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

Depression in later life: who benefits most from antidepressants plus exercise?

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Linda Gask explores an RCT of physical exercise for depression in later life, which considers the best way to customise the intervention for primary care.

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Probiotics for depression: robust and compelling evidence?

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A team from the Centre for Affective Disorders at King’s College London appraise a new systematic review on probiotics for depression, which claims to have found robust and compelling evidence that these supplements can alleviate depressive symptoms.

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CBT may help reduce anxiety and depression in people with diabetes, but standardised approach needed

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Ben Perry explores the findings of a recent systematic review looking at the effectiveness of cognitive-behavioural therapy on glycaemic control and psychological outcomes in adults with diabetes.

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Exercise and iCBT for depression: how do ‘alternative’ treatments compare to usual care?

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Bethan Davies publishes her debut blog on a recent Swedish RCT of exercise and internet-based cognitive-behavioural therapy for depression.

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Two-question screening for depression in older adults

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Andrew Sommerlad reviews a new systematic review and meta-analysis and asks: Can two questions identify depression in older people?

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

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Diet and depression: can we eat our way out of clinical depression? The ‘SMILES’ trial

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Murtada Alsaif chews over the SMILES RCT of dietary improvement for adults with major depression, which reports encouraging results for healthy diet in people with depression.

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Use of mental health services may reduce adolescent depression

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Jess Bone publishes her debut blog on a recent longitudinal cohort study, which looks at the reduction in adolescent depression after contact with mental health services.

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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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