Beliefs of people taking antidepressants about the causes of their own depression

Where do "chemical imbalance" beliefs come from? Evaluating the impact of different sources

Introduction

Although the etiology of depression is incredibly complex, the narrative that it is caused by a simple "chemical imbalance" persists in lay settings. We sought to understand where people are exposed to this explanation (i.e., the "source"), and the relative influence of each source.

Methods

A total of 1,219 college students were asked where they had heard of the chemical imbalance explanation and how much they believed this to be true. Independent raters coded open-ended responses and we used self-report measures to capture chemical imbalance belief endorsement.

Results

The most common sources of exposure to this explanation were the classroom, the Internet/media, other people (e.g., friends), and healthcare providers. In a regression analysis, only learning about the chemical imbalance explanation from healthcare providers uniquely predicted the adoption of the chemical imbalance belief. The correlation held even after controlling for depression symptoms, a family history of depression, and having had a diagnosis or treatment of mental health disorder (all of which also uniquely predicted chemical imbalance belief endorsement).

Discussion

These results suggest that healthcare providers play an important role in the dissemination of the chemical imbalance message, which is an oversimplified, scientifically controversial, and potentially treatment-interfering narrative. Interventions directed at healthcare providers may help them engage with more accurate messages.

Languaging psychopathology: neurobiology and metaphor

Explanatory models of the mind inform our working assumptions about mental illness with direct implications for clinical practice. Neurobiological models assert that the mind can be understood in terms of genetics, chemistry, and neuronal circuits. Growing evidence suggests that clinical deployment of neurobiological models of illness may have unintended adverse effects on patient attitudes, public perception, provider empathy, and the effectiveness of psychiatric treatment. New approaches are needed to find a better language for describing (let alone explaining) the experience of mental illness. To address this gap, we draw upon interdisciplinary sources and semiotic theory to characterize the role of metaphor in the conceptualization and communication of psychopathology. We examine the metaphors recruited by contemporary neurobiological models and metaphor's role in facilitating descriptive clarity or evocative creativity, depending on intention and context. These multiple roles reveal the implications of metaphorical reasoning in clinical practice, including cognitive flexibility, personalized communication, and uncertainty tolerance. With this analysis, we propose a clinical approach that embraces the meta-process of ongoing novel metaphor generation and co-elaboration, or languaging metaphors of psychopathology. Our goal is to bring attention to the value of employing ever-evolving, shapeable metaphorical depictions of psychiatric illness: metaphors that enable a capacity for change in individuals and society, reduce stigma, and nurture recovery.

Is the mainstream construction of mood disorders resistant to systemic thinking?

Introduction

In this study we explore how the diagnostic category of mood disorders is constructed in two handbooks of Psychopathology as an example of the mainstream construction of psychopathology. Despite the increasing criticism and lack of evidence, the debunked chemical imbalance theory of the etiology of depression still dominates the professional and pop/folk understanding and interventions.

Methods

We analysed the breadth of the inference field and the type of etiopathogenetic contents of the explanations of mood disorders using the "1to3" Coding System.

Results

Our findings show that the dominant explanations draw almost exclusively onto monadic explanations, followed by limited dyadic ones. Intrapersonal etiopathogenetic contents prevailed, and biomedical explanations were dominant in both textbooks.

Discussion

We critically discuss the underpinnings of these results and address the clinical implications of these biased representations, as well as potential alternative approaches to psychopathology.

Closed-Loop Neuromodulation and Self-Perception in Clinical Treatment of Refractory Epilepsy

Background: Newer "closed-loop" neurostimulation devices in development could, in theory, induce changes to patients' personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment.Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception.Results: Participants generally did not attribute changes in patients' personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients' experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians.Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients' illness experiences and social circumstances.

Universal association between depressive symptoms and social-network structures in the workplace

An unhealthy communication structure at a workplace can adversely affect the mental health of employees. However, little is known about the relationship between communication structures in the workplace and the mental health of employees. Here, we evaluated the face-to-face interaction network among employees (N = 449) in a variety of real-world working environments by using wearable devices and investigated the relationship between social network characteristics and depressive symptoms. We found that the cohesive interaction structure surrounding each individual was negatively correlated with depressive symptoms: a universal relationship regardless of occupation type. This correlation was evident at the group scale and was strongly related to active interactions with abundant body movement. Our findings provide a quantitative and collective perspective on taking a systematic approach to workplace depression, and they suggest that the mental health of employees needs to be addressed systematically, not only individually.

'The Explanation You Have Been Looking For': Neurobiology as Promise and Hermeneutic Closure

The biomedical aspiration of psychiatry has fundamentally reoriented clinical practice since the DSM-III in 1980 and reverberated in the public sphere. Over time, lay public understanding of the causes of mental suffering has increasingly endorsed biological conceptions. In this paper, I explore the sources from which a neurobiological model for mental suffering reaches ordinary people, and investigate its rhetorical appeal, personal appropriation, and consequences. Drawing on interviews and other data, I show that these sources-physicians, popular media, and advertising-share common ontological and moral assumptions. These assumptions, in turn, influence how people take up neurobiological explanation to account for their suffering, and how, paradoxically, they join it to their projects of self-determination. I conclude by considering how, from a phenomenological perspective, a neurobiological account fails to enhance self-knowledge or determination but leads to a hermeneutic dead end.

