1. Etiology of depression: Case Study 2 By: Shantel Sharma

2. Trisha is 35 years old and has three children. In addition to caring for her children; she works part time as a cashier at the local supermarket. Three years ago, Trisha’s husband was killed unexpectedly in a car crash. Since the accident, Trish has been feeling sad and lonely. She has sleepless nights and frequently suffers from severe migraines. Although her friends and family have been very supportive, Trish does not like to discuss her problems with them as she feels that she does not deserve their attention. She does not want other people wasting their time trying to help her. Last year, Trish visited her doctor who prescribed her SSRI anti-depressant drugs. Although these seemed to help, Trish was unable to afford the prescription and stopped taking them after a few months.

3. Etiology of Depression – Biological Factors Neurobiological researchers suggested that depression may be caused by a deficiency in neurobiological systems e.g. neurotransmitters (serotonin), hormones (cortisol) Depression is caused by low levels of serotonin (neurotransmitter) suggested by Coppen (1967) It is possible that MDD may cause this imbalance of neurotransmitters Trish was prescribed with SSRI anti – depressant drugs which increase the levels of serotonin

4. * There is some evidence that serotonin may be involved in depression and that this may be linked to stress and stress hormones such as cortisol * Scientific research has failed to show a clear link between serotonin levels and depression. * The fact that anti-depressants drugs can increase serotonin levels is not sufficient evidence for serotonin being the cause of depression

5. * Cortisol is a major hormone of the stress system * Patients with MDD have high levels of the hormone cortisol, which is present in large amounts when individuals are stressed * Stress could have occurred from her being 35, having 3 children, working part time, husband was killed unexpectedly = sad, lonely, migraines, sleepless nights * Indicates a possible link between long term stress and depression * High levels of cortisol could have affected the serotonin levels

6. * Beck (1976) Cognitive theory of depression * Depressed people tend to think depressed thoughts (she felt worthless) * There is disturbance in the mood (does not want people wasting their time on her) * Therefore there is negative thinking about oneself and the world * Suffers from self criticism and pessimism * Negative thoughts are a symptom of depression and are instead the cause according to traditional theories

7. * Negative cognitive schemas are activated by stressful events which was the death of Trish’s husband in a unexpected car crash. * Research has confirmed a possible link between negative cognitions and depression e.g. Alloy et al (1999) & Lewinshohn et al (2001)

8. if a mental problem is caused by a biological dysfunctiom, the cure is to use drugs to restore biological system. Drugs affect the neurotransmission and thus increases it at the synaptic gap Took SSRI anti-depressant drugs to increase serotonin levels and is done by blocking the reuptake process for serotonin It affects the mood and emotional responses positively in Trish and but because she couldn’t afford it, she couldn’t continue to take them. SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRI) BIOMEDICAL APPROACH TO TREATMENT SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRI)

9. Women are more likely to be diagnosed with depression than men. Stress of being responsible for 3 children and lack of social support. Part time as a cashier at the local supermarkets. According to Brown and Harris (1978), results of the working class women in the general population, 23% had been depressed. Among the working class women, those who had one or more young children were at higher risk of becoming depressed than those with no children or older children. Women who were currently caring for three young children were particularly likely to have experienced a depressive episode Women who were widowed, like Trish had a high rate of depression

10. Symptoms: Physiological- severe migraines Cognitive – Trish does not like to discuss he rprobelms with her friends and family as she feels that she does not deserve their attention. Does not want other people wasting their time trying to help her (feelings of worthlessness, negative attititude towards the self and the world) Emotional – feeling sad and lonely Behavioral – sleepless nights and avoidance of social company

11. Prevalence Poongothai et al (2009) – South India Problem with generalizability Depression is 2-3 times more common in women (23.1%) than men (12.7%)

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