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Theories of Depression

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Theories of Depression

Depression is one of the most common mental health disorders. In 2017, over 19% of the UK population showed symptoms of either depression or anxiety. Globally, 280 million are reported to have depression.¹ Depression can be debilitating. Due to its prevalence in society, identifying the causes of depression has been of interest to psychologists for decades. We will discuss the two leading theories of depression that guide contemporary treatment approaches.

Theories of depression, sad person sitting on a couch, StudySmarterDepression is one of the most common mental health disorders, freepik.com

What is depression?

How can we tell when the low mood becomes clinical depression? To diagnose depression, clinicians use diagnostic manuals like the International Classification of Diseases 10 (ICD 10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Let's examine the criteria outlined for a depression diagnosis.

The characteristics of clinical depression

The International Classification of Diseases lists ten symptoms of depression based on which an individual is diagnosed. If a patient has experienced at least four of these symptoms in the past two weeks, they can be diagnosed with mild depression; experience of five to six suggests moderate depression and more than seven symptoms point to severe depression.

The frequency of symptoms is also essential for making diagnoses. Here is an overview of depressive symptoms from the ICD.

  • Depressed mood for most of the day and almost every day
  • Decreased energy and fatigue
  • Loss of interest or pleasure in activities that are usually enjoyable
  • Changes in appetite and weight
  • Changes in sleep patterns or sleep disturbance (e.g. sleeping more or less than usual)
  • Decrease in confidence and self-esteem
  • Feelings of guilt, excessive self-criticism
  • Thoughts of death and suicide
  • Decreased ability to concentrate or think
  • Excessive agitation or retardation (slower movements)

We can distinguish between bipolar and unipolar depression. Bipolar depression includes experiences of both depressive episodes and episodes of mania or hypomania (emotional highs), while unipolar depression only involves experiences of depressive episodes without manic episodes.

Key statistics on depression

  • The reported prevalence of depression varies. It is estimated that 4.5% of the adult population in the UK suffers from depression.
    • However, this number is likely larger. In 2017, 17% of the adult population was prescribed antidepressants.
  • Statistics also show differences in prevalence depending on gender (higher rates of depression tend to be reported for women) and age (higher rates of depression have been reported in groups of older adults).
  • Differences have also been reported based on ethnicity. Black women are more at risk of experiencing depression than White women.
  • Recovery from depression is common. According to NHS 2017-18 statistics, over 50% of treatments for depression end with the patient's recovery.

What are the psychological theories of depression?

Traditionally, the biological theory of depression argues that biological dysfunction in the body causes depression. Often you can hear that mental illness results from a 'chemical imbalance' in the brain.

However, there's little evidence that biological factors cause depression. The psychological theory of depression looks beyond biological correlates and focuses on cognitive and behavioural processes in depression.

Both approaches have informed treatment approaches, the biological theory has led to the development of antidepressant medications, and the psychological theory has informed therapeutic treatment approaches like cognitive behavioural therapy.

Psychological theories of depression

Psychological theories of depression focus on cognition and behaviour in regulating mood. This approach stresses the influence of our past experiences (nurture) in shaping our thought patterns that can result in depressive symptoms.

Past experiences can cause people to develop negative schemas – biased patterns of thinking about ourselves, others and the world around us, maintaining psychological distress. The psychological theories of depression are supported by the effectiveness of therapies like CBT, which aim to challenge negative schemas in treating depressive symptoms.

Theories of depression, a person stressing out, StudySmarterNegative schemas maintain depressive symptoms, freepik.com

Biological theories of depression

Biological theories of depression identify biological factors like genes, brain structure, and the function of neurotransmitters and hormones as the cause of depression. Biological theories stress the influence of nature in causing depression.

Theories of depression, a brain with a tired face, StudySmarterBiological theories focus on physical factors that correlate with depression, flaticon.com

Depletion of neurotransmitters: the monoamine theory of depression

The monoamine theory of depression predicts that depression results from reduced levels of monoamines like serotonin. Serotonin is a neurotransmitter. It functions as a messenger in the brain and is associated with regulating functions that are affected in depressed individuals, like mood and sleep.

Based on this theory, antidepressants (SSRIs) have been developed and shown to reduce depressive symptoms in some patients. A significant criticism of antidepressants is that their effectiveness is not much higher than a placebo, and they can cause serious side effects in some patients. However, antidepressant treatment can be more accessible than therapy for many patients.

