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

Psychotherapy for adult depression: is it as good as it’s cracked up to be?

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Ellie Gant summarises a meta-analysis that asks: Was Eysenck right after all? A reassessment of the effects of psychotherapy for adult depression. The paper suggests that we seriously overestimate the benefits of psychotherapy by including biased trials in meta-analyses, and that there’s insufficient reliable research to be certain about the effectiveness of problem-solving therapy, interpersonal psychotherapy and behavioural activation.

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Cognitive biases in adolescent depression: the more you have, the worse you feel

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Maria Loades explores a cross-sectional study of the combined influence of cognitions in adolescent depression, which investigates biases of interpretation, self-evaluation and memory, and concludes that a negative evaluation of the self is strongly associated with depression severity and with a diagnosis of depression.

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Teenage depression linked to poor psychological and social outcomes in later life

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Maria Loades writes her debut elf blog on a recent systematic review and meta-analysis on the long-term psychosocial outcomes of teenage depression, which finds that depression as a youth is linked to poor academic outcomes, unemployment and problems with relationships in adult life.

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How can we prevent depression in young adults?

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Mental Health Masters Students from UCL explore a recent systematic review and meta-analysis of interventions to prevent depression in young adults. The review finds some evidence for the effectiveness of preventative interventions in reducing depressive symptoms in young adults, but the evidence in this area remains weak.

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Genetic predictors of depression trajectories in adolescence

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Megan Skelton explores a study that uses polygenic scores in the context of longitudinal developmental data, to characterise developmental trajectories and the role of neuropsychiatric genetic risk variants in early-onset depression.

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Genetics of depression: understanding risk and improving treatment

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Douglas Levinson on a genome-wide meta-analysis of depression in 807,553 individuals, which identifies 102 independent variants relating to the genetics of depression.

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Do you have my back? Perceived social support, loneliness, and its impact on mental health outcomes

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In the lead up to our Loneliness Mental Health Question Time on 3rd Dec 2018, Dr Michelle Lim summarises a recent systematic review on the associations between loneliness and perceived social support and outcomes of mental health problems.

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The impact of facial scarring: routinely assess for affective distress

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Andrew Thompson writes his debut blog on a recent systematic review that explores the associations linking facial scarring (largely caused by assaults or burn injuries) to depression and anxiety.

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Improving antidepressant outcomes: what works for whom and why?

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Thalia Eley and Gerome Breen explore a new systematic meta-review of predictors of antidepressant treatment outcome in depression, which looks at clinical and demographic variables, but also biomarkers including both genetic and neuroimaging data.

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