A case study on suffering with depression

Depression is a whole body illness, meaning it affects your body, mood and thoughts. It can be a very serious illness which affects the way you eat and sleep, the way you feel about yourself and the way you think about things. It is more than just a passing mood, and is very different from the usual feelings of sadness and feeling fed up. The feelings of depression usually last more than a few days; they can last for months or even years. If left untreated, these feelings can interfere with the daily life of the individual and can also have an effect on the people around them.

Depression can affect anyone at any age, including children, although it is more likely to occur if there has been a family history of depression. Health professionals use different terms to describe depression, these are: depression, depressive illness and clinical depression (NHS, 2009).

It is commonly thought that depression is not a real illness. It is seen more like a weakness or a failure in an individual however, just because it is not visible does not mean it is not real.

Types of depression

There many different forms of depression, these can range from mild depression through to severe depression and individuals who suffer with severe depression may also show psychotic symptoms.

Major depression, probably the most common form of depression, is manifested by a combination of symptoms that interfere with the individual’s ability to eat, sleep, work and study. Usually the individual will lose interest in once pleasurable activities and also has a feeling of hopelessness. Some individuals only have a single depressive episode, while others have recurring episodes. (Psychology Information Online, 2009)

Dysthymia is a mild, chronic state of depression and the symptoms are similar to major depression, but less severe. A person may suffer from dysthymia depression for years before being diagnosed, thus they would still continue with everyday life and may not even realise that they are suffering with depression, they could just have a feeling that something is not quite right. (Psychology Information Online, 2009)

Atypical depression is different to major depression in the way that an individual will feel better temporarily when a positive life event occurs, whereas an individual suffering from major depression will nearly always feel low. This type of depression can last for a couple of months or can be with an individual for their entire life. (Depression About.com, 2009)

Bipolar disorder, or manic depressive disorder, is an emotional disorder “in which an individual alternates between states of deep depression and extreme elation.” (Bipolar About.com, 2009) It is characterised by sudden changes in mood, thoughts and behaviour and there is a high suicide rate seen in individuals who suffer from manic depression. The two extremes of depression are where the individual feels very low and mania where the individual feels very high. (NHS, 2009)

Postpartum depression affects woman, almost always, immediately after childbirth. It is thought that postpartum depression is triggered by the hormonal changes that follow childbirth. Some woman have severe and long lasting symptoms that require treatment, others can generally beat the baby blues with good self-care and support from friends and family. (Depression About.com, 2009)

There are other less serious forms of depression for example, premenstrual dysphoric disorder (PDD) and seasonal affective disorder (SAD).

Symptoms

There are many different symptoms of depression and these symptoms can include physical, psychological and social symptoms. These symptoms can vary from one individual to another and also depend on the severity of the depression. Depression causes changes in thinking, feeling, behaviour and physical well-being, for example it can cause the individual to lose interest in activities that they previously enjoyed.

The physical symptoms can include: slowed speech and movement; a change in weight and appetite; constipation; lack of energy; changes to the menstrual cycle and disturbed sleeping patterns. (NHS, 2009)

The psychological symptoms of depression can include: a feeling of hopelessness and helplessness; a low self esteem; tearfulness; feelings of guilt; feeling irritable and intolerant of others; lack of motivation; lack of enjoyment; feeling anxious or worried; reduced sexual drive; suicidal thoughts or thoughts of harming others. (NHS, 2009)

The social symptoms can include: a reduced interest in hobbies; difficulties in home and family life; fewer social activities; and isolation. (NHS, 2009)

Diagnosis

Depression is a very common condition and can affect anyone of any age, including children. When an individual is suspected of suffering from depression, they should immediately seek advice from their GP. Depression cannot be diagnosed by a blood test or any kind of physical investigation: it is diagnosed by the presence of characteristic symptoms. The characteristic symptoms are listed in a publication called the DSM-IV. The GP will make the initial diagnosis and if the individual is showing some or all of these characteristics, the GP will usually provide treatment or will refer the individual to another suitable professional.

PROFILE OF INDIVIDUAL, FAMILY AND SOCIAL NETWORKS

Mary’s father was an alcoholic who was verbally and physically abusive, he suffered from the ‘Casanova’ complex and therefore had 23 children with nine different women, and was married five times. When Mary was born her father was not married to her mother, but was still married to another woman. Mary’s parents eventually married but got divorced when Mary was six and because of this divorce, Mary’s mother became a divorcee with illegitimate children. Subsequently Mary’s mother became an outcast in the small town they lived in, so she moved Mary and her siblings to London. Due to all the strains and stresses of her life, Mary’s mother became very angry and became extremely violent towards her children (DLCentre, 2008).

