Depression
Psychology
Depression
 Seligman (1973) referred to depression as the ‘common
cold’ of psychiatry because of its frequency of
diagnosis. According to BPS figures a staggering 9 million
people in Britain reported feelings of depression to their
GP in 1998!
 However to continue Seligman’s analogy, although this
‘cold’ may have reached epidemic proportions in the West
it is certainly not pandemic since many cultures and areas
of the World report little or no depression
Characteristics
 Depression is an affective disorder in that it is
characterised by disturbances of affect (or mood). During
the course of any period of time it is not unusual for a
person’s mood to alter. However with affective disorders
this variation is more marked and is accompanied by other
symptoms.
 These symptoms of depression do vary; the DSM-IV
recognise three main types of depression, only two of
which will be mentioned here, and only one of which will
be covered in detail.
Emotional symptoms
 The symptoms we most associate with depression,
those feelings of sadness, loss of mood and loss of
pleasure from what were previously enjoyable
activities.
 Mood may also alter during the course of the day,
typically being lowest in the morning and gradually
showing improvement as the day progresses. This
may be associated with circadian rhythms
Physical symptoms
 Disturbances of sleep: patients sometimes report
insomnia, but sleeping longer than before is also
common, perhaps as patients attempt to escape their
problems.
 Appetite can also decrease or it may increase in the
form of comfort eating. Part of this may be due to
boredom since typically depressed people tend to
have lower activity levels.
Motivational symptoms
 Apathy and loss of drive are common. Typically the
depressed person will sit around waiting for things to
happen, making no attempt to initiate activity or
social contact. This could be because they don’t want
people to see them in a depressed state.
Cognitive Symptoms
 These can vary from negative self thoughts, loss of
self esteem and self confidence, feelings of despair
and hopelessness, inability to concentrate on tasks
for any length of time to feelings of inadequacy and
blaming themselves for their situation and on
occasions and suicidal thoughts.

Categories of Depression:
Unipolar (major or clinical
depression)
 This is what we normally consider to be depression
and can comprise a combination of any of the
symptoms mentioned above.
 Minor depression occurs when the patient suffers the
low mood but without any of the cognitive or other
disturbances.
Dysthimic disorder (or chronic
depression)
 DSM-IV-TR now recognises a milder form of
depression with a lower level of diagnosis.
 The patients only needs three of the symptoms
rather than the usual five to be considered to be
suffering from dysthimic disorder. Note: dysthimic
does not include suicidal thoughts!
Bipolar (manic depression)
 Involves bouts of clinically depressed symptoms that
alternate with periods of near normal mood and/or
elevated mood (mania).
 Bipolar 1: usually consists of mania and depression but
can on rare occasions be mania on its own
 Bipolar 2: major depression with hypomania (a less
extreme form of mania)..
Differences between
Unipolar
 Persistent low mood
 Up to 3 times more common in
Women
 Around 5% incidence in the
general pop
Bipolar
 Swings between high and low
moods
 Similar in both men and
women
 Around 1% in the general
population
 Far more common in creative
people
Diagnosis
 These are the two most widely used and quoted methods
of categorising mental illness.
 DSM (Diagnostic and Statistical Manual) devised by the
American Psychiatric Association in 1952. Its last major
revision was 1994 when DSM-IV was published. DSM-V is
currently under construction and is expected in 2013.
 ICD (International Statistical Classification of Diseases and
Related Health Problems) devised by the World Health
Organisation and categorises all illnesses. Currenty we are
on ICD-10 with ICD-11 due in 2015.
Endogenous or reactive depression
 This is a second way of distinguishing between depressions that
relates more to causes rather than symptoms.
 Endogenous depression (as the name suggests) comes from within
and is thought to be caused by chemical Reactive depression on the
other hand is caused by external factors such as loss of job, death of
relative etc. and is usually explained using psychological approaches
such as behaviourist or cognitive models.
 Depression is also a major factor in a number of other related
disorders such as Seasonal Affective Disorder (SAD), Premenstrual
syndrome (PMS) and Postpartum depression (PPD). The latter was
formerly known as post natal depression
Depression and anxiety
 Generally speaking the general population are accepting of depression but
tend to be more concerned about psychotic disorders such as
schizophrenia. Mood disorders, like anxiety disorders are not seen as
threatening and are usually not too far removed from ‘normal’ or everyday
behaviour. They are also far more common than psychoses.
 There tends to be lots of overlap between depression and anxiety, both in
terms of symptoms and in terms of diagnosis. It’s thought that as many as
90% of patients suffering from depression also exhibit symptoms of anxiety,
such as interruptions of sleep, ability to concentrate and panic. Some have
even suggested a new category of ‘mixed anxiety depression’ with the
unfortunate abbreviation ‘MAD.’ It’s also worth mentioning that stress can
be a symptom of both, as well as a potential cause!
Reliability and Validity of Beck’s
Depression Inventory (BDI)
 The BDI is one of the most widely used tests for assessing
the severity of depression. When it was first published in
1961 it signalled a major shift in the view of depression
which until that time had been viewed in psychodynamic
terms. Aaron Beck considered the cognitive symptoms of
depression rather than seeing it as a self destructive and
inwardly displaced anger.
 The BDI consists of 21 item self-report questionnaire. Each
item is designed to test the severity of a specific symptom
Task
 Read through the BDI hand-out and feedback your
thoughts on the reliability and validity