Beck’s Cognitive Theory of Depression – Going Deeper into the Human Mind

In 1967, American psychiatrist Aaron Beck developed his own cognitive theory of depression after he became disillusioned with the psychodynamic philosophies, on observing that the psychoanalytic methods often did not help relieve depression for his patients. Beck proposed that depression is a result of irrational and pessimistic thought process. He believed that distorted thinking patterns and illogical beliefs can cause a variety of mental or psychological problems, including depression and chronic anxiety. In his view, the way an individual perceives his life events affects his emotional state, that is to say, negative life events do not by themselves cause depression, but it is the unreasonable perception of an individual that results in depressive disorders.

Beck’s Cognitive Model of Depression

According to Beck’s cognitive model of depression, certain kinds of early experiences lead to the formation of dysfunctional beliefs, which are rigid, extreme and counterproductive, and make a person vulnerable to depression later in life. These beliefs are triggered when a critical incident occurs or depressive mood sets in. They tend to intensely influence the current thought process, creating a pattern of negative automatic thoughts that in turn produce symptoms of depression (behavioral, motivational, affective, cognitive and somatic), thus enveloping the mind in a web of pessimistic notions.

Beck’s theory of depression has three aspects: first, the cognitive triad, which explores the negative views regarding the self, the world and the future. Second, schemas, which are the conceptual patterns in the mind of maladaptive or adaptive attitudes and beliefs. Third, cognitive distortions, which are incoherent thoughts; pessimistic and unrealistic perceptions of life.

The Cognitive Triad

People suffering from depression have extremely negative thoughts about themselves, about their experiences and their surroundings, and about the future. The feeling of despair and helplessness is often accompanied by the belief that nothing they do will make a difference in their worthless lives. The world seems meaningless to them and everything else insignificant. They draw negative conclusions while completely ignoring the good things happening around them. The illogical thoughts running though their mind make the future seem bleak.

Schemas or underlying beliefs

Beck’s Cognitive Theory of Depression – Going Deeper into the Human MindThe depressogenic schemas or dysfunctional beliefs are thought to develop during childhood and adolescence as a result of negative and emotionally or psychologically damaging experiences with one’s parents or other significant people. These set of assumptions are deeply embedded in one’s mind. Though, one might not be consciously aware of these thoughts, but they are present in the subconscious mind and tend to covertly influence an individual’s current attitude and behavior.

Information Processing

Beck also hypothesized that negative cognitive triad is maintained by a variety of negative cognitive errors. People who are depressed are inclined to misinterpret the information from the world. The way they process information is distortional and misleading. Their perception is biased as they tend to make unrealistically negative interpretations about their life. Some common examples of misinterpretations are:

Dichotomous or all-or-none thinking: a tendency to think in extremes and seeing everything in terms of “all or nothing”, “black or white”, etc.; it also includes establishing false and unrealistic assumptions and trying to live according to fixed rules.

Arbitrary inferences: a habit of jumping to a negative conclusion without any evidence to support it.

Personalizing:  holding one responsible for all the unpleasant incidents that take place. Blaming oneself unnecessarily for each and every negative occurrence increases insecurity and decreases self-esteem.

Selective abstraction: an inclination to focus on only the negative aspects of a situation while ignoring all the other positive elements.

Overgeneralization: involves illogically drawing conclusions based on a single event with minimal or no evidence.

Catastrophizing: a tendency to exaggerate the importance of an insignificant matter or situation. Irrationally believing that something is far worse than it actually is.

Descriptive perspective of Beck’s theory

Over the years, extensive research has been conducted to examine the various aspects of Beck’s cognitive theory of depression. It has become more detailed and thorough while still maintaining its fundamental standards and beliefs. It has led to the generation of a very effective form of treatment for depression known as cognitive therapy. It has also been supported as a descriptive theory that shines light upon many important characteristics of depression.

It is a known fact that people suffering from depression possess a pessimistic attitude not only towards the world but themselves, as well. Depressed people are inclined to think more negatively about themselves and their lives as compared to non-depressed people. They tend to be more reclusive and often experience feelings of worthlessness, helplessness, guilt and self-blame. On the other hand, non-depressed people have the ability to positively perceive every situation and be optimistic about the future, which serves as a protective factor against depression.