Mary was the oldest child in her extremely dysfunctional family and when she was just 17 she moved out, taking her brothers and sisters with her, and subsequently took on a more parental role and became their main source of support (DLCentre, 2008).

Mary feared being abandoned, therefore suffered anxiety in marriage and family commitments, this could possibly have been due to her parent’s divorce and from not receiving any positive reinforcement. Mary eventually married a dentist who had promised to stay with her forever and she devoted herself to her family and two daughters. She did not make friends easily and therefore had very few close personal friends, but she had one close friend with whom she confided everything to except anything about her past. Mary suffered with suicidal feelings, resentment towards her mother, anger and frustration with her oldest daughter and poor communication with her husband (DLCentre, 2008). These are all common effects of a person who suffered from a dysfunctional family as a child.

Conflict, misbehaviour and abuse are common occurrences within a dysfunctional family. Dysfunctional families are mainly caused by adults who are affected by alcoholism, substance abuse, or any other addictions, untreated mental illnesses or personality disorders, or possibly even as a result of the parents acting out on their own dysfunctional family experiences and copying their parents. Many children from dysfunctional families are often unaware of their situation and believe that what they experience on a day to day basis in completely normal. Children from dysfunctional families often take on different roles, which include: the good child; problem child; caretaker; lost child; mascot and mastermind (Wikipedia, 2009). Mary became aware that something was not right in her family life, which was evidenced by her moving out and taking on the role of the good child by moving her siblings in with her, and thus becoming their main source of support.

Other effects children suffer by living in a dysfunctional family include: moderate to severe mental health issues; distrust of others; paranoia; difficulty forming healthy relationships with others; feeling angry, anxious, depressed & unlovable and having mixed feelings of love-hate towards certain family members (Wikipedia, 2009). Looking at her symptoms, Mary suffers from these effects and is therefore a victim of a dysfunctional family.

The abuse Mary suffered from both her parents could have led Mary to her depression.

OUTLINE THE ONSET AND PROGRESSION OF THE CONDITION

Prior to seeing her GP, Mary’s condition was so severe that she had no interest in anything. Her physical symptoms included low energy, shaking and trembling, heart palpitations, menstrual problems, poor sleep patterns and constipation. At the onset of therapy, Mary started to show suicidal feelings, resentment towards her mother, anger and frustration towards her daughter and poor communication with her husband (DLCentre, 2008). From these symptoms, it could be concluded that Mary is suffering from major depressive disorder (Psychnet-UK, 2009).

There are many factors that have possibly led Mary to her depression. Her father was verbally and physically abusive and her mother became violent and angry towards Mary and her siblings. Mary had a strong fear of being abandoned and this could possibly have been due to her parent’s divorce and from not receiving any positive reinforcement.

Major depression is the most common and most severe form of depression. It is manifested by a combination of symptoms that interfere with the individual’s ability to eat, sleep, work and study. Usually the individual will lose interest in once pleasurable activities and also has a feeling of hopelessness (Psychnet-UK, 2009).

Major depression can be triggered from a single traumatic event in an individual’s life, or may develop slowly as a consequence of numerous personal disappointments and life problems. Some people appear to develop the symptoms of a major depression without any obvious life crisis causing it. Some individuals only have a single depressive episode, while others have recurring episodes. (Psychology Information Online, 2009) It could also be caused by an inherited gene passed onto children from their parents (Psychnet-UK, 2009).

SOCIALISATION AND ROLE THEORY

Counselling or therapy is where the patient would involve in a discussion with a therapist to uncover unconscious conflicts and abnormalities. This method allows the individual to discover what is causing the abnormal behaviour and to help the individual to think about their problems in order to find new ways of dealing with them. The patient is then able to consciously deal with the issues and resolve them, enabling them to be able to handle current life situations better too. (Psychology Information Online, 2009)

In order to be able to do this a good rapport needs to be built. The therapist can offer a safe relationship for building trust and help Mary to re-establish a certain sense of security. Communication skills are paramount in building a trusting relationship with the therapist and when Mary feels safe and secure with the relationship she has with the therapist then the wider network of family can be brought in.

