Help seeking behaviour can be seen as a decision-making process that follows the stages of symptom appraisal, attitudes towards help seeking and translating intentions into behaviour. If people can be encouraged to seek help early on when they experience depression, this can prevent the escalation of difficulties. The aim of the present study was to understand the process of help seeking for depression, with a focus on how severity of symptoms, past experiences with depression and past help seeking for depression might influence future decision-making. Online social networks were utilised to generate a sample of 202 participants (M=33.5 years, SD=9.80) of which 61% were female. Participants completed the hospital anxiety and depression scale, a brief state measure of anxiety and depression, to control for their current levels of distress. Participants were then presented with three short vignettes describing a person experiencing depression of different severity levels (mild, moderate, and severe). These vignettes were created for this study, and had been piloted. Participants were asked to rate either their actual help seeking behaviour if they had experienced that severity of depression in the past, or their intentions to seek help if they had not experienced that severity of depression in the past. Help seeking routes included both formal and informal sources of help. Two-way repeated measures analysis of variance (ANOVA) showed that the more severe the symptoms of depression the higher the reported help seeking behaviour and intention for both formal and informal help. Intention to seek informal help as well as help seeking behaviour from informal sources was higher than from formal sources of help for mild and moderate symptoms of depression. For severe symptoms of depression, both formal and informal help seeking and help seeking intentions were at similar levels. Multivariate analysis of covariance (MANCOV A) indicated that intention to seek help for more severe symptoms of depression in the future was not related to past experience of depression of different severity levels, whereas past help seeking behaviour was correlated with increased intention to seek help for more severe symptoms of depression. The theoretical implications of the study, as well as the implication for practice are discussed and recommendations for future research are offered.

Background & Aim The PhD aimed to quantify preferences for depression treatments using Discrete Choice Experiments (DCEs). A secondary aim was to investigate the relationship between demographic variables, psychological variables and preferences. Methods & Analysis Two DCEs were designed and administered, investigating preferences for treatment of depression by: (1) a drug and (2) a physical activity intervention. The DCE designs were informed by focus groups and qualitative interviews. A best-worst scaling DCE was used for both studies. The physical activity intervention DCE was included in the baseline questionnaire of an RCT at the University of Bristol. Demographic information and psychological measures (including BDI scores) were analysed alongside the DCE. The drug treatment DCE was distributed as a postal questionnaire to a general population sample of 5000. Psychological measures of illness and medicine beliefs as well as the BDI were included in the questionnaire. Demographic data were also collected. Quantitative data were analysed primarily using conditional logistic regression. Results Results from the Physical activity DCE (for 152 patients) indicated that on average, patients particularly valued key aspects of the intervention, such as small goals, fitting activity into daily routine and having support over the intervention itself (being one giving choice of activity rather than exercise on prescription). Results from Drug study DCE (for 425 respondents) revealed a particular desire for no side-effects: large improvements in likely effectiveness are required to compensate respondents for non-zero risks of these. Heterogeneity analysis for both studies revealed effects of a number of demographic and psychological variables on preferences for attributes of depression treatment. Discussion Results of both studies are discussed in terms of their policy relevance and also from a methodological angle. The implications the results have on the use of DCEs in health care is considered.

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Serotonin (5-HT) has long been implicated in the pathophysiology of depression and anxiety, and the therapeutic effect of treatments. Several drugs useful in treatment produce either acute or neuroadaptive changes in 5-HT_2C receptor activity, and there has been growing interest in how alterations in the 5-HT_2C receptor might be important in mediating antidepressant and anxiolytic activity. The neuropsychological hypothesis of drug action implies that the clinical effects of medications active in anxiety and depression are best understood through the effects of these agents on the processing of emotional information. Thus far, however, there has been no systematic attempt to identify the role of the 5-HT_2C receptor in drug-induced changes in emotional processing in humans. The current research therefore investigated the effects of drug treatments with 5-HT_2C blocking properties on neural and behavioural responses to emotional information in healthy volunteers. An fMRI study demonstrated that a single dose of mirtazapine, an antidepressant with action at the 5-HT_2C receptor, reduces activation in regions important in emotional processing, such as the amygdala and the fusiform gyrus, to threat-relevant stimuli. A series of behavioural studies utilized drugs acting, at least in part, as 5-HT_2C antagonists and agonists to show that these drugs are able to alter emotional processing, particularly emotional memory. A seven-day administration of mirtazapine was shown to increase the recall of positive versus negative personality characteristics. A single dose of agomelatine, also an antidepressant with putative action at the 5-HT_2C receptor, did not increase slow wave sleep, suggesting, the drug had no effect of 5-HT_2C blockade in the brain. In Chapter 4, agomelatine and mCPP, a 5-HT_2C agonist, also shown to had no significant effect on emotional processing measures, but there was a statistical trend for agomelatine to increase memory for positive stimuli, and for mCPP to increase memory for negative stimuli. These findings suggest that antidepressants may work by altering the bias in emotional processing. Overall, the results of this exploration of the role of the 5-HT_2C receptor in emotional processing have contributed to the understanding of antidepressant treatment, and raise new possibilities for the continuation of study in this field.