Do Psychologists generally believe that depression can be inherited?

Freiheit

With no environmental cause? Just reading a book by a which says that it can but it's probably only a small minority of diagnosed cases of depression. Do Counsellors and Psychologists generally believe this?

JuliusCaesar

I wouldn't necessarily say that depression is inherited; I would say that a vulnerability to depression can be inherited, and that having a depressed parent might influence a person's learning in their growing up.

steddyeddy

I wonder is there a evolutionary purpose to depression.

bohemian2010

the predominant model for the aetiology of depression is the biopsychosocial model, there is evidence that there is a genetic/hereditary link to unipolar depression (and an even stronger link for bipolar affective disorder) as shown by twin studies - monozygotic (identical) twins have a far higher concordance for depression vs non-identical twins and other siblings. Family studies also show that offspring of depressed parents are more likely to develop illness themselves- to the best of my knowledge researchers have yet been unable to identify specific genes involved (i could be wrong on this).
psychological factors involved in the development of depression are explained well by aaron beck the psychologist who developed CBT. He believed that low mood/depression was born out of negative thoughts which arose as a result of cognitive distortions laid down in early life: selective abstraction, arbitrary inference, magnification, minimisation, rumination. These cognitive distortions cause people to look at every situation, the world,future, themselves in a negative light thus causing low mood and depression which in turn affects thinking even further - vicious circle.
Social factors include lack of a confiding/suppportive relationship,unemployment, co-existing alcohol abuse, having 3 or more children under the age of 14, maternal loss before age of 12, and chronic illness/disability. Apologies for long post, its just that depression is a subject i have a lot of interest in

steddyeddy

bohemian2010 wrote: »

the predominant model for the aetiology of depression is the biopsychosocial model, there is evidence that there is a genetic/hereditary link to unipolar depression (and an even stronger link for bipolar affective disorder) as shown by twin studies - monozygotic (identical) twins have a far higher concordance for depression vs non-identical twins and other siblings. Family studies also show that offspring of depressed parents are more likely to develop illness themselves- to the best of my knowledge researchers have yet been unable to identify specific genes involved (i could be wrong on this).
psychological factors involved in the development of depression are explained well by aaron beck the psychologist who developed CBT. He believed that low mood/depression was born out of negative thoughts which arose as a result of cognitive distortions laid down in early life: selective abstraction, arbitrary inference, magnification, minimisation, rumination. These cognitive distortions cause people to look at every situation, the world,future, themselves in a negative light thus causing low mood and depression which in turn affects thinking even further - vicious circle.
Social factors include lack of a confiding/suppportive relationship,unemployment, co-existing alcohol abuse, having 3 or more children under the age of 14, maternal loss before age of 12, and chronic illness/disability. Apologies for long post, its just that depression is a subject i have a lot of interest in

Please dont apologise for a interesting post i found that very informative, especially the part about cognitive distortions earlier in life!

Freiheit

Currently reading a great book called 'Manufacturing Depression, the secret history of a modern disease'. While for the most part critical of the medical model,he does say that some biological factor probably is responsible for a small minority of cases, but as bohemian says, what chemicals exactly are not yet known. Says that in some cases anti-depressants can make one feel better, but not in the way that they claim to, because the reasons for 'innate depression' are not yet established, so a drug to counteract this doesn't yet exist.

Resolve

well depression in my opinion is a multifaceted entity with numerous interlinking components. this nature versus nurture is such an interesting debate and as a counsellor i can only believe it is 50/50. some of the other above posts were really interesting some clever people on here which is refreshing

Freiheit

he also emphasised anti-depressants as a billion dollar industry and to be honest about their effectiveness, would cost hundreds of millions. I stress he doesn't say that they are useless , just that they don't quite help in the way they claim they do and that even if they do help, it doesn't mean you were sick in the chemical sense to begin with.

hotspur

This paper by Aaron Beck from 2008 is excellent I think:
http://ajp.psychiatryonline.org/cgi/content/full/165/8/969

steddyeddy, there have been numerous theories about the possible evolutionary purpose of depression over the years. Probably the most plausible has been the suggestion that it is a surrender response. As a primatologist I'm sure I don't need to describe that concept to you.