The aim is to try and build a social network of support and to engage more fully with life, within the family and independently. Friends and family are an important part of building a trusting relationship.

HOW COULD MARY BE TREATED?

In order to make an initial diagnosis, the GP will first need to know the individual’s background and family history, mainly to see if there is a history of depression within the family. If there is, then depression is more likely to occur however, it is also possible for individuals with no family history to develop depression.

A cognitive approach could be taken and this deals with the way a person thinks. It involves talking with a therapist in order to discover the beliefs and expectations that cause their unhappiness. This form of treatment involves cognitive reconstructing, which is where the patients are encouraged and taught to replace negative thoughts with rational, positive ones – giving them a more adaptive thinking pattern. It involves the individual keeping a diary of their thoughts and feelings, this information would then be passed on to the therapist who would analyse it and find out how the thoughts could be turned around. The therapist will do this by setting the patient reasonable goals so that they can introduce realistic and rational beliefs into their thought pattern (Psychology Information Online, 2009). Therefore it can be concluded that the change in Mary’s personality is due to the way she sees the situation. Mary has been more susceptible to depression because of her past experiences of violence, negative reinforcement and her feelings of abandonment. Aaron Beck (1985, cited in Gross, 2005) stated ‘that psychological problems can be overcome if the misconceptions are corrected using introspection, insight, reality testing and learning’.

Drug therapy is the use of tranquillisers, antidepressants and other drugs. They help lessen the symptoms, but are not a successful treatment for everyone. This form of therapy would not be beneficial to Mary on its own, mainly because it hasn’t been successful before, but could prove to be most beneficial when combined with cognitive therapy (Psychology Information Online, 2009).

Electro-convulsive therapy is where a high current is passed through the patient’s brain for 0.5 seconds whilst the patient is under anaesthetics and this procedure induces a convulsion that lasts for about one minute. This therapy is used mainly to treat severe depression and is a short term treatment which lasts for up to one year. ECT offers fast relief and can cause memory loss (Cardwell, Flanagan, 2003). Mary may benefit from this treatment as a quick relief to her symptoms, as this may stop the feelings of being suicidal, however this treatment may not help with the resentment towards her mother, anger and frustration towards her daughter and poor communication with her husband.

The psychoanalytical theory is the classical model. Freud (1915) noted that depression is precipitated. It aims to analyse the person’s feelings of loss and abandonment through the loss – free association. The belief supported by this model is that psychological problems arise from the personality (psyche) rather than from physical causes (Cardwell & Flanagan, 2003). This theory aims to analyse the persons feelings of loss and abandonment by talking about their past. This treatment method involves having the individual going back to an earlier age, which in Mary’s case would probably be her childhood in order to explore her feelings about the divorce and the violence. The therapist will then go on to help Mary to look at and re-evaluate the situations and to reconsider her past losses so as to gain a new perspective on them.

Interpersonal Therapy (IPT) focuses on relationships with other people (Cardwell & Flanagan, 2003). As Mary has had issues with her family in the past and is currently having problems with her family IPT would be an incredible advantage to Mary.

All of these therapies would be good treatment for Mary, as they explore all of the areas of her life and will help her to deal with and come to terms with her past. If she is able to do this, she may be able to move on and may also be able to stop her children from experiencing the same things she experienced during her life and may even be able to prevent her children from suffering with depression.

THE EFFECTIVENESS OF INTERVENTIONS

Depression can be treated in many different ways which include drug therapy, electro-convulsive therapy, psychosurgery and cognitive therapy.

Drug therapy is the use of tranquillisers, antidepressants and other drugs. Tranquillisers are used to alleviate anxiety, or in stronger doses they can be used to treat psychotic disorders and antidepressants are used to treat depressive disorders. Drugs help lessen the symptoms and are not a successful treatment for everyone. Drug therapy can be a quick solution and can therefore prove to be economical however, there is a chance of addiction, allergic reaction or intolerance and side effects may be worse than the original symptoms. Alternative therapies are available for example, St John’s Wort, which is a herbal treatment and is effective in treating mild depression but it comes with its own disadvantages. It can cause serious problems if the individual is already taking medications such as anticonvulsants and anticoagulants, and can also reduce the effect of oral contraceptives.

