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

Emotional symptoms in adolescent girls: what can we learn from the functional connectivity of neural pathways?

yoab-anderson-f_cRilQQE3Q-unsplash

Shubhangi Karmaker on a recent resting-state fMRI study that explores neural network disturbances that underpin the emergence of emotional symptoms in adolescent girls.

[read the full story...]

Is too much screen time bad for our children? Perhaps, but how much do we really know?

hal-gatewood-alntq-WvZZM-unsplash

David Turgoose explores a systematic review of reviews that looks at the effects of screen time on the health and well-being of children and adolescents. The review found that higher levels of screen time were related to some physical and mental health concerns, such as poor diet, obesity and depression.

[read the full story...]

Intranasal esketamine for treatment-resistant depression: the first clinical study

shutterstock_174166007

Jodi Rintelman writes her debut elf blog on the first randomised controlled trial on the efficacy and safety of intranasal esketamine as an adjunctive treatment to antidepressants for treatment-resistant depression.

[read the full story...]

Adolescent cannabis use and risk of depression and suicide

shutterstock_618029801

Benjamin Janaway blogs about a major data analysis that links adolescent cannabis use with increased risk of depression and suicide. He considers the opportunities for early recognition of cannabis use and public intervention.

[read the full story...]

Youth anxiety and depression treatment not as good as we think? What should we tell the children?

anton-darius-thesollers-157037-unsplash

Ola Demkowicz writes her debut elf blog about a study that evaluates reliable improvement rates in depression and anxiety at the end of treatment in adolescents.

[read the full story...]

Higher doses of antidepressants “not optimal”, according to new review

shutterstock_322041725

Jonathon Tomlinson considers his options as a GP supporting people with depression and complex needs, after reading a new systematic review and dose-response meta-analysis, which suggests that higher doses of antidepressants bring maximum side effects with only marginal gains.

[read the full story...]

Global mental health and its implicit priorities

william-navarro-1441997-unsplash

Tessa Roberts writes her debut elf blog on a recent systematic review of the term ‘global mental health’, which seeks to determine the implicit priorities of scientific literature that self-identifies with this term.

Follow #PsychosisGlobal today for a live expert discussion from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN).

[read the full story...]

Who gets bullied? Using genetic information to identify individual vulnerabilities

shutterstock_1085259374

Lucy Bowes explores a multi-polygenic score approach to identifying individual vulnerabilities associated with the risk of bullying, which suggests that depression, ADHD, risk taking, BMI and intelligence are independently associated with exposure to bullying.

[read the full story...]

Mental illness in clinical psychologists: stigma stops people from seeking help

shutterstock_581251126

Dafni Katsampa considers how mental health problems can affect clinical psychologists, and the impact that stigma has on disclosure and help-seeking.

[read the full story...]