicidal feelings and immense anger and resentment towards her mother, poor communication with her husband and anger and frustration towards her oldest daughter (DLCentre, 2008).
From these symptoms, it could be concluded that Mary was indeed suffering from a major depressive disorder (Psychology 4A).
Looking at Mary’s past life, there are many factors they may have been a contributing factor to her depression. Her parents both had addictive personalities but her father was verbally and physically abusive and left her mother. Her mother became angry and violent towards Mary and her siblings after being abandoned by her husband. This reinforces negative fear of abandonment (DLCentre, 2008).
Major depression is extremely common but also it is the most severe form. If left untreated the symptoms will not subside, but just get worse and can lead to suicidal thoughts and action. The symptoms consume the individual and this intense materialization of symptoms will then affect the person’s ability to function. The individual then loses interest in everything (Overcome Depression, 2010).
Depression can run in families or be triggered from a single event or trauma. Some individuals develop depression with no real cause which could last for one episode to many episodes Gershon (1990) found that the prevalence of depression is up to three times higher in families with a history of the disorder than it is within the general population as a whole. Also Wiessman (1987) suggests that first degree family members with mood disorders were more likely to suffer from mental illnesses (Cited by Psychology 4A).
Interventions
Once a GP have made the initial assessment after an in depth interview about background and family history (included genetic), they will suggest a treatment, which can be drugs, talking therapies and self help (NHS, 2009). Treatment differs depending on mild or severe cases of depression.
Socialisation and Role Theory
Therapy or counselling involves discussing thoughts (conscious or unconscious) and feelings from the past to present day. From there the therapist would be able to decipher the information and uncover any abnormalities or underlying problems that may be the root cause of the disorder. They will be able to then offer recommendations and guidance to alleviate the individual’s symptoms by evaluating their thoughts and how they can deal with them. This would give them the tools to deal with their problems on a conscious level so they can deal with everyday life. Before this can happen the therapist will have to secure trust with the individual, to build a safe relationship with open communication channels.
In the situation of Mary, this would allow her to deal with her most immediate issues, allowing her to slowly deal with everyday routines and then progress to past issues. Furthermore, feeling secure and safe is essential with her relationship with the therapist. This will allow her to open up and talk about issues instead of keeping them inside and will also help to reconcile with her husband and daughters and open up communication with them and build network of social support. Her husband and support network must also be supportive and this must include conversation skills and non verbal communication.
How Mary Could Be Treated
First a diagnosis from the GP will be needed. They will asses Mary, including the background and family history, just to see if there may be a genetic or history of depression link. Once this initial step has been completed, effective treatments will be suggested. In Mary’s situation, this may be more than one therapy.
Drug therapy such as SSRI, as they increase the serotonin level in the brain and give the body a natural high but calm feeling. These are less likely to have side effects for Mary. However, research shows that drugs are not the most effective method, when comparing to cognitive therapy, but short-term may help take the edge of her symptoms (NHS, 2009).
Electro convulsive therapy would not be suitable. It induces convulsions by electric shock which can cause memory loss. This treatment can be effective in some but with the deep rooted cause being associated with her parents, ECT may not be in her best interest (Psychology 4A).
Cognitive behavioural therapy would be the best approach to take. It deals with the way people process negative thoughts and issues and the cause of problem. CBT therapy replaces negative and irrational thoughts to positive and rational thoughts and works on the ‘here and now’ whilst having a safe, secure relationship with the therapist. The therapist will set goals for Mary to attain, which may start with writing a daily diary of how she is feeling and what thoughts she has. This is a positive step and the therapist will analyze and work on issues and thoughts raised in the diary by breaking each problem in to smaller more manageable issues (RcPsych.ac.uk, 2009). CBT is one of the best therapies to have alongside antidepressants, in Mary’s situation as CBT is a slow process and is not a quick fix.
With Mary’s relationship problems including the violent relationship with her mother and father, it may also be good to introduce Interpersonal therapy along with CBT. This focuses more on relationships in the past and present day and looks at why they went wrong. This would help Mary greatly as she has a fear of abandonment, anger and resentment towards her mother and daughter. By working through these past and present relationships, Mary can learn to communicate with her husband and daughter to learn to have a relationship with them both again. This will benefit Mary for the future in making friendships with more people (DLCentre, 2000). However, CBT and Interpersonal therapies are not for everyone. It takes great courage to open up and discuss their thought and feelings. Also, another point to discuss is in some therapist/ patient relationships transference can occur. This is the redirecting of feelings, fears or emotions towards the therapist.
Many of these therapies would be good for Mary as it explores her past and all areas of her life she had shut away. It will help her move on and in most cases come to terms with the past but also look to the present and the effects her depression may have on her children, so effectively to stop history repeating itself.
The Effectiveness of Interventions
Depression can be treated in many ways: drug, electro, psychodynamic and cognitive therapy.
Drug Therapy
Trycyclics
These are: dothiepin, imipramine and amitryptyline and treat different degrees of depression. These work by raising the levels of the chemicals in your brain, which help to lift your mood and alleviate the symptoms (NHS, 2009). These drugs help in 70-80% of cases (DLCentre, 2000).
MAOI’s
These are: nardil or phenelzine sulphate, is at times used to help treat ‘atypical depression’, the sufferer tends to eat and sleep more than they normally would (NHS, 2009). These are said to be more effective in depression cases that have additional problems like anxiety (DLCentre, 2000).
Bennett (2006) suggests these only have a 50% success rate (Psychology4A).
SSRI’s
These are: Fluoxetine, citalopram and sertraline and have less side effects.
SSRIs increase the level of a natural chemical in your brain called serotonin, which lifts your mood. Research shows that there is a risk of self-harm and suicidal behaviour may amplify if they are used to treat depression in children under 18 years (NHS, 2009).