Initially, Beck had postulated that a source of stress, pressure or strain was required to trigger the dysfunctional attitudes or depression-producing schemas, but recent research has shown that depressogenic schemas can be activated in a previously depressed individual by simply inducing a depressed mood.

A substantial amount of evidence has been gathered which supports the cognitive errors responsible for maintaining the negative cognitive triads.  Many experiments have been conducted that confirm that depressed people are able to recall negative information, unpleasant events and gloomy memories more easily than positive emotional information whereas it is the opposite for non-depressed people. Furthermore, depressed people are more prone to jump to negative conclusions without any sufficient evidence and often undervalue the positive aspects of any situation. Their depressiveness compels them to think unhappy or negative thoughts as they are what effectively maintain the vicious cycle of depression.

Beck’s Cognitive Therapy

Beck’s cognitive therapy focuses on specific problems and emphasizes on modifying beliefs and thoughts in order to treat depression. Since, he believed that distorted patterns of thinking and illogical beliefs are responsible for depression; he tried to help patients in adopting rational and constructive ways of thinking. He challenged their extreme statements and helped them to identify distorted thoughts. Most of the depressed people interpreted events in disastrous terms; they would only think about the worst consequences and tragic possibilities. Beck thought this to be because of faulty thinking, so he suggested those ways to alter their thinking and adopt a positive outlook.

Beck’s Cognitive Theory of Depression – Going Deeper into the Human Mind

In the initial phase of therapy, patients are familiarized with their negative automatic thoughts. They were made aware of the relationship between their patterns of thinking and emotional responses. They are asked to keep records of each negative thought that passes through their mind and of their emotional reactions to various incidents or situations. With the help of therapy, they are able to detect the cognitive errors they had been making for so long. They are taught to challenge the rationality of every negative automatic thought.

In Beck’s cognitive therapy, patients are not made to change their beliefs and thoughts through debate or persuasion, rather, they are asked to gather information about themselves. They are even encouraged to find out the dysfunctional beliefs or schemas that may be the cause of their pessimistic point of view and low self-esteem. This is an essential phase for the patient as these techniques keep him from being pulled back into the realm of depression. The causal factors that make the patient vulnerable to depression need to be dealt with effectively so that the improvement is long-lasting.

The effectiveness of Beck’s cognitive therapy has been well documented. Research suggests that Beck’s approach of treatment is highly beneficial in relieving the patients from depression and other disorders. The improvements in patients are abiding and the chances of relapse are minimal. It has been proved to one of the most reliable forms of psychotherapy.

MS Symptoms or Drug Side Effects: Telling the Difference

When MS patients suffer infections, colds or allergies, they don’t always know whether the symptoms are due to MS or another problem. This is because multiple sclerosis affects the nervous system in so many different ways that it can cause everything from slight numbness in the extremities to total blindness and paralysis. As a result, patients are always on the alert for symptoms of fatigue, pain and other issues that could be MS symptoms or drug side effects. Recognizing MS symptoms is key to keeping treatment on track and getting the best results. Below is a look at common MS symptoms and medication side effects.

MS Symptoms or Drug Side Effects: Telling the DifferenceFatigue

Four out of five patients living with MS report suffering from chronic fatigue. However, interferon drugs that are often used in MS treatment can also make patients sleepy.

Depression

Depression is another common symptom among MS patients, but it’s also a known side effect of several interferon drugs. Researchers are still unclear on whether the drugs cause or only worsen patients’ depression.

Chest Pain

Some MS patients suffer from aching or burning feelings around their chest. Other patients describe sharp pains in the chest area. At the same time, chest pain can be caused by fingolimod, a newer MS drug. Fingolimod can negatively affect heart function for six hours after a dose. Due to the dangers involved, the drug is usually administered in a hospital setting, where the patient’s heart can be monitored.

Flu Symptoms

Flu symptoms are common side effects of several interferon drugs, including Betaseron, Rebif, INF-B and Avonex. Many patients suffer fever and aches about an hour after being injected with these medications. For some patients, these flu symptoms can worsen their existing multiple sclerosis symptoms.

