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

Antecedents of depression in children and young people

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Emily Stapley summarises a recent 4-year longitudinal study of the antecedents of new-onset major depressive disorder in children and adolescents at high familial risk.

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Work can make you mentally ill, but we still have a lot to learn about the links between employment and mental health

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Chris O’Sullivan explores a recent systematic meta-review of work-related risk factors for common mental health problems.

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Perinatal mental health problems in fathers are common and legitimate, but we need better ways to reach and help them

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André Tomlin explores a recent qualitative study of fathers’ views and experiences of their own perinatal mental health, and also shares his own lived experience of postnatal depression and anxiety.

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Job clubs may protect unemployed people from depression

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Ian Cummins explores a recent systematic review of interventions to reduce the impact of unemployment and economic hardship on mental health in the general population.

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Targeting unhelpful repetitive negative thinking in young people to prevent anxiety and depression

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Michelle Moulds publishes her debut blog on a recent randomised controlled trial about the prevention of anxiety disorders and depression by targeting excessive worry, rumination and repetitive negative thinking in young adults.

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Third wave psychotherapies for depression and anxiety in older people

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Sarah McDonald is left feeling frustrated by this meta-analysis of mindfulness-based cognitive therapy and acceptance and commitment therapy for depression and anxiety in older people.

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NICE guidelines: mental health problems in people with learning disabilities

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Rachel Allan and Tom Crossland present the recent NICE guidance on mental health problems in people with learning disabilities, and comment on how useful these new recommendations are for people with learning disabilities and their care givers.

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CBT and severity of depression

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Joe Hayes summarises a new meta-analysis in the British Journal of Psychiatry that shows how the initial severity of depression does not alter the efficacy of cognitive behavioural therapy.

This is the first in a new series of Mental Elf blogs produced in partnership with the British Journal of Psychiatry.

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Collaborative care may help older adults with subthreshold depression: CASPER trial

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Ben Hannigan summarises the new CASPER trial of collaborative care versus usual care for older adults with subthreshold depression.

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Self-guided iCBT for depression: effective but still not sticky enough

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Stefan Rennick-Egglestone highlights a brand new IPD meta-analysis of self-guided Internet-based cognitive behavioural therapy for the treatment of depression.

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