Relying only on biological treatments for depression can be considered reductionist, as antidepressants focus only on changing the levels of neurotransmitters but don't necessarily address the underlying psychological causes of depression.

Behavioural theory of depression

Behavioural theory of depression proposes that depressive symptoms are perpetuated by avoidance behaviour. Depressed individuals will often avoid potentially rewarding activities and become withdrawn, making their symptoms worse. One way this approach influences treatment is by informing behavioural interventions like Behavioural Activation, which encourages clients to schedule pleasant activities. Rather than focusing on changing one's thoughts and feelings, this approach attempts to increase the amount of positive experiences in one's daily life, which can in turn influence one's mental state.

Ann was experiencing low mood and has become socially withdrawn. During Behavioural Activation, she was encouraged to schedule a meeting with a friend. The meeting turned out to be a very pleasant experience for her, and now she is considering meeting with friends more often. This experience positively reinforced engagement in social activities, which can be an important step for Ann in her recovery from depression.

The social rank theory of depression

Stevens and Price developed the social rank theory of depression. They proposed depression is an evolutionary adaptation; it allows individuals that fell to lower social ranks to accept their position.

Depressive symptoms prevent weaker individuals from engaging in conflicts that threaten their survival. Accepting one's lower position allows people to save resources instead of spending energy on conflicts and trying to regain a lost social rank, which could result in greater losses upon defeat.

While some literature findings align with this theory, it has been criticised for reductionism. In this case, depression is reduced to only evolutionary influences and situations when one loses social status. Still, we know depression is not limited to these situations and can result from a variety of life events.

Tandoc et al. (2015) survey study of 736 college students found that Facebook use was negatively correlated with depression unless accompanied by envy.

The level of envy predicted depressive symptoms among Facebook users. As the social rank theory predicted, feelings of envy (perceiving yourself as a lower rank) predicted depressive symptoms.

Cognitive theory of depression

The ABC Model of clinical depression proposed by Ellis (1957) argues that distorted irrational beliefs (B) cause distress, forming as a response to an activating event (A). According to this model, depression is the consequence (C) of irrational beliefs.

Irrational beliefs can form automatically, and we may not even realise that we hold them. Irrational beliefs can include catastrophising, 'black and white' thinking and personalising.

Catastrophising occurs when we interpret a difficult event as worse than it is.

For example, if you didn't have time to prepare for a test, a catastrophising belief in that situation could be that you will fail it and all your exams as well, and you'll never be able to achieve anything in life.

Therapy helps individuals identify their irrational beliefs and challenges them so they can replace them with more adaptive ones.

Since our cognition and behaviour can be influenced by outside events or our own physiology, the ABC model supports the idea that we don't always have free will when we make decisions about our behaviour. This puts into question how responsible, people experiencing cognitive distortions are for their behaviour.

Beck's negative cognitive triad

Aaron Beck (1967) proposed three main types of beliefs that maintain depressive symptoms. These include negative thoughts and beliefs about the self, the world, and the future. The three types of negative beliefs can be mutually reinforcing; for example, a negative belief about the world can strengthen a negative belief about the future.

Negative belief about oneself: 'I am a failure' or 'I am a bad person'

Negative beliefs about the world: 'Others hate me' or 'Others want to see me fail'

Negative beliefs about the future: 'I will never find a partner' or 'I will never succeed'

Beck proposed different types of cognitive distortions commonly present in depressed individuals.

  • Beck's cognitive distortions include minimisation of positive events, overgeneralising a single event, magnification of negative events, personalisation (feeling guilty for things you shouldn't), arbitrary inference (making conclusions that fit with negative beliefs without sufficient evidence) and selective abstraction (focusing only on negative elements of a situation and making conclusions based on that).

Seligman's negative attributions

According to Seligman, depression is an outcome of learned helplessness. Depressed individuals feel like no matter what they do, they cannot control the negative events in their life.

Learned helplessness is maintained by believing that we are the cause of the failure; we cannot change the cause, it's stable, and the failure is global. We will always fail in every situation. By challenging these thoughts, individuals can learn to feel more in control of their life and reduce the sense of learnt helplessness associated with depressive symptoms.