Headaches

Headaches aren’t classified as symptoms of multiple sclerosis, but certain severe types of headaches are more common among MS patients. For example, cluster headaches and migraines can cause terrible long-lasting pain for patients.

Side Effects or MS Symptoms?

The line between MS symptoms and drug side effects isn’t always clear, but one way to tell the difference is to track the beginning of side effects compared to dosing times. In most cases, MS drug side effects begin around an hour after injection and go away after a few more hours. In the case of Avonex, however, side effects can remain for days afterwards. Side effects of other interferons tend to last for around eight hours. When symptoms don’t leave, they are more likely to be caused by multiple sclerosis rather than a medication.

The tips above are sure to help patients tell the difference between drug side effects and multiple sclerosis symptoms, but patients should remain cautious. When there is doubt about the cause of symptoms, it’s best to call a medical professional experienced with MS. By speaking with a physician or nurse as soon as symptoms appear, there will be no delay in the process of sorting drug side effects, MS symptoms and problems from other health conditions that may be present.

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Treatment for Dysthymic Disorder Using Citalopram Hydrobromide

Dysthymia or chronic depression is a mild form of depression that begins in childhood or early adulthood. It can sometimes manifest itself by an acute episode of major depression. The most commonly used drug to treat dysthymia is citalopram HBr. Uses of citalopram other than dysthymia include treatment of dementia, alcohol abuse, smoking cessation, diabetic neuropathy and obsessive compulsive disorder in children; however, these uses have not been approved by the FDA yet.

Mechanism of Action

It belongs to the class of selective serotonin reuptake inhibitors (SSRI). Its structure is unrelated to other SSRIs. Citalopram works by inhibiting the absorption of serotonin in the brain which results in elevated serotonin levels necessary to combat depression.

Dosage Administration

Citalopram HBr, also known as Celexa is available for oral administration in the form of film coated tablets, available in the potency of 10, 20, and 40 mg.

Treatment of dysthymia starts at an initial dose of 20 mg OD (once daily), and can be gradually increased up to 40 mg per day over a period of at least one week. Doses above 40 mg are not recommended because such a high dose may lead to QT prolongation.

Metabolism

Citalopram is mainly metabolized by the liver’s Cytochrome P450 System into the less toxic or inactive metabolites which are then excreted through urine.

Drug Interactions

Citalopram can interact with the drugs that affect CYP enzymes. There are some medications that inhibit the CYP enzyme resulting in increased levels or enhanced effects of Citalopram. Examples of such drugs are verapamil, quinidine, nefazodone, diclofenac, doxycycline, protease inhibitors and azole antifungals. Others induce the enzyme and limit the efficacy of citalopram, for example nafcillin, nevirapine, carbamazepine, phenytoin, aminoglutethimide and rifamycins.

Other Adverse Effects:

  1. Frequently observed effects are as under:
  2. Cardiovascular: tachycardia, postural hypotension
  3. Central and Peripheral nervous systems: paresthesia, migraine
  4. Endocrine System: goiter, hyperthyroidism
  5. Urinary system: Polyuria
  6. Digestive System: increased salivation, flatulence

Precautions before Starting Treatment

Celexa contains a few inactive ingredients that can become a basis for allergic reactions or other complications in prone patients. Before using this medicine, discuss with your doctor if you have a family history of suicide attempts, manic depressive or bipolar disorder, renal impairment, liver disease, low sodium level in blood, peptic ulcers or bleeding problems.

Discontinuation of treatment

As with other SSRIs and SNRIs, withdrawal symptoms are associated with the discontinuation of citalopram. Therefore, the dose should be gradually tapered off. Patients should be closely monitored for the symptoms. If intolerable symptoms appear then it is recommended to resume the dose. Subsequently, it should be decreased at a more gradual level.

The Chemistry

Celexa® (citalopram HBr) is an orally administered selective serotonin reuptake inhibitor (SSRI) with a chemical structure unrelated to that of other SSRIs or of tricyclic, tetracyclic, or other available antidepressant agents. Citalopram HBr is a racemic bicyclic phthalane derivative designated (±)-1-(3-dimethylaminopropyl)-1-(4-fluorophenyl)-1,3-dihydroisobenzofuran-5- carbonitrile, HBr with the following structural formula:

Treatment for Dysthymic Disorder Using Citalopram Hydrobromide

The molecular formula is C20H22BrFN2O and its molecular weight is 405.35.