Those interested in the more biological side of depression may find this lecture by Robert Sapolsky interesting:
http://sciencestage.com/v/21906/stanfords-sapolsky-on-depression-in-u.s.-%28full-lecture%29.html

bohemian2010

The neurochemical basis for depression is based on the monoamine theory whereby it was believed that a deficit of a group of neurotransmitters called the catecholamines (serotonin,noradrenaline etc..) in the brain caused low mood/depression, the funny thing is that the theory was a retrospective hypothesis developed in the middle of the last century whereby doctors doing research into antihypertensive meds (Beta-blockers,alphablockers, methyldopa, -drugs which block cathecholamines) caused patients to become quite depressed. This monoamine theory formed the basis of all future antidepressant drugs. I agree with freiheit that this neurochemical theory is very flawed and a majority of mental health professionals (including psychiatrists) do accept that depression is more complex than that theory purports. although it was a simplistic theory it did allow development of antidepressants, a group of drugs which although much maligned have literally saved lives

bohemian2010

on the matter of efficacy of antidepressants, a gp friend of mine says that the leading cause of failure with antidepressants was patients not taking them!! he was saying that research conducted by the rcgp in the uk suggested that proper compliance with antidepressant regimes was as low as 45-50%.

Freiheit

I don't want to reiginite an old debate here, because it will ineviatably be a tempestuous draw, and we've had it before. But there's no doubt , for various reasons that anti-depressants are overprescribed. I'll say no more.

Valmont

Freiheit wrote: »

I don't want to reiginite an old debate here, because it will ineviatably be a tempestuous draw, and we've had it before. But there's no doubt , for various reasons that anti-depressants are overprescribed. I'll say no more.

Please, let's not start that up again.

I would not dispute that CBT effectively treats depression but can we really say that this illuminates the cause of it in the first place?

hotspur

Valmont wrote: »

I would not dispute that CBT effectively treats depression but can we really say that this illuminates the cause of it in the first place?

Have you ever heard the joke about the person driving along and a nail on the road bursts their tyre? They pull into a garage, if the mechanic is CBT orientated he will fix the burst tyre and send them on their way; if the mechanic is psychoanalytically orientated he will put the person in his truck and drive off back down the road to find the nail that burst the tyre.

JuliusCaesar

Valmont wrote: »

I would not dispute that CBT effectively treats depression but can we really say that this illuminates the cause of it in the first place?

Do tell? What's the "cause"? Are you saying we omit the biosocial aspects?

Valmont

With regards to the faulty thought patterns hypothesis: are they the result of other factors which predispose one to depression or is it the other way around? Which comes first? Are the faulty thought patterns the cause of depression or are they a result of depression?

hotspur

Valmont wrote: »

With regards to the faulty thought patterns hypothesis: are they the result of other factors which predispose one to depression or is it the other way around? Which comes first? Are the faulty thought patterns the cause of depression or are they a result of depression?

You could consider a person to have a cognitive vulnerability to depression just as you might consider them to have a biological vulnerability. They may have maladaptive schemas consisting of non-adaptive core beliefs about themselves, others, and the world which are latent in the sense that their effects may not be seen as long as the person is buffered by supports. These schemas may come to the fore when the person experiences a significant setback or loss of some thing(s) which support them.

So it may be considered to be a cognitive form of vulnerability along the lines of the diathesis-stress model.

Take an example of a person who has a core belief that they are defective or undesirable. They may operate in the world with a rule that if they are nice to people all the time then they won't get rejected. They may have a successful relationship which buffers them against the core belief that they are defective / undesirable / unlovable.

If that relationship breaks up then that core belief may become active again and come to the fore. Such a person may become clinically depressed and exhibit the kind of depressogenic thinking of viewing themselves, their experiences, and the future negatively because, after all, they are fundamentally defective and unlovable!

In this situation the person had a cognitive vulnerability to depression, but they may very well have had a biological vulnerability to depression too, and they also experienced a negative life event, and they may not have had sufficient other social supports.

Feelings obviously also affect thoughts. Some depressogenic thinking is intuitively more likely when one is feeling down, for example pessimism about the future. But it is far more counterintuitive to imagine that someone with a strong core belief of self-worth is likely to start believing that they are worthless as a result of a particular life event.

Although the interrelationship maintenance cycle between thoughts and feelings (and behaviour and physiology) is paramount in CBT they do focus more on the thoughts --> feelings direction in respect of treatment because changing thoughts directly is easier than changing feelings.

Lazarus's multimodal therapy is more recognising of the other direction, but that is also the direction of cause and effect of pharmacotherapy - physiology --> feelings --> thoughts and behaviour. Also the behavioural activation component of CBT, which is the first thing done for depression, alters depressogenic thinking too. So much so that component analysis studies of cognitive therapy for depression suggest that the cognitive restructuring work may be superfluous.

