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

iCBT for depression: reflections from university students

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Sharon Eager summarises a qualitative study conducted with university students in South Africa who identify the pros and cons of iCBT for depression.

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Just one shot at it: single session interventions for adolescent depression

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Maria Loades and Georgia Herring consider a randomised trial of online single-session interventions for adolescent depression during COVID-19.

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Do psychotherapies help children or adolescents with subclinical depression?

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David Hallford summarises a meta-analysis of psychotherapies for subthreshold depression, which suggests they may have positive acute effects in adolescents, but are not effective in children less than 12 years of age.

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Mindfulness in schools: MYRIAD trial findings offer limited support for school based mindfulness training

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Lucinda Powell reports on the findings of the huge MYRIAD (My Resilience in Adolescence) project, which looked at the effectiveness of school based mindfulness training across more than 100 UK schools.

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HIV stigma and depression: new systematic review of people in South Africa

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Rudo Dude summarises a systematic review which examines the links between HIV stigma and depression among people living with HIV/AIDS in South Africa.

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School based humanistic counselling: a little better than pastoral care, but more expensive

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In her debut blog, Annie Stevenson reports on an RCT finding that school-based humanistic counselling reduces psychological distress, but is not cost-effective.

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Depression and anxiety among doctors during the COVID-19 pandemic: yet more collateral damage?

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Eleana Frisira summarises a systematic review that presents recent global prevalence data about the rates of depression and anxiety among doctors during the COVID-19 pandemic.

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Perinatal loss and mental health: are psychosocial interventions beneficial for parents?

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Jill Domoney explores a recent review, which suggests that psychosocial interventions may improve depression, anxiety, and grief amongst parents suffering from perinatal loss.

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How important is understanding perfectionism for reducing depression and anxiety? #BABCP2022

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Alice Potter considers a meta-synthesis of qualitative studies on the link between anxiety, depression, and perfectionism in young people, and the implications for treatment.

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Experiences of junior doctors working during the pandemic in England

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Alejandro Arguelles Bullon summarises a qualitative study investigating the experiences of junior doctors in England during the Covid-19 pandemic.

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