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Depression is one of the most common mental health disorders. In 2017, over 19% of the UK population showed symptoms of either depression or anxiety. Globally, 280 million are reported to have depression.¹ Depression can be debilitating. Due to its prevalence in society, identifying the causes of depression has been of interest to psychologists for decades. We will discuss the two leading theories of depression that guide contemporary treatment approaches.
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Depression is one of the most common mental health disorders, freepik.com
How can we tell when the low mood becomes clinical depression? To diagnose depression, clinicians use diagnostic manuals like the International Classification of Diseases 10 (ICD 10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Let's examine the criteria outlined for a depression diagnosis.
The International Classification of Diseases lists ten symptoms of depression based on which an individual is diagnosed. If a patient has experienced at least four of these symptoms in the past two weeks, they can be diagnosed with mild depression; experience of five to six suggests moderate depression and more than seven symptoms point to severe depression.
The frequency of symptoms is also essential for making diagnoses. Here is an overview of depressive symptoms from the ICD.
We can distinguish between bipolar and unipolar depression. Bipolar depression includes experiences of both depressive episodes and episodes of mania or hypomania (emotional highs), while unipolar depression only involves experiences of depressive episodes without manic episodes.
Recovery from depression is common. According to NHS 2017-18 statistics, over 50% of treatments for depression end with the patient's recovery.
Traditionally, the biological theory of depression argues that biological dysfunction in the body causes depression. Often you can hear that mental illness results from a 'chemical imbalance' in the brain.
However, there's little evidence that biological factors cause depression. The psychological theory of depression looks beyond biological correlates and focuses on cognitive and behavioural processes in depression.
Both approaches have informed treatment approaches, the biological theory has led to the development of antidepressant medications, and the psychological theory has informed therapeutic treatment approaches like cognitive behavioural therapy.
Psychological theories of depression focus on cognition and behaviour in regulating mood. This approach stresses the influence of our past experiences (nurture) in shaping our thought patterns that can result in depressive symptoms.
Past experiences can cause people to develop negative schemas – biased patterns of thinking about ourselves, others and the world around us, maintaining psychological distress. The psychological theories of depression are supported by the effectiveness of therapies like CBT, which aim to challenge negative schemas in treating depressive symptoms.
Negative schemas maintain depressive symptoms, freepik.com
Biological theories of depression identify biological factors like genes, brain structure, and the function of neurotransmitters and hormones as the cause of depression. Biological theories stress the influence of nature in causing depression.
Biological theories focus on physical factors that correlate with depression, flaticon.com
The monoamine theory of depression predicts that depression results from reduced levels of monoamines like serotonin. Serotonin is a neurotransmitter. It functions as a messenger in the brain and is associated with regulating functions that are affected in depressed individuals, like mood and sleep.
Based on this theory, antidepressants (SSRIs) have been developed and shown to reduce depressive symptoms in some patients. A significant criticism of antidepressants is that their effectiveness is not much higher than a placebo, and they can cause serious side effects in some patients. However, antidepressant treatment can be more accessible than therapy for many patients.
Relying only on biological treatments for depression can be considered reductionist, as antidepressants focus only on changing the levels of neurotransmitters but don't necessarily address the underlying psychological causes of depression.
Behavioural theory of depression proposes that depressive symptoms are perpetuated by avoidance behaviour. Depressed individuals will often avoid potentially rewarding activities and become withdrawn, making their symptoms worse. One way this approach influences treatment is by informing behavioural interventions like Behavioural Activation, which encourages clients to schedule pleasant activities. Rather than focusing on changing one's thoughts and feelings, this approach attempts to increase the amount of positive experiences in one's daily life, which can in turn influence one's mental state.
Ann was experiencing low mood and has become socially withdrawn. During Behavioural Activation, she was encouraged to schedule a meeting with a friend. The meeting turned out to be a very pleasant experience for her, and now she is considering meeting with friends more often. This experience positively reinforced engagement in social activities, which can be an important step for Ann in her recovery from depression.
