depression

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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

Can gamified cCBT prevent depression in secondary school students?

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Lisa Burscheidt summarises a school-based RCT of an online gamified cCBT intervention (SPARX-R) for preventing depression in final year secondary school students in Australia.

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Depression in fathers affects children as much as depression in mothers

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Jennifer Burgess writes her debut elf blog on evidence from two population-based cohorts of the association between depression in fathers and their adolescent children.

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Guided cCBT for depression: optimising therapist support and maximising efficiency

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Monisha Nahar writes her debut blog on a recent RCT that explores how we can improve the efficiency of psychotherapy for depression. The trial compares web-based guided CBT with face-to-face CBT for people with depression who are not taking medication.

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Common mental health problems and psychotic experiences in IAPT

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Mark Smith reviews a recent service evaluation looking at common mental health conditions and psychotic experiences occurring at the same time in IAPT services.

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Over 1 in 10 women have depression during pregnancy or postnatally #HopeNov20

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Emma Molyneaux writes her debut blog about a recent systematic review and meta-regression of the prevalence and incidence of perinatal depression.

We are covering the #HopeNov20 event today at parliament to raise awareness of mental health conditions during pregnancy and beyond. Search Twitter for #HopeNov20 from 1-6pm to follow the conversation.

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Bullying in childhood: cause or consequence of mental health problems? #AntiBullyingWeek

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Stefan Brugger publishes his debut elf blog on a recent study, which looks at the role of vulnerability and resilience in relation to mental health and bullying in childhood.

Today marks the start of #AntiBullyingWeek, so look out for lots of activity around this theme on social media.

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Brief behavioural therapy for children and adolescents with anxiety and depression

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Mona Jones publishes her debut elf blog on a recent RCT of brief behavioural therapy for paediatric anxiety and depression in primary care.

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Are digital tools the answer to improving employee wellbeing and effectiveness? #WorldMentalHealthDay

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It’s #WorldMentalHealthDay today and the theme this year is promoting awareness of mental health in the workplace.

We’re getting in on the act with Chris O’Sullivan looking in detail at a recent systematic review of web-based psychological interventions delivered in the workplace, to improve employee wellbeing and effectiveness.

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Is mental malaise the psychological equivalent of obesity?

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Stan Kutcher reflects on a recently published briefing paper entitled: mental ill-health among children of the new century, which concluded that one in four 14 year old girls had self-reported “high symptoms of depression”.

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cCBT for people with learning disabilities: Pesky gNATs #MHNR2017

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Leen Vereenooghe presents the results of an RCT of computerised cognitive behavioural therapy for people with learning disabilities, featuring the computer game “Pesky gNATs: The Feel Good Island”.

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