So pure behaviour therapy for depression is back in vogue somewhat with what is called behaviour activation therapy. If interested I recommend reading Christopher Martell's Behavioural Activation for Depression that he published this year (you can get it on filestube btw ) Giving up the experiential avoidance in depression and subjecting oneself to the contingencies in the flow of life (with its rewards) can change the depressogenic thinking organically it would appear.

But the question is - is it sufficient to just give people symptomatic relief with anti-depressants and behavioural activation or ought people be treated in a way which speaks to the fundamental cognitive vulnerabilities of their core beliefs and way they process information?

One strategy being used for people with recurrent depression is to attempt to explicitly alter the way people stand in relation to their own thoughts (which was always implicit in CBT really). This is done through teaching mindfulness. Segal, Williams, and Teasdale created mindfulness based cognitive therapy as a prophylactic for recurrent depression. It is based on work by Marsha Linehan with her dialectical behaviour therapy for BPD and Kabat-Zinn's mindfulness based stress reduction programme for chronic pain. It is also used by the acceptance and commitment therapy brigade.

I learnt and practice mindfulness and I recommend it. A good place to start is actually Williams, Segal, Teasdale, and Kabat-Zinn's book The Mindful Way Through Depression (also available from filestube with audio files of the mindfulness exercises).

^^ What is it about the Internet which makes people ramble on so?

JuliusCaesar

hotspur wrote: »

But the question is - is it sufficient to just give people symptomatic relief with anti-depressants and behavioural activation or ought people be treated in a way which speaks to the fundamental cognitive vulnerabilities of their core beliefs and way they process information?
....

^^ What is it about the Internet which makes people ramble on so?

Anyone who has worked with people with severe depression will realise a talking therapy will get nowhere. People with severe depression are so slowed down that they are barely able to have a conversation, never mind introspect.

BA is just the first part. Once the mood is sufficiently elevated, then we can start introducing therapy, in order to get people better and prevent relapse. But it's a team approach in Mental Health, so the sufferer has a number of inputs at the same time.

Resolve

Valmont wrote: »

Please, let's not start that up again.

I would not dispute that CBT effectively treats depression but can we really say that this illuminates the cause of it in the first place?

Ah Psychoanalysis the metaphorical equivalent of getting a tire punctured and walking back along the road to find out where and why the puncture first occurred! as a result your tire never gets fixed

Freiheit

psycho analysis will give you a stronger tyre, one that won't deflate so easily.......or alternatively teach you to go around the nail/pin etc rather than over it.......

Read recently about woman in difficult circumstances, very controlling husband was on anti-depressants. She came to realise over time that all they were doing was making her happy to accept a situation that was unacceptable..........

Odysseus

Please can we drop the psychoanalysis vs CBT or whatever type treatment discussion, before people get too involved. If we get entrenched in that it just stops discussion. Whilst we are all passionate about our treatment of choice, becoming fundamental about it just blocks any learning. One of the reasons I use this board is because most people recognise that no one modality suits all or has all the answers.

On the question of inherited from my viewpoint we would be looking at the psychological processes of indentification rather than an inherited trait. Even if it was an inherited disposition there is little I can offer in a treatment setting, other than dealing with the psychological aspect of it and its effect on the subject.

Freiheit

I'm curious as to whether even if a doctor was a devout follower of the medical model whether they generally still believe that cbt could help? Is cbt of any use for conditions such as adhd or schizophrenia?

Odysseus

Freiheit wrote: »

I'm curious as to whether even if a doctor was a devout follower of the medical model whether they generally still believe that cbt could help? Is cbt of any use for conditions such as adhd or schizophrenia?

I have only had minor training in CBT but I do remember reading papers about the use of CBT in a group format for psychotic patients, at the end of the day most talkning therapies CBT or Psychoanalysis are limited in the treatment of schizophrenia or delusional disorder, certainly they can help but limited they are. I had a few ADHD patients flow in and out of therapy with me over the years, but as they where also chaotic drug users it has been difficult to formulate an opinion on their departure from therapy. A fellow team member I work with used to work in a centre that dealt with schizophrenia only and their work was very CBT focused.

I would imagine that CBT may be useful to someone with ADHD in controlling some of the associated problems. The CBT people would be better able to answer it.