Theories of depression - Key takeaways

  • Clinicians use diagnostic manuals like the International Classification of Diseases 10 (ICD) andDiagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose depression.
  • Unipolar depression involves only depressive episodes, while bipolar depression involves both manic and depressive episodes.
  • Depression is one of the most common mental health disorders. The prevalence of depression in UK adults is around 4.5%. The prevalence varies across ages, genders and ethnicities. Most people recover from depressive episodes following treatment.
  • Biological theories of depression focus on physical correlates of depression, like genes, brain structure or neurotransmitters. The monoamine theory of depression stresses the role of neurotransmitters, and the social rank theory of depression emphasises the influence of evolutionary factors.
  • Psychological theories of depression focus on irrational beliefs and negative thoughts that maintain depressive symptoms. The ABC model proposes that depression is the consequence of irrational beliefs.
  • Beck's negative cognitive triad highlights the three types of negative beliefs in depression: negative beliefs about oneself, the world and the future. Seligman identified negative attributions that maintain feelings of learnt helplessness associated with depression.

1. World Health Organization, Depression, 13 September 2021

Frequently Asked Questions about Theories of Depression

Biological theories of depression include the monoamine theory of depression, which stresses the role of neurotransmitters and the social rank theory of depression, which stresses the influence of evolutionary factors.

Psychological theories of depression, like the ABC model, focused on internal states and thought patterns that maintain depressive symptoms. 

The interpersonal theory of depression proposes that poor relationships are a significant risk factor for depression and that people experiencing depression may be more likely to engage in activities that further weaken the quality of their relationships with others. For example, by repeatedly seeking assurance they are worthy or liked by others.

According to Aron Beck, the severity of negative thought patterns a person experiences can predict the severity of one's depression. Dysfunctional beliefs (Beck's negative cognitive triad) predict the occurrence of depressive symptoms in individuals.

Freud proposed a loss in life causes depression by reminding us of the feelings of loss of affection or the relationship with our parents. Feelings of loss result in self-directed anger that reduces our self-esteem and causes depression.

Cognitive theories of depression focus on irrational beliefs and cognitive distortions that affect the judgements of people experiencing depression and maintain the disorder. By challenging their beliefs people can learn to make alternative interpretations of events, which can reduce their depressive symptoms.

Final Theories of Depression Quiz

Question

How do clinicians diagnose depression?

Show answer

Answer

To diagnose depression clinicians use diagnostic manuals like the  International Classification of Diseases 10 (ICD 10).

Show question

Question

The International Classification of Diseases lists 10 symptoms of depression, based on which an individual is diagnosed. List some of the symptoms.

Show answer

Answer

Examples can include

  1. Depressed mood for most of the day and almost every day
  2. Decreased energy and fatigue
  3. Loss of interest or pleasure in activities that are usually enjoyable
  4. Changes in appetite and weight
  5. Changes in sleep patterns or sleep disturbance 
  6. Decrease in confidence and self-esteem
  7. Feelings of guilt, excessive self-criticism
  8. Thoughts of death and suicide
  9. Decreased ability to concentrate or think
  10. Excessive agitation or retardation 

Show question

Question

What is unipolar depression?

Show answer

Answer

Unipolar depression involves depressive episodes but not manic episodes.

Show question

Question

What is bipolar depression?

Show answer

Answer

Bipolar depression involves both depressive and manic episodes.

Show question

Question

What is the estimated prevalence of depression in UK adults?

Show answer

Answer

4.5%

Show question

Question

What are the gender differences in the prevalence of depression?

Show answer

Answer

Higher rates of depression tend to be reported for women.

Show question

Question

In what age group the prevalence of depression is the highest?

Show answer

Answer

older adults

Show question

Question

How common is recovery from depression?

Show answer

Answer

According to NHS 2017-18 statistics over 50% of treatments for depression end with the recovery of the patient. 

Show question

Question

What causes depression based on biological theories of depression?

Show answer

Answer

Biological theories of depression identify biological factors like genes, brain structure, the function of neurotransmitters and hormones as the cause of depression.  

Show question

Question

What is the monoamine theory of depression?

Show answer

Answer

The monoamine theory of depression predicts that depression is the result of reduced levels of neurotransmitters (monoamines) like serotonin in the brain.  

Show question

Question

What is a criticism of the monoamine theory of depression?

Show answer

Answer

It can be considered reductionist as it only focuses on neurotransmitters but not on psychological factors related to depression.

Show question

Question

What is the social rank theory of depression?

Show answer

Answer

The social rank proposes that depression is an evolutionary adaptation, it allows individuals that fell to lower social ranks to accept their position. Accepting one's lower position allows people to save resources, instead of spending energy on conflicts, trying to regain a lost social rank, which could result in greater losses upon defeat. 