Causal explanations of depression on perceptions of and likelihood to choose cognitive behavioural therapy and antidepressant medications as depression treatments

OBJECTIVES

This research examined whether people's causal explanations of depression were associated with acceptability and efficacy-related treatment perceptions and likelihood to choose cognitive behavioural therapy (CBT) and antidepressant medication (ADM) as depression treatments.

DESIGN

A cross-sectional internet-based design was used.

METHODS

A general population sample was used over a clinical sample to study those who had not yet chosen to enter treatment. A total of 422 individuals were recruited through a crowdsourcing platform to complete an online survey. Measures included perceived causes of depression, perceived acceptability, efficacy and choice likelihood for ADM and CBT, and demographics.

RESULTS

Those with biological causal explanations of depression were more favourable towards ADM on all three perceptual measures of acceptability, efficacy and likelihood to choose ADM as a treatment for depression. Personality/character-related causal explanations of depression were positively related to perceived efficacy and likelihood to choose CBT as a depression treatment. Those endorsing environmental stress causes of depression were more likely to choose CBT as a treatment for depression.

CONCLUSIONS

Results indicated that people's beliefs about the causes of depression were related to their perceptions of and likelihoods to choose ADM and CBT as depression treatments.

PRACTITIONER POINTS

Provides evidence of how different causal explanations of depression influence sufferers' likelihoods to choose ADM and CBT as possible treatments for their depression. Provides support for exploring potential patients' causal explanations about depression prior to recommending a treatment regimen.

Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia

OBJECTIVE

Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital.

METHODS

This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants.

RESULTS

49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%).

CONCLUSIONS

Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia

OBJECTIVE

Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital.

METHODS

This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants.

RESULTS

49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%).

CONCLUSIONS

Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample

BACKGROUND

Public perceptions of mental illness are increasingly construed in neurobiological and genetic terms. Accumulating evidence suggests there are some unintended consequences of these explanations, including reduced optimism for recovery among individuals with depression. However, little is known about how these beliefs relate to treatment process and outcomes in a psychiatric treatment setting, a gap this study aimed to fill.

METHODS

We examined etiological beliefs about depression in a sample of patients (N = 279) seeking acute treatment in a behaviorally-based therapy program at a psychiatric hospital and examined relations with treatment expectations and outcomes.

RESULTS

We found that although psychosocial explanations of depression were most popular, biogenetic beliefs, particularly the belief that depression is caused by a chemical imbalance, were prevalent in this sample. Further, the chemical imbalance belief related to poorer treatment expectations. This relationship was moderated by symptoms of depression, with more depressed individuals showing a stronger relationship between chemical imbalance beliefs and lower treatment expectations. Finally, the chemical imbalance belief predicted more depressive symptoms after the treatment program ended for a 2-week measure of depression (but not for a 24-hour measure of depression), controlling for psychiatric symptoms at admission, inpatient hospitalizations, and treatment expectations.

LIMITATIONS

The sample was homogenous in terms of race and ethnicity and we did not assess how patients came to their beliefs.

CONCLUSIONS

Together, the results illustrate the correlates and possible impacts of etiological beliefs in a real-world clinical setting and invite a critical discussion about predominant messages about the etiology of depression.

A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report

BACKGROUND

In 2019, a literature review indicated that more than half of people who try to come off antidepressants experience withdrawal effects. Both the National Institute of Health and Care Excellence and the Royal College of Psychiatrists updated their positions in line with that review, and Public Health England published a 152-page report called Dependence and withdrawal associated with some prescribed medicines: an evidence review. The report made several recommendations relevant to general practice.

METHOD

In order to facilitate implementation of these recommendations, an online survey was designed to explore United Kingdom general practitioner (GP) experiences, opinions, knowledge and needs in relation to depression, ADs and withdrawal. A total of 66 GPs had completed the survey when COVID-19 occurred.

RESULTS

In keeping with previous findings, this small sample of GPs had a predominantly psycho-social perspective on the causes of, and treatments for, depression. They broadly considered ADs effective for moderate/severe depression and ineffective for minimal/mild depression, for which they preferred psychological therapies and social prescribing. There was a marked lack of consistency in GPs' knowledge about the incidence and duration of withdrawal effects. Only a minority (29%) felt their knowledge about withdrawal was 'adequate' and fewer (17%) believed this about their 'Ability to distinguish between withdrawal effects and return of the original problem (e.g. depression)'. Two-thirds (68%) would like more training on these matters.

CONCLUSION

It is hoped that even this small sample will be helpful when designing, and seeking funding for, GP training programmes, and when implementing the PHE recommendations for support services, based in the primary care system, for the millions of people contemplating or initiating withdrawal from ADs every year in the UK.

