Recovery

We also know something of the relieving factors for depression, and these, too, can be delineated in biopsychosocial domains. Antidepressants or exercise may change physiological systems (such as serotonin [5-HT] transmission) such that people sleep better and are less exhausted, and boost PA, leading to increased confidence to make changes in their lives. Changing how one thinks about oneself (via psychological interventions) may produce various physiological changes that aid mood. Physiological treatments have major psychosocial effects, and psychological treatments affect physiological processes (e.g., Gabbard, 2000; Thase et al., 1996). Brown et al. (1987) have shown that depression can often remit in the face of fresh-start (positive) life events.

At its best, the biopsychosocial approach is holistic. However, it also recognises the importance of individual differences. These differences can show up in how stressors trigger defensive responses, the intensity of the response(s), and the speed and form of recovery from them (Davidson, 2000). Hence, how your systems interact may be different from mine. Therefore, our needs and responses to treatment will be different, and this includes responses to biological and psychological treatments. Regarding alcohol, it is clear that some people drink to relax and have fun, but others become aggressive. Some like to feel tipsy while others hate it. Some can take it or leave it, while others become addicted. For most trials of treatment, effectiveness is based on averages and applies to the average patient, but there is no such thing as 'the average patient'. We are all individuals in so many unique ways, from our genes to our histories, to the context of our lives. So we should not be surprised to find that some like antidepressants and find them life-savers, while others feel detached, suffer awful side effects, and hate them; some may be worse off with an antidepressant because of the nature of the mood disorder (Akiskal & Pinto, 1999). Some people take to cognitive therapy like ducks to water and do well (Blackburn & Moorhead, 2000), but others do not. For biopsychosocial clinicians, these individual differences guide therapy, and it becomes the role of clinician and patient to work out which is the best treatment or combination of treatments for that individual. Such a procedure requires detailed understanding of family and personal history (Akiskal & Pinto, 1999). Theories guide our understanding, and frameworks and evidence guide our interventions, but, ultimately, therapy is a process that must respect the individual. It has been the failure of clinicians to address the problems of individual differences in treatment, and their inclination to see depression only as 'a disease' that has caused many of the problems in the use of antidepressants (Healy, 2001). Similarly, psychologists need to be sensitive to genetic, physiological, and social factors in some depressions. So, clearly, we cannot outline all the many and salient pathways of interaction here, and, in any case, there are likely to be unique individual variations for people. Integrationist approaches are best orientated to the complexity of interactions for research and intervention.

In what follows, we will explore some of the interactions that seem pertinent to depression. Space requires some selection of focus of these, and if any seem to be played down, or ignored, it should not be taken to imply their unimportance but, more probably, the limitations of the author.

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