Antidepressants do not work straight away. They can take 2-4 weeks to get into the body. They can have many side effects or some can cause suicidal thoughts. It is thought that antidepressants are hugely over prescribed, which was shown in the 2004 GP Survey where 80% had prescribed when possibly there was no need to(Psychology 4A).However,they have many side-effects and are not the right treatment for everyone. It can also cause problems if the individual is taking certain medication such as, anticonvulsants and also can reduce the effect of the contraceptive pill.
Electro Convulsive Therapy (ECT)
This is mainly a last resort when drugs fail. Anaesthetic is administered which is followed by a muscle relaxant. This method is 80-110 volts shock administered to the patient. This is applied at the temples, either both (bilateral) or attached to non-dominant hemisphere (unilateral) (DLCentre, 2000). Petrides et al (2001) found that between 65% and 85% of patients had a ‘favourable response’ to ECT, which suggest that ECT can be effective. However, side effects can be memory-loss and Breggin (1997) argues that there is little evidence that shows beneficial results last more than 4 weeks. However, ECT works when all other therapies fail (Psychology 4A).
Cognitive Behavioural Therapy (CBT)
Developed by Aaron T. Beck, it combines primarily the cognitive model with aspects of psychoanalysis and behaviour therapy and is seen as the most effective. The aim of CBT is ‘cognitive restructuring’ designed to bring about ‘lasting changes in target emotions and behaviour’ (Wessler 1986, Cited by Psychology 4A).
CBT has been extensively used by many therapists over time and has been revised with each therapist and changed for their individual procedures. However, they all have various characteristics in common and Beck and Weishaar (1989).
This therapy involves talking to a therapist. Therapists give positive reinforcement to irrational thoughts and low moods. So the client can be encouraged to respond to a thought by saying “I am good at this”. It also sets attainable goals for the individual. CBT is the best treatment as it gets to the root cause rather than using drugs to lift your mood: which doesn’t get to the cause. Whish is suggested by a study by Rush et al (1977) showed CBT to be more effective in reducing low mood than the drug imimprimine (Cited by Psychology 4A). However, although effective this therapy is not a quick fix and can be costly and time consuming to get to results.
Psychodynamic Therapy
This therapy analyzes feelings of loss and abandonment by free association. Regression to earlier stages of life to gage the cause of feelings can be practised. This allows the client to learn from these experiences and accept them (DLCentre, 2000). This again is good at getting to the root cause of the depression and can be effective but costly and time consuming.
Combining two treatments can work better than just one. For example, cognitive and drug therapy (Psychology Information Online).However, consideration needs to be taken as treatments and individual symptoms differ from person to person, so what works for one may not work for the other.
Likely Prognosis for the Future
If a family member suffers from depression, there is a bigger chance of other members of the family will suffer with depression. Full recovery is possible with the correct treatment for that individual. However, there are instances where a trigger can cause a further episode.
There is no reason why Mary could not make a full recovery with a combination of CBT and drug therapy. Her life should improve and thoughts of suicide and her negative thoughts and feelings should subside over a period of time. This will endeavour to improve her relationship with her husband and daughter.
Summary
Depression is a real condition that debilitates the person suffering. This means the sufferer is unable to function properly in their daily routine. However, people tend to generalise the condition by stating it’s only a blue mood and expect them to snap out of it, but it is not that simple as depression is far more complex then that. Symptoms of depression differ from person to person, so not everyone will have the same symptoms which also mean the severity of depression differs. Depression can be genetic, or caused by emotional trigger or by no real reason at all. It is also more apparent that if a first degree family member suffers from depression, other members may follow.
Treatment for depression is not regimental. Each case is assessed and evaluated separately and treatment is specific for that individual. The best form of therapy is a combination of drug and cognitive therapies. However, this may not work for everyone and people respond to treatment differently.
Mary’s depression was brought on by complex factors of childhood which left her having a dysfunctional upbringing with violence and abusive parents. All this and more lead to her severe depression. With the right combination of treatment discussed, she should improve her life and feel much happier and improve her immediate relationships.
REFERENCING
DLCentre (2008), Dip_Social_roles_asses. UK: DLCentre
Hayday. K, Maciejkowicz .B, DLCentre (2000), Unit 4: Affective Disorders, p2-15. DLCentre
Berhman, A. (2004) [Online] Types of Depression. Available at:
http://depression.about.com/od/mooddisordertypes/p/depressiontypes.htm [Accessed 2nd May 2010]
Schimelpfening, N. (2007) [Online] 7 Most Common Types of Depression. Available at:
http://depression.about.com/od/mooddisordertypes/tp/types.htm [Accessed 2nd May 2010]
NHS (2009) [Online] Depression: Types of Depression. Available at:
http://www.nhs.uk/conditions/depression/Pages/Introduction.aspx [Accessed 2nd May 2010]
Psychologyinfo.com (2009) [Online] Major Depression. Available at:
http://www.psychologyinfo.com/depression/major.htm [Accessed 2nd May 2010]
Womens Health (2010) Postpartum Depression. Available at:
http://www.womens-health.co.uk/depression.html [Accessed 2nd May 2010]
Statistic Solution (2009) [Online] Beck Depression Inventory. Available at:
http://www.statisticssolutions.com/methods-chapter/directory-of-survey-instruments/beck-depression-inventory/ [Accessed 3rd May 2010]
[Online] Depression. Available at:
http://www.psychology4a.com/Depression.htm [Accessed 3rd May 2010]
Overcome Depression (2010) [Online] Major Depression. Available at:
http://www.overcomedepression.co.uk/MajorDepression.html [Accessed 3rd May 2010]
Blenkiron, P. DR (2009) CBT. Available at:
http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx [Accessed 3rd May 2010]
