Psychoanalytic theory as postulated by both Freud and Abraham emphasized
the connection between mourning and melancholia. wherein the melancholic
patient experiences a loss of self-esteem with associated helplessness,
prominent guilt and self-denigration. According to the theory, this results
from internally directed anger which or aggression turned against the self,
lead-ing to a depressive experience. Self-psychologists have described the
effects of loss and trauma on the development of a coherent sense of self.
Bowlby’s work on attachment elucidates the impact of very early loss and trauma
with a resultant predisposition to depression among other things.
Behavioral theory holds that depression is an overgeneral-ized response
to loss of social support. Indeed, the lack of social support appears to be one
of the strongest factors in promoting vulnerability to depression. The
experience of depression may also elicit negative responses from others which
reinforces nega-tively held personal beliefs.
The cognitive-behavioral perspective emphasizes a set of dysfunctional
attitudes, cognitions and images associated with depressive symptomatology.
This theory is the most empirically examined psychosocial theory in relation to
the management and treatment of the depressed patient, and emphasizes how
cogni-tive distortions and negative self-image cause depression and are
associated with maintenance of the disorder.
The cognitive perspective as well as contributions from the
helplessness–hopelessness models formed an empirical basis for CBT. In CBT,
education, behavioral assignments and cogni-tive retraining form the active
components of the psychotherapy.
This cognitive therapy has been demonstrated to be an effective
short-term psychotherapy for depression. Another current ther-apy called
interpersonal therapy derives from a focus on diffi-culties in current
interpersonal functioning. The relationship be-tween psychological health and
one’s interpersonal environment has received substantial attention.
The current iteration of the interpersonal approach is re-flected in the
development of a specific treatment for depression termed interpersonal
psychotherapy of depression (IPT). IPT in-volves a formal diagnostic
assessment, inventory of important current and past relationships, and
definition of the current prob-lem area. In IPT, four areas of focus that could
relate to depres-sive symptoms are: 1) grief, 2) interpersonal role disputes,
3) role transitions, and 4) interpersonal deficits.
The loss of “social zeitgebers” has been proposed as a link between biological
and psychosocial formulations. The social zeitgebers theory suggests that
social relationships, interpersonal continuity and work tasks entrain
biological rhythms. Disrup-tions of social rhythms due to loss of relationships
interfere with biological rhythms that maintain homeostasis. This disruption
leads to changes in neurobiological processes including altera-tions in
neurotransmitter functions, neuroendocrine regulation, and neurophysiologic
control of sleep/wake cycle and other nor-mal circadian oscillations.