Citalopram HBr occurs as a fine, white to off-white powder. Citalopram HBr is sparingly soluble in water and soluble in ethanol.

Celexa (citalopram hydrobromide) is available as tablets or as an oral solution.

Celexa 10 mg tablets are film-coated, oval tablets containing citalopram HBr in strengths equivalent to 10 mg citalopram base. Celexa 20 mg and 40 mg tablets are film-coated, oval, scored tablets containing citalopram HBr in strengths equivalent to 20 mg or 40 mg citalopram base. The tablets also contain the following inactive ingredients: copolyvidone, corn starch, crosscarmellose sodium, glycerin, lactose monohydrate, magnesium stearate, hypromellose, microcrystalline cellulose, polyethylene glycol, and titanium dioxide. Iron oxides are used as coloring agents in the beige (10 mg) and pink (20 mg) tablets.

Celexa oral solution contains citalopram HBr equivalent to 2 mg/mL citalopram base. It also contains the following inactive ingredients: sorbitol, purified water, propylene glycol, methylparaben, natural peppermint flavor, and propylparaben.

More at http://www.rxlist.com/celexa-drug.htm

Paroxetine Withdrawal Side Effects

Paroxetine is one of the most widely prescribed medications for depression and is a type of drug known as a selective serotonin reuptake inhibitor; also called SSRI. Diagnosing generalized anxiety, post-traumatic stress and obsessive compulsive disorder, this drug has revolutionized the treatment options available for a number of anxiety disorders.

How Paroxetine works 

Paroxetine works by keeping the brain flooded with chemicals that are responsible for positive moods and happy feelings. This in turn makes the person feel less prone to anxiety and depression as their mood is kept stabilized at a healthy level.

If You Want the Info Quick, See This Video for a Summary

Paroxetine has been proven to relieve depression, panic and fear but it may take two to four weeks for its effects to be apparent. It is important to continue taking the prescribed dosage even if the patient feels that the medication is not having a positive effect on their symptoms. Although, if the patient clearly feels that the symptoms of depression or anxiety have increased after starting the medication, or have been replaced by thoughts of self-harm, it is essential to seek help from their health provider immediately.

Side effects and withdrawal symptoms

Paroxetine has proved a beneficial treatment for a large number of people suffering from depression; however, it has been reported that patients experience severe withdrawal symptoms and at times even suicidal thoughts from taking this SSRI medication.

It cannot be stressed enough that abrupt discontinuation of Paroxetine or other similar SSRIs should be avoided. Although most pharmaceutical companies vehemently deny that the withdrawal symptoms are caused by the medication, the vast majority of patients that experience them think otherwise.

Withdrawal symptoms include dizziness, nausea, diarrhea, palpitations, sweating, confusion and irritability. It is essential to mention that the symptoms are temporary and usually can be avoided by discontinuation of the drugs gradually, over a period of a few weeks. Brain zaps- characterized as “zaps” or “flashes” where the brain goes blank, confusion and muscle spasms are some more withdrawal symptoms experienced by patients who forget to take the medication for a day or two.

Because of these severe side effects of SSRIs, it is unsafe for the patient to drive or operate any type of machinery. The patient should monitor their symptoms for a while after they begin taking Paroxetine to fully understand the effects it may have on their particular system and performance level.

Many SSRI drugs including Paroxetine cause the sodium level in the blood stream to drop drastically, which may make the patient experience symptoms such as drowsiness, confusion, muscle twitches or convulsions.

SSRI antidepressants can also cause severe restlessness in some, which can be unpleasant and distressing for the patient, as well as those around them. It causes a continuous need to keep moving and the patient is unable to sit or stand still. Although these symptoms are more likely to occur in the first few weeks of treatment, some patients continue to suffer from a mild case of restlessness during the course of the treatment.

The last word

Although the potential side effects of the drug may sound daunting, it is important to remember that SSRI antidepressants have helped many patients deal with their individual conditions to live content, symptom free lives.