Men's views of antidepressant treatment for depression, and their implications for community pharmacy practice

BACKGROUND

Men with depression can express and navigate their condition differently to women. Understanding this population's needs, and experiences, can help healthcare professionals better support these patients. There is a lack of knowledge in this area, and no studies have explored men's depression in the context of community pharmacy.

OBJECTIVES

Explore views of men around their medication for the treatment of depression and the role of community pharmacy in their treatment.

SETTING

United Kingdom (UK) primary care.

METHOD

Semi-structured in-depth interviews were conducted. Eligible participants were male, aged 18-65 years, and treating depression with antidepressants. Participants were recruited through 5 UK pharmacies (via the pharmacist or poster recruitment) and a UK University (poster recruitment). A thematic approach was used for analysis.

RESULTS

14 men aged 26-61 years, predominantly of white ethnicity were interviewed. Key themes were found. The theme 'Antidepressant's attributions to benefits' highlighted all men noticed benefits when taking antidepressants, but held uncertainty on what extent their antidepressants caused this. The themes 'Views of pharmacist's role influences engagement', and 'Influence of cognitive state upon healthcare interactions' demonstrated men were not inclined to discuss concerns with the community pharmacist. These men didn't see this as the pharmacist's role, nor had these men given cognitive space to evaluate their treatment beliefs or information needs. Yet the theme 'Reflection of support and information needs' shows men did have unmet information and support needs. This also links into the 'Hegemonic Masculinity and taking antidepressants' theme, where taking antidepressants could challenge ones masculinity.

CONCLUSION

Community pharmacists should create opportunities for men to engage in conversations around their antidepressants and wider support. Men, as a requisite for engagement, will need to see such interactions as within the community pharmacists' remit, and as part of a collaborative healthcare system.

Beliefs about the causes of depression and recovery and their impact on adherence, dosage, and successful tapering of antidepressants

BACKGROUND

Continuation of antidepressant medication (ADM) after remission is widely used to prevent depressive relapse/recurrence. Little is known about predictors of ADM use in terms of adherence, dosage, and successful tapering. The current study aimed to explore beliefs about the causes of depression and recovery (i.e., causal beliefs) and to examine whether they predict ADM use.

METHODS

The data were drawn from a controlled trial and an extension of this trial with additional experience sampling. In total, 289 remitted patients with recurrent depression (ADM ≥ 6 months) were randomly assigned to Preventive Cognitive Therapy (PCT) with ADM tapering, PCT with maintenance ADM, or maintenance ADM alone. Adherence, ADM dosage, and causal beliefs regarding the first and last depressive episodes were explored via questionnaires.

RESULTS

Most patients mentioned stressful life events as cause of depression, although more patients tended to endorse external causes for the first episode and internal causes for the last episode. ADM was most often mentioned as helpful during recovery from both episodes. Over half of all patients were adherent and under half of the patients in the tapering condition were able to complete the taper. Causal beliefs did not predict ADM use.

CONCLUSIONS

The results suggest that causal beliefs play little role in the use of maintenance ADM. More information is needed on factors contributing to successful tapering. The results must be interpreted with caution as this is not a naturalistic study and the results might be biased toward a more favorable view regarding ADM.

Mood Instability Is a Precursor of Relationship and Marital Difficulties: Results from Prospective Data from the British Health and Lifestyle Surveys

The DSM system implies that affective instability is caused by reactivity to interpersonal events. We used the British Health and Lifestyle Survey that surveyed community residents in 1984 and again in 1991 to study competing hypotheses: that mood instability (MI) leads to interpersonal difficulties or vice versa. We analyzed data from 5,352 persons who participated in both waves of the survey. Factor analysis of the Eysenck Personality Inventory neuroticism scale was used to derive a 4-item scale for MI. We used depression measures that were previously derived by factor analyzing the General Health Questionnaire. We tested the competing hypotheses by regressing variables at follow-up against baseline variables. The results showed that MI in 1984 clearly predicted the development of interpersonal problems in 1991. After adjusting for depression, depression becomes the main predictor of spousal difficulties, but MI remains a predictor of interpersonal difficulties with family and friends. Attempts to investigate the reverse hypothesis were ambiguous. The clinical implication is that when MI and interpersonal problems are reported, the MI should be treated first, or at least concurrently.

Neuroessentialism: Theoretical and Clinical Considerations

Neuroessentialism is the view that the definitive way of explaining human psychological experience is by reference to the brain and its activity. This leads to the view that psychological disorders, such as depression, are fundamentally brain disorders. Neuroessentialism has grown increasingly popular for academic and public audiences. It has also attracted critics. This article describes neuroessentialism, the reasons for its rising prominence, and the theoretical and clinical concerns it raises. It connects these concerns to evidence from empirical studies that suggest that neuroessentialistic conceptualization of depression can have negative clinical impacts that need to be considered by mental health professionals.