Discuss the relationship between etiology and therapeutic approach in relation to one disorder

 

 

·         Etiology means explaining the cause of a disorder. This is often very difficult within abnormal psychology. There are no simple explanations of complex psychological disorders. Logic suggests that the cause of a disorder should dictate the treatment. This is done in medicine but it is not possible in the case of psychiatric disorders such as major depression because the causes of disorders are not well known and cures have yet to be found.

 

·         Scientific research has failed to show a clear link between serotonin levels and depression. The fact that antidepressant drugs like SSRI can regulate serotonin levels and produce an effect does not mean that low serotonin levels cause depression.

 

 

Etiology and therapeutic approach in major depression

 

Treatment of major depression often involves antidepressant medication that interferes with neurotransmission (e.g. serotonin and dopamine) in the brain. This can be seen as an attempt to regulate what is believed to be an imbalance in the serotonin system.

 

Some psychiatrists question the usefulness of antidepressants that interfere with serotonin balances in the brain on the grounds that:

 

·         the serotonin system in the brain is very complex and not much is known about the drugs’ long-term effect

·         the drugs do not cure depression and have side effects

·         studies show that placebo might be just as effective

·         psychotherapy (particularly CBT) is just as effective and in some cases more effective.

 

Etiology: the serotonin hypothesis

 

·         The serotonin hypothesis suggests that depression is caused by low levels of serotonin in the brain (Coppen, 1967).

·         Anti-depressants in the form of SSRI block the re-uptake process for serotonin. This results in an increased amount of serotonin in the synaptic gap. The theory is that this improves mood.

·         SSRI such as Prozac, Zoloft and Paxil are now among the most sold anti-depressants, and the drug companies spent millions of dollars on advertising campaigns all over the world. This has been taken as indirect support of the serotonin hypothesis. According to Lacasse and Leo (2005) this is an example of backward reasoning. Assumptions about the causes of depression are based on how people respond to a treatment and this is logically problematic. For example, it is clear that aspirin can cure headaches but this does not prove that low levels of aspirin in the brain cause headaches.

 

Henninger et al. (1996) performed experiments where they reduced serotonin levels in healthy individuals to see if they would develop depressive symptoms. The results did not support that levels of serotonin could influence depression and they argued that it is necessary to revise the serotonin hypothesis.

 

Elkin et al. (1989) Controlled outcome study of treatment for depression

 

·         The study is one of the best controlled outcome studies of depression. A sample of 280 patients diagnosed with major depression were randomly assigned to either an anti-depressant drug plus the normal clinical management, a placebo plus the normal clinical management, CBT (cognitive-behavioural therapy) or IPT (interpersonal therapy).

 

·         The treatment ran for 16 weeks and the patients were assessed at the start, after 6 weeks, and after 18 months.

 

·         The results showed a reduction of depressive symptoms of over 50% in the therapy groups and in the drug group. Only 29% recovered in the placebo group. There was no difference in the effectiveness of CBT, IPT or antidepressant treatment. For the most severely depressed patients, medication and clinical management was most effective in reducing symptoms but this does not prove that serotonin causes depression.