CAUSES OF DEPRESSION

While the exact cause of depression isn’t known, a number of things can be associated with its development. Generally, depression does not result from a single event, but from a combination of biological, psychological, social and lifestyle factors.

Personal factors that can lead to depression include:

• Family history – depression can run in families and some people will be at an increased genetic risk. However, this doesn’t mean that a person will automatically experience depression if a parent or close relative has had the condition.

• Personality – some people may be more at risk because of their personality, particularly if they tend to worry a lot, have low self-esteem, are perfectionists, are sensitive to personal criticism, or are self-critical and negative

• Serious medical conditions – these can trigger depression in two ways. Serious conditions can bring about depression directly or can contribute to depression through the associated stress and worry, especially if it involves long-term management of a condition or chronic pain

• Drug and alcohol use – can both lead to and result from depression. Many people with depression also have drug and alcohol problems.

• Life events and depression – such as long-term unemployment, living in an abusive or uncaring relationship, long-term isolation or loneliness or prolonged exposure to stress at work can increase the risk of depression.

Significant adverse life events, such as losing a job, going through a separation or divorce, or being diagnosed with a serious illness, may also trigger depression, particularly among people who are already at risk because of genetic, developmental or other personal factors.

Changes in the brain – disturbances in normal chemical messaging processes between nerve cells in the brain are believed to contribute to depression.

TREATMENT FOR DEPRESSION AND BIPOLAR DISORDER

Most modern antidepressants have an effect on the brain’s chemical transmitters, in particular serotonin and noradrenaline, which relay messages between brain cells. This is thought to be how medications work for depression.

Much of the issue appears to related to serotonin, the neurotransmitter that regulates mood. Today we know that 90% of all Serotonin resides in the gut. We also know that most Americans have a leaky gut from eating conventional foods that attack the gut and make holes causing the Serotonin to leak out. The solution to this one is simple, eat clean food. It is amazing how much it helps and how many other things get better as well. Bone broth is perhaps the easiest way to heal repair the gut.

Other alternative medical treatments such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) may  be recommended for people with severe depression who have not recovered with lifestyle change, social support, psychological therapy and clean food.

While these treatments also have an impact on the brain’s chemical messaging process between nerve cells, the precise ways in which these treatments work is still being researched.

Treatment options may include:

• mood-stabilising medications

• antidepressant medications

• anti-psychotic medications

• psychological therapies

• hospitalisation – for appropriate treatment during acute episodes

• education – to help people understand and manage their condition and be more self-sufficient

• community support programs – to provide rehabilitation, accommodation and employment support

• self-help groups for emotional support and understanding.

When it comes to medications antidepressants are readily available but should be used when all else fails given the side effects. Always consult your doctor when seeking treatment for depression.

PSYCHOLOGICAL TESTING

Testing has a scary ring to it for many people. But if you think about it, psychological testing and assessment are similar to medical tests. If a patient has physical symptoms, a primary care provider may order X-rays or blood tests to understand what’s causing those symptoms. The results of the tests will determine the treatment plan. Psychological evaluations serve the same purpose. Psychologists use tests and other assessment tools to arrive at a diagnosis and to guide treatment. It’s as simple as that.

That said, psychological tests are used for a variety of reasons. Children who are experiencing difficulty in school, for example, may undergo aptitude testing or tests for learning disabilities. Neuropsychological tests look at dexterity, reaction time, and memory in order to diagnose conditions such as brain injuries or dementia. Testing can also shed light on problems at work or in personal relationships.  Finally, tests can help a psychologist understand whether a person has a personality disorder and/or whether or not the person is depressed or anxious.

The point is that the underlying cause of a person’s problems isn’t always clear and testing is often the most scientific and expeditious way of clarifying what is really happening for that person. For example, if a child is having trouble in school, do they have a reading problem such as dyslexia? An attention-deficit/hyperactivity disorder (ADHD)? Difficulty with impulse control? Psychological tests and the assessment process allows a psychologist to understand the nature of the problem, and to figure out the best way to solve it.

TESTS AND ASSESSMENTS

Tests and assessments are two separate but related components of a psychological evaluation. Psychologists use both types of tools to help them arrive at a diagnosis and a treatment plan.

TESTING

Testing involves the use of formal tests such as questionnaires or checklists. These are often described as “norm-referenced” tests. That simply means the tests have been standardized so that everyone is evaluated in the same way such that the individual’s results are compared to other children of similar age or grade level.

ASSESSMENT

Assessment is a broader term that often includes testing. In fact psychological assessment can include all of the following:

• Norm-referenced psychological tests

• Informal tests and surveys

• Interview information

• School or medical records

• Medical evaluations

• Observational data.

So assessments can be used to determine such things as whether the person has:

• A learning disorder

• Is competent to stand trial

• A traumatic brain injury

• Management potential

One common assessment technique is the clinical interview. I begin every case with an extensive intake interview designed to clarify the nature of the problem, how and when it started and the impact that it is currently having. From there, it may be clear that more information is needed in the form of testing, medical records, school records etc.

PSYCHOLOGICAL TESTS MEASURING DEPRESSION

Scientists have recently begun to make distinctions between psychological tests versus assessments. While tests are typically thought of as pen-and-paper or computer-based tools for considering differences between people, the term ‘assessment’ acknowledges the wide variety of other approaches a psychologist may use to evaluate these differences. To begin, here are the three most commonly used tests used among mental health practitioners:

Minnesota Multiphasic Personality Inventory (MMPI-2) – First published in 1989, the MMPI-2 is the world’s most widely used psychometric test for measuring mental health ailments that feature as forms of psychopathology (Rogers, Robinson, & Jackson, 2016). The scale has 567 true–false statements, which assess 10 clinical sub-scales:

1. Hypochondriasis

2. Depression

3. Hysteria

4. Psychopathic deviate

5. Masculinity/Femininity

6. Paranoia

7. Psychasthenia

8. Schizophrenia

9. Hypomania

10. Social introversion

In addition to these 10 primary clinical scales, the MMPI-2 also contains three sub-scales to detect lying, defensiveness, and inconsistent responses. Finally it features many additional content scales assessing specific cognitions, behaviors, physical experiences, and motivations, such as self-doubt, competitive drive, and gastrointestinal issues.

BECK DEPRESSION INVENTORY

Finally, used in conjunction with the Beck Anxiety Inventory, is the Beck Depression Inventory. This inventory consists of 21 items and contains detailed scoring information to indicate whether symptoms are in a normal range or severe.

Respondents complete each item of the scale by selecting the statement that best reflects their current emotional state. For example, the first item and accompanying scoring are as follows:

• 0 – I do not feel sad.

• 1 – I feel sad.

• 2 – I am sad all the time, and I can’t snap out of it.

• 3 – I am so sad and unhappy that I can’t stand it.

No Fear

Psychological testing isn’t like taking a multiple-choice exam that you either pass or fail. Here at W&W we use information from the various tests and assessments to reach a specific diagnosis so that we can develop a treatment plan that helps you address and solve a problem once and for all in a scientific and empathic way.

Some people are tempted to peek at the tests ahead of time. Not a good plan as it often backfires.  Many of the tests have validity scales and trying to psych out the test may invalidate it or give us the wrong diagnosis.

Remember, psychological testing is nothing to fear. It’s not something you need to study for. Rather, it’s an opportunity for us to determine the best way to help you.