Stevens and Price developed the social rank theory of depression. They proposed depression is an evolutionary adaptation; it allows individuals that fell to lower social ranks to accept their position.
Depressive symptoms prevent weaker individuals from engaging in conflicts that threaten their survival. Accepting one's lower position allows people to save resources instead of spending energy on conflicts and trying to regain a lost social rank, which could result in greater losses upon defeat.
While some literature findings align with this theory, it has been criticised for reductionism. In this case, depression is reduced to only evolutionary influences and situations when one loses social status. Still, we know depression is not limited to these situations and can result from a variety of life events.
Tandoc et al. (2015) survey study of 736 college students found that Facebook use was negatively correlated with depression unless accompanied by envy.
The level of envy predicted depressive symptoms among Facebook users. As the social rank theory predicted, feelings of envy (perceiving yourself as a lower rank) predicted depressive symptoms.
The ABC Model of clinical depression proposed by Ellis (1957) argues that distorted irrational beliefs (B) cause distress, forming as a response to an activating event (A). According to this model, depression is the consequence (C) of irrational beliefs.
Irrational beliefs can form automatically, and we may not even realise that we hold them. Irrational beliefs can include catastrophising, 'black and white' thinking and personalising.
Catastrophising occurs when we interpret a difficult event as worse than it is.
For example, if you didn't have time to prepare for a test, a catastrophising belief in that situation could be that you will fail it and all your exams as well, and you'll never be able to achieve anything in life.
Therapy helps individuals identify their irrational beliefs and challenges them so they can replace them with more adaptive ones.
Since our cognition and behaviour can be influenced by outside events or our own physiology, the ABC model supports the idea that we don't always have free will when we make decisions about our behaviour. This puts into question how responsible, people experiencing cognitive distortions are for their behaviour.
Aaron Beck (1967) proposed three main types of beliefs that maintain depressive symptoms. These include negative thoughts and beliefs about the self, the world, and the future. The three types of negative beliefs can be mutually reinforcing; for example, a negative belief about the world can strengthen a negative belief about the future.
Negative belief about oneself: 'I am a failure' or 'I am a bad person'
Negative beliefs about the world: 'Others hate me' or 'Others want to see me fail'
Negative beliefs about the future: 'I will never find a partner' or 'I will never succeed'
Beck proposed different types of cognitive distortions commonly present in depressed individuals.
According to Seligman, depression is an outcome of learned helplessness. Depressed individuals feel like no matter what they do, they cannot control the negative events in their life.
Learned helplessness is maintained by believing that we are the cause of the failure; we cannot change the cause, it's stable, and the failure is global. We will always fail in every situation. By challenging these thoughts, individuals can learn to feel more in control of their life and reduce the sense of learnt helplessness associated with depressive symptoms.
1. World Health Organization, Depression, 13 September 2021
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What are the different theories of depression?
Biological theories of depression include the monoamine theory of depression, which stresses the role of neurotransmitters and the social rank theory of depression, which stresses the influence of evolutionary factors.
Psychological theories of depression, like the ABC model, focused on internal states and thought patterns that maintain depressive symptoms.
What is the interpersonal theory of depression?
The interpersonal theory of depression proposes that poor relationships are a significant risk factor for depression and that people experiencing depression may be more likely to engage in activities that further weaken the quality of their relationships with others. For example, by repeatedly seeking assurance they are worthy or liked by others.
What is Beck's theory of depression?
According to Aron Beck, the severity of negative thought patterns a person experiences can predict the severity of one's depression. Dysfunctional beliefs (Beck's negative cognitive triad) predict the occurrence of depressive symptoms in individuals.
What is Freud's theory of depression?
Freud proposed a loss in life causes depression by reminding us of the feelings of loss of affection or the relationship with our parents. Feelings of loss result in self-directed anger that reduces our self-esteem and causes depression.
What is the cognitive theory of depression?
Cognitive theories of depression focus on irrational beliefs and cognitive distortions that affect the judgements of people experiencing depression and maintain the disorder. By challenging their beliefs people can learn to make alternative interpretations of events, which can reduce their depressive symptoms.
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