depression

9511213674_31a3c06cc7_z

Introduction

Clinical, unipolar depression is more than just feeling low for a day or two.

Depression is characterised as episodes of sadness, loss of interest and pleasure, often including feelings of low self-worth. Depression can also include a range of physiological symptoms, such as fatigue, pain, diminished appetite, lack of interest in sex, disturbed sleep, and poor concentration.

The World Health Organisation estimates that, globally, as many as 350 million people are affected at any given time, with one person in 20 reporting an episode of depression in a 12 month period (in a global sample of 17 countries). They describe depression as the leading cause of disability worldwide.

What we know already

We know that, despite the considerable global burden of depression, not everybody receives treatment, with figures ranging from 50% to 10% in less developed countries.

Evidence suggests that combined psychological and pharmacological treatments seem to work well. Broadly, we know that psychotherapies work in many cases – but not every time. We know that neurochemical factors, such as serotonergic dysfunction, play an important role in depression, which goes a long way in explaining the efficacy of SSRI treatments.

We also know that depression has a nasty habit of recurrence, and some psychological interventions, such as Mindfulness-Based Cognitive Therapy (MBCT) is recommended particularly for people who have experienced multiple episodes of depression, but not are currently severely depressed.

We know that people living with chronic physical illness are more likely to experience depression, and this combination is linked with poorer clinical outcomes.

Importantly though, we know that people with depression can still enjoy themselves, and a common misconception in depression is that people feel totally awful all of the time.

Areas of uncertainty

There is much still to determine. For example, we know that depression is hereditable, however the extent of heredity versus environmental influences are unclear.

We are also unsure as to the precise mechanisms that determine those who respond best to treatments, be they psychopharmacological, or psychological, or both.

What’s in the pipeline?

Despite advances in our understanding of depression, and how it is treated, it remains a highly recurrent difficulty, with many people not achieving complete remission between episodes.

Preventative interventions, either physiological, or psychological, may improve people’s resilience to depression, particularly those identified as being highly prone.

References

Cuijpers, P. (2015). Psychotherapies for adult depression: recent developments. Current Opinion in Psychiatry, 28, 24-29. [Abstract]

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. and Galea, A. (2012) Long-term conditions and mental health: the cost of co-morbidities. The King’s Fund, London, UK [PDF]

World Health Organisation (2015).Factsheet 369: Depression [Link]

Photo Credits

Sascha Kohlmann CC BY 2.0

Acknowledgement

Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Nov 2015
Review due: Sep 2016

Our depression Blogs

Is there still a digital divide in mental health?

15115777092_31c07f2fd2_k

Lisa Marzano writes her debut elf blog on a recent cross-sectional survey of Internet use in people with psychosis and depression, which explores the extent of the digital divide in mental health.

[read the full story...]

Social networking sites and mental health: friend or foe?

8464661409_4efdfbeae4_o

Una Foye and Josefien Breedvelt from the Mental Health Foundation publish their debut elf blog on a recent systematic narrative review that aimed to identify and summarise research examining depression and anxiety in the context of social networking websites.

[read the full story...]

One size does not fit all: divergent outcomes from CBT and antidepressants for depression

4417026016_b8ae7a8cec_b

Suzanne Dash explores a recent meta-analysis of CBT and antidepressants for depression, which looked at negative and positive responses to treatment and what predicted different outcomes.

[read the full story...]

iCBT for depression: how does it work?

9468927282_4bfe2f422b_o

Mark Smith presents the findings from a qualitative systematic review of iCBT for depression, which tries to unearth the mechanisms of change of internet-based or computerised cognitive behavioural therapy.

[read the full story...]

Mental health of prisoners: have we reached a state of crisis?

5993520162_148e1a50e9_z

Ian Cummins highlights the increased risk of all-cause mortality, suicide, self-harm, violence and victimisation in prisoners. He welcomes a recent review of reviews which contains clinical, policy and research recommendations.

[read the full story...]

Chronic pain and depression: genetic and environmental risks

5725464417_183424f30a_b

Marcus Munafo explores a recent study that uses genetic data and family environmental information to quantify the risk of chronic pain and the contribution of risk variants for major depressive disorder.

[read the full story...]

In praise of little: sponsorship bias in depression research

2737146722_8681e3711e_o

Samei Huda welcomes a new meta-analysis of sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression.

[read the full story...]

Rumination and postnatal depression: a systematic review and cognitive model

376961572_eff9249102_b

Jill Domoney publishes her debut Mental Ef blog on a recent systematic review focusing on the perinatal period, which includes a new cognitive model of rumination and postnatal depression.

[read the full story...]

Migrant mental health may improve with children’s educational success

6660141777_f3c5978a8e_b

John Moriarty’s debut blog investigates a recent cross-sectional study looking at whether the mental health of migrant parents is supported by the educational achievements of their children.

[read the full story...]