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

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In her debut blog, Sue Brown explores an RCT from the US, which finds that computerised CBT was effective at treating depression in primary care patients, and was also beneficial to those with lower educational attainment, reading proficiency and incomes.

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What’s the link between neurodevelopmental or mental disorders and school absence or exclusion?

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Chris Fielding summarises a Welsh cohort study which finds that neurodevelopmental and mental disorders are linked to school absenteeism and exclusion.

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Common mental health inequalities across racialised groups: the gaps are getting bigger

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Lucy Barrass reviews a study on the prevalence of common mental disorders and treatment receipt for people from ethnic minority backgrounds in England.

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How could MDMA-assisted and psilocybin-assisted psychotherapy help people with depression and PTSD?

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Anya Borissova and Philip Brooks consider a recent review exploring MDMA-assisted psychotherapy and psilocybin-assisted psychotherapy for trauma-related mental health difficulties.

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Do school-based depression and anxiety prevention programmes work?

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Ariadna Albajara Saenz blogs a systematic review that suggests school-based depression and anxiety prevention programmes are likely to have a significant public health impact when implemented on a large scale.

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#SmokingAndMentalHealth conversations: NIHR 3 schools webinar

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SmokingAndMentalHealth – Carolyn Chew-Graham summarises the conversations that took place at the Smoking and Mental Health webinar on 28th September 2022.

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In her debut blog, Sarah Nicholson summarises a systematic review of pre-pregnancy BMI and the risk of antenatal and postnatal depression.

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“We are family, even when apart”: family separation and mental health in refugees

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In her debut blog Elizabeth Hall reviews a study focusing on the impact of family separation on mental health outcomes among settled refugees in Australia.

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Youth mental health interventions: umbrella review presents efficacy and acceptability data

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In his debut blog, Nick Meader tackles a huge umbrella review of youth mental health interventions, which presents the efficacy and acceptability of 72 different approaches to help children and young people.

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Aerobic exercise for major depression: the role of reward processing and cognitive control

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Francesca Bentivegna summarises a trial which looks at how aerobic exercise can help students with major depression by examining reward and cognitive control as predictors and treatment targets.

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