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

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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Antidepressant withdrawal: reviewing the paper behind the headlines

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Joseph Hayes and Sameer Jauhar set the record straight on antidepressant withdrawal. They show how the recent review by Davies and Read is seriously flawed and does not accurately portray the data. They conclude that we urgently need clearer evidence on the incidence, severity and duration of any symptoms related to antidepressant withdrawal.

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Treating depression with physical activity in young people

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Simon Brett summarises a robust systematic review that looks at the effectiveness of physical activity as a treatment for depression in adolescents and young adults.

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Is income inequality damaging our mental health?

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Andy Bell from Centre for Mental Health writes his debut elf blog on a systematic review of income inequality and depression, which explores the associations between the two, but also the likely causes of these associations.

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Medical cannabis for mental