Resolve

I wasnt getting involved in any debates either... anyone who wants to argue about the efficacy of any therapy would do well to examine the arguement of specific vs common factors. results have shown (i am devoid of a reference at the moment but will post it) that it is rather the relationship ie the common factors which heals and not the therapy ie the specifics. its a very interesting debate and i can honestly say as an "ECLECTIC!!!!" therapist that no one theory can claim to answer all problems. it is the relationship that heals i feel. CBT in my opinion can be cold due to its technicality. Psychoanalysis can go too deep and border on the abstract. Humanistic theories can take to long to bring about resolution. that is why i personally would feel that if a therapist trains in one certain school then they can get boxed into that theory. now correct me if im wrong but is a counsellor with more knowledge and theories under his/her belt coupled with the skill to establish a valid therapuetic relationship in a better position to help somone???

Valmont

That was a very informative post, Hotspur.

hotspur wrote: »

I learnt and practice mindfulness and I recommend it.

I abhor mindfulness meditation. I participated in a 5 week course for one of my fellow student's undergraduate thesis (they were qualified) and I can honestly say that the sessions made me feel angry, frustrated, uncomfortable and annoyed. Being constantly told to focus on the breath flowing through my nostrils will rank as one of the most irritating things I have ever done. I'm not rubbishing the putative therapeutic benefits of mindfulness and the research supporting it but it felt like a faddish new therapy to me that wasn't that much different to other, more traditional meditation techniques. That's just my opinion, of course. Feel free to enlighten me, but please don't suggest more mindfulness, I'd rather walk on hot coals!

Freiheit

I don't claim claim that cbt has all the answers either, there is no absolutes....I've no objection to medication making one feel better if it works!:)...on a flippant point that's why people drink and smoke...to feel better!...

From my time in a support group,which is cbt based for the most part, (now as a facilitator) certain people benefit a lot from this approach, some very little, but almost all benefit from the support.

hotspur

Valmont wrote: »

That was a very informative post, Hotspur.

I abhor mindfulness meditation. I participated in a 5 week course for one of my fellow student's undergraduate thesis (they were qualified) and I can honestly say that the sessions made me feel angry, frustrated, uncomfortable and annoyed. Being constantly told to focus on the breath flowing through my nostrils will rank as one of the most irritating things I have ever done. I'm not rubbishing the putative therapeutic benefits of mindfulness and the research supporting it but it felt like a faddish new therapy to me that wasn't that much different to other, more traditional meditation techniques. That's just my opinion, of course. Feel free to enlighten me, but please don't suggest more mindfulness, I'd rather walk on hot coals!

That's weird. I can imagine mindfulness not being someone's cup of tea (not really mine either in terms of personality and attitude), but I wouldn't have imagined that it could make anyone angry and annoyed.

In essence mindfulness is just paying attention non-judgementally to the present moment. What you pay attention to can vary - it could be your breath, your thoughts as they float by, your environment, your body (moving or still) etc.

The purpose is to switch from the doing mind to the being mind. I think of the doing mind in terms that is explained by William Glasser in reality therapy which itself is informed by Power's control systems theory -

Glasser thought of people functioning as closed loop systems like your heating system in the house. Your heating system has a setting you can put to a certain desired temperature. The way the system works is by comparing the current "perception" of temperature in the house to the desired perception. When there is a discrepancy between the perceptions the system acts to reduce the discrepancy and turns on the heat.

Glasser said that people function like this. We all have in our heads a quality world of goal perceptions for ourselves. When we perceive our current situation as being different from the goal perception then we act to reduce the discrepancy. That's how people get to drive home. They don't plan every turn of the wheel etc. in advance. What they do is continually compare their goal perception of being home with their current perception of where they are and act in order to decrease the discrepancy between the two perceptions.

So this "doing" mind is always comparing our current perceptions with referent goal perceptions. If you sit down and think about yourself and your life you will get bombarded by the doing mind with all the ways in which you and your life are different from your goal perceptions of how you wish you and your life were. This is supposed to stir you to action to reduce the discrepancies.

But it is a never ending process of desires and current perceptions which fall short of what you want. This is at the essence of Eastern Buddhist psychology.

With mindfulness you engage the being part of the mind which purposely does not compare your current perceptions to any goal perceptions. You just pay attention to the present perception nonjudgementally. This has the effect of cutting off the past and, more importantly, the future in experiencing the present.

A fundamental effect of this is that if you are paying attention to your current perception in the present without any reference to how you really wish it to be then you can accept the current perception and experience unconditionally. It promotes acceptance of being. In this way the experience of it is a radical departure from the usual way of experiencing being which is usually compared to a counterfactual preferred perception of self.

That's kind of my understanding of it, although I've never read anything which described it in relation to Glasser's or Powers's way of thinking.