Show question

Question

What evidence supports the social rank theory of depression?

Show answer

Answer

Tandoc et al. (2015) survey study of 736 college students, found that the level of envy predicted depressive symptoms among Facebook users. As the social rank theory predicted, feelings of envy (perceiving yourself as a lower rank) predicted depressive symptoms.

Show question

Question

What is the cause of depression according to psychological theories?

Show answer

Answer

Psychological theories argue that irrational beliefs and negative schemas about ourselves, others and the world around us cause psychological distress.  

Show question

Question

Explain the ABC model of depression.

Show answer

Answer

According to the ABC model, Activating events (A) can lead to irrational beliefs (B) that in turn lead to depressive symptoms, which are the negative Consequence (C) of the beliefs.

Show question

Question

What are the types of negative beliefs according to the ABC model?

Show answer

Answer

Catastrophising, "black and white" thinking and personalising

Show question

Question

What is Beck's negative cognitive triad?

Show answer

Answer

Beck's negative cognitive triad includes 3 main types of beliefs that maintain depressive symptoms: negative beliefs about the self, the world and the future. 

Show question

Question

What is depression?

Show answer

Answer

Depression is a mood disorder that causes people to feel unhappy and discontent. They may feel unmotivated and have periods of extreme sadness and negativity. It interferes with their daily lives and how they operate, affecting motivation, the ability to sleep, as well as other daily tasks.  

Show question

Question

What is unipolar depression?

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Answer

Unipolar depression is also known as major depressive disorder and is when someone has been in a near-constant state of low mood for a while. People with unipolar depression have low moods, feel less pleasure from doing activities they once enjoyed, may gain or lose weight, and struggle to sleep.

Show question

Question

What are the biological explanations for depression?

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Answer

  • Imbalances in neurotransmitter levels
  • Abnormal brain structures
  • Influence of our genes

Show question

Question

What are neurotransmitters?

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Answer

Neurotransmitters are the chemical messengers that allow neurons to pass impulses to one another through the synaptic cleft. They facilitate (help) the communication between neurons. 

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Question

What two neurotransmitters are most involved in depression?

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Answer

Serotonin and norepinephrine. 

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Question

What are some of the abnormal brain structures linked to depression?

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Answer

The amygdala, hippocampus, and the dorsomedial thalamus are all brain regions associated with depression.  

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Question

Smaller hippocampal volumes have been found in patients with depression, true or false?

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Answer

True.

Show question

Question

Low levels of serotonin are associated with depression, true or false?

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Answer

True.

Show question

Question

The theory on neurotransmitters and depression suggests that an ________ in neurotransmitters in the brain, such as having too much or too little, can cause depression.  

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Answer

imbalance

Show question

Question

What is the serotonin hypothesis in depression?

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Answer

The serotonin hypothesis in depression is that low levels of serotonin produce depression-like symptoms.

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Question

What are the two different mechanisms in the serotonin hypothesis in depression?

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Answer

First, there is a reduced level of serotonin within the brain which lowers the availability of serotonin overall, and second, there may be some defect or abnormality in the receptors for serotonin on the postsynaptic neurons. 

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Question

What is norepinephrine associated with?

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Answer

Norepinephrine is associated with our ability to concentrate and our alertness/awareness, and is important in regulating executive functions.

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Question

What is the role of serotonin?

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Answer

Serotonin is important in mood modulation and feeling happy and relaxed, amongst other essential functions. It helps to ward off feelings of fear and anxiety. 

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Question

What do SSRI and SNRI stand for?

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Answer

SSRIs stand for Selective serotonin reuptake inhibitors 


SNRIs stand for Serotonin–norepinephrine reuptake inhibitors 

Show question

Question

Are SSRIs and SNRIs effective in treating depression?

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Answer

Yes, research supports their use and effectiveness, however, they are more effective when used in conjunction with psychological treatments, such as CBT. 

Show question

Question

What are some issues with the biological explanation of depression?

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Answer

  • Reductionism
  • Simplistic
  • Conflicting/outdated research and evidence

Show question

Question

Low levels of norepinephrine cause _________, which may explain the symptoms of depression.

Show answer

Answer

lower levels of concentration, lower levels of energy and reduced levels of cognitive ability

Show question

Question

What are neurotransmitters released into to transmit a nerve impulse from one neuron to another?

Show answer

Answer

The synaptic cleft. 

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