Electro-convulsive therapy is where a high current is passed through the patient’s brain for 0.5 seconds whilst the patient is under anaesthetics and this procedure induces a convulsion that lasts for about one minute. This therapy is used mainly to treat severe depression and is a short term treatment which lasts for up to one year. ECT offers faster relief than drugs which is important in suicidal patients and was a popular treatment prior to drug therapies, although drugs are safer. Treatment of ECT can cause memory loss, however ECT may work where other methods fail. (Cardwell, Flanagan, 2003 pp. 222-223)

Psychosurgery is the most extreme form of therapy and is used as a last resort. It involves removing the section of dysfunctional brain tissue and the procedure is not reversible. It is believed that by removing the dysfunctional brain tissue the symptoms and problems will disappear and will not reoccur. The effects of psychosurgery are not consistent and there is also the ethical issue of informed consent. It is not a quick fix and therapists need effective training before performing the treatment. (Cardwell, Flanagan, 2003 pp. 222-223)

Another type of treatment is cognitive therapy. It is derived from various sources including behaviour therapy and psychoanalysis, which define and operationalise cognition in different ways. It involves talking with a therapist in order to discover the beliefs and expectations that cause their unhappiness. The patients are encouraged and taught to replace negative thoughts with rational, positive ones – giving them a more adaptive thinking pattern. The therapist will set the patient reasonable goals so that they can introduce realistic and rational beliefs into their though pattern. This form of therapy is a popular choice but it may be lengthy and costly.

A combination of two treatments usually works better than just one treatment for example, combining drugs and cognitive therapy (Psychology Information Online, 2009). However, each therapy is different and so is each individual person and what works for one individual may not work for others, so it is difficult to make comparisons between different therapies.

When the symptoms are extremely severe the individual may either admit themself or be admitted into hospital for a short time. This short time away helps the individual to get away from the daily stresses that have caused the depression. Some treatments are only available in a hospital setting for example, ECT (Cardwell, Flanagan, 2003).

LIKELY PROGNOSIS FOR THE FUTURE

An individual is likely to suffer from depression if there is a family history of it. A full recovery is possible with treatment but there is also a risk it could return for example, it could be triggered by a traumatic event in the future.

If Mary is responding well to treatment she could resolve her differences with her family and will possibly start to see that her life is not worthless. Her physical state of health will drastically improve and the suicidal thoughts she has been feeling will begin to disappear.

SUMMARY

Depression is real and is a common condition which affects an individual in the way they feel, act and behave. There are symptoms for depression and different types of medications or therapies that can be used to treat the individual. Depression can take many forms from mild through to severe and not all sufferers present the same symptoms. It can be genetic and can also be triggered by certain traumatic life events.

Each treatment is different and so is each individual, thus it is impossible to compare and recommend a specific model of therapy. The best way to treat depression is possibly to combine two different therapies.

Mary has suffered many problems in her life, from violence and abuse to abandonment. A combination of the medical and cognitive therapies would help Mary.

The generalisations about depression could include that one treatment/therapy would suit everyone, but that is not necessarily the case as each person has different problems. Not all models of care will work on everyone and some people may recover quicker than others. It is not possible to generalise depression as it is by far a more complex illness than people are aware of.

BIBLIOGRAPHY

About.com Bipolar Disorder (2009) Bipolar Disorder – Manic Depressive Illness From Diagnosis to Medications [online] Available from: http://bipolar.about.com/ [Accessed 22 December 2009]

About.com Depression (2009) About Depression – Information and support for depression [online]. Available from: http://depression.about.com/ [Accessed 22 December 2009]

Cardwell, M. Flanagan, C., (2003) Psychology A2: the complete companion. UK: Nelson Thornes Ltd

Eysenck, M., (2001) Psychology for A2 level. UK: Psychology Press Ltd

Gross, R., (2005) Psychology – The Science of Mind and Behaviour. 5th ed. London: Hodder Education.

NHS Choices (2009) Depression [online]. Available from: http://www.nhs.uk/Conditions/depression/Pages/Introduction.aspx [Accessed 22 December 2009]

NHS Choices (2009) Understanding Depression [online]. Available from: http://www.nhs.uk/Pathways/depression/Pages/Landing.aspx?WT.srch=1 [Accessed 22 December 2009]

Psychology Information Online (2009) Depression Information and Treatment [online]. Available from: http://www.psychologyinfo.com/depression/ [Accessed 22 December 2009]

Psychnet-UK (2009) Major depressive Episode [online]. Available from: http://www.psychnet-uk.com/dsm_iv/major_depression.htm [Accessed 22 December 2009]