It has become very big in modern therapy. And surprisingly a lot of Buddhist psychology has crept into CBT type therapy over recent years, with acceptance and mindfulness being important components. I started reading Buddhist orientated psychology stuff organically through reading mindfulness stuff, Paul Gilbert's stuff on compassion, the American clinical psychologist and Buddhist monk Jack Kornfield (he has some wonderful and beautiful stuff).

I have enjoyed a lot of it, which for someone without a spiritual bone in their body and unfortunately more on the cynical side of sceptical has been a welcome surprise.

Mind you something like mindfulness is always going to attract the yahoos. Maybe you got someone bad. Like I said, I can't imagine how paying attention in the present moment non-judgementally can be annoying. But I can certainly imagine an annoying trainer while you're trying to do it.

Resolve

Valmont wrote: »

That was a very informative post, Hotspur.

I abhor mindfulness meditation. I participated in a 5 week course for one of my fellow student's undergraduate thesis (they were qualified) and I can honestly say that the sessions made me feel angry, frustrated, uncomfortable and annoyed. Being constantly told to focus on the breath flowing through my nostrils will rank as one of the most irritating things I have ever done. I'm not rubbishing the putative therapeutic benefits of mindfulness and the research supporting it but it felt like a faddish new therapy to me that wasn't that much different to other, more traditional meditation techniques. That's just my opinion, of course. Feel free to enlighten me, but please don't suggest more mindfulness, I'd rather walk on hot coals!

I feel your pain i too found it very difficult to relax into it too i felt bored and my mind didnt stop racing but i feel it is a skill and after a while i got the hang of it. one of my lecturers told me that my early inability to do it was due to not "being comfortable in my own skin" if that makes sense?

HOTSPUR excellant post by the way love Glassers work, great interpretation of it

Odysseus

Resolve wrote: »

I wasnt getting involved in any debates either... anyone who wants to argue about the efficacy of any therapy would do well to examine the arguement of specific vs common factors. results have shown (i am devoid of a reference at the moment but will post it) that it is rather the relationship ie the common factors which heals and not the therapy ie the specifics. its a very interesting debate and i can honestly say as an "ECLECTIC!!!!" therapist that no one theory can claim to answer all problems. it is the relationship that heals i feel. CBT in my opinion can be cold due to its technicality. Psychoanalysis can go too deep and border on the abstract. Humanistic theories can take to long to bring about resolution. that is why i personally would feel that if a therapist trains in one certain school then they can get boxed into that theory. now correct me if im wrong but is a counsellor with more knowledge and theories under his/her belt coupled with the skill to establish a valid therapuetic relationship in a better position to help somone???

It was aimed at anyone in particular rather the contant, by that I'm saying I have seen similar threads go downhill very fast, so sorry if it came across as being aimed at the poster.

I'm wary of people who claim to be eclectic, it can be used to justify anything if you want by cherry picking bits from here and there. I wary not saying this applies to everyone, I have come across therapists who told me they work psycho-dynamically [for example], upon questioning they never even seen a book by Freud. I remember this old psychiatrist stating electicism is the refugee of the rogue, and to a certain piont I would agree with that. Then again I work in an area that does attrach a certain amount of "rogue" therapists, and we are often left picking up the pieces. However, I'm sure there are therapists who manage this well too.

However, with saying that I would use different modalities with different patients, my main area of study psychoanalysis is not suited to everyone or may not be suited at a particular time, or in the case of a an example of high suicidial intent i will have to move out of a psychoanalytic position.

I don't know about being boxed in by your modality, if your trained well you should be either able to work with the reason for presentation or posess the ability to recognise your limitations; and therefore refer the person on.

However, I do agree that that one should read and study outside of your area; it's a must if you are going to be part of a multi-dis team giving you the ability to interact with your co-workers or other agencies.

I'm not trying to trap you or anything but I'm wondering about your too deep and abstract comment about psychoanalysis, can I ask what type of training or experience lead you to that type of conclusion?

hotspur

This thread has been quite the roller-coaster. Are we heading for a debate about the theory of integrationism versus assimilation versus eclecticism?

The thing is when we refer to a modality such as CBT we are talking about a model which is inherently integrative in nature, and there are CBTers such as Guidano, Liotti, and Mahoney who have utilised attachment theory perspectives in orientating CBT towards more developmentally informed constructivist forms of CBT.

Have you ever had a gander at cognitive analytic therapy Odysseus? I don't know anything about it myself really. I was wondering if it's just a sop to managed health care demands for time limited therapy or whether it has theoretical merit.

JuliusCaesar

Crumbs. Take a day off and look what happens.

Yous are all off-topic! Way off topic!




(but I'm not going to do anything about it!)