Diagnosis and Treatment Options for Hypertension

Hypertension refers to the condition where blood pressure is elevated throughout the body.  As the heart pushes blood out, the pressure should decrease somewhat as it travels away from the heart and into smaller veins throughout the body.  High blood pressure, or hypertension, does not always manifest itself with many symptoms but it can lead to serious health conditions and complications which has earned it the name ‘The Silent Killer’.

Diagnosing Hypertension

The most common way high blood pressure is determined is simply by measuring a patient’s blood pressure on regular wellness check visits with doctors or nurses.  Blood pressure is measured with a cuff which delivers two different numbers given as one number over the other.  These two numbers represent the following information:

  • Systolic Pressure

This is the first number number and it represents the pressure of the blood against the walls of the arteries

  • Diastolic Pressure

This is the second number and it shows how much pressure there is within the arteries in the heart as it rest and then refills between each beat

This result is measured against what is considered to be normal and balanced for blood pressure and can also signal the need to simply keep an eye on blood pressure for patients who begin to have consistently higher readings.  According to the American Heart Association the guidelines for blood pressure readings are as follows:

  • Around 120/80: Normal blood pressure
  • Above 120-80 to 139/89: Pre-hypertension
  • 140/59 to 190/99: Stage 1 Hypertension
  • Over 160/100: Stage 2 Hypertension

Treating Hypertension

Hypertension can be the result of many different things, from weight and general lifestyle to age and family history.  As a result, treatment for hypertension varies depending on each individual case.  Medications are available for patients who need them but there are other ways to safely lower blood pressure without the need for medication.

Weight – Losing weight is often the first step to naturally lowering weight loss.  In addition to simply losing weight, patients should also be aware of their waistline measurement which has been linked to blood pressure.  Men should keep their waistline measurement below 40 inches and women should aim for a measurement of 35 inches or below

Regular Exercise – In addition to exercise encouraging weight loss it can also promote healthier blood flow which can, in turn, lower blood pressure

Nutrition – A diet which is rich in fruits and vegetables along with whole grains, can lower blood pressure

Reducing Sodium and Alcohol – Salt and alcohol have both been shown to greatly increase blood pressure.  Even a modest reduction in these can result in significant lowering of blood pressure

Natural and pharmaceutical methods for lowering blood pressure can be discussed directly with your primary care doctor.  This way, your own health care team can work with you to target aspects of your lifestyle which may be contributing to higher blood pressure.  Some factors, however, cannot be treated simply by lifestyle changes.  For example, age, race and family history all play a role in the chances of someone developing hypertension.  For these patients a combination of healthy lifestyle changes and medication can work to bring blood pressure reading down to the normal range.

Here are Some Facts about Hypertension taken from http://www.medicinenet.com.

  • High blood pressure (hypertension) is designated as either essential (primary) hypertension or secondary hypertension and is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg.
  • High blood pressure is called “the silent killer” because it often causes no symptoms for many years, even decades, until it finally damages certain critical organs.
  • Poorly controlled high blood pressure ultimately can cause damage to blood vessels in the eye, thickening of the heart muscle and heart attacks, hardening of the arteries (arteriosclerosis), kidney failure, and strokes.
  • Most antihypertensive medications can be used alone or in combination. Some are used only in combination. Some are preferred over others in certain specific medical situations. And some are not to be used (contraindicated) in other situations.
  • Several classes of antihypertensive medications are available, including ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators.
  • The goal of therapy for hypertension is to bring the blood pressure down below 140/85 in the general population and to even lower levels in diabetics, African Americans, and people with certain chronic kidney diseases.
  • High blood pressure (hypertension) in pregnancy can lead to preeclampsia or eclampsia (toxemia of pregnancy). Pregnant women should be monitored closely by their obstetrician for complications of high blood pressure.
  • Lifestyle adjustments in diet and exercise and compliance with medication regimes are important factors in determining the outcome for people with hypertension.
  • High salt intake, obesity, lack of regular exercise, excessive alcohol or coffee intake, and smoking may all adversely affect the outlook for the health of an individual with high blood pressure.
Medical Author: Medical Editor: Jay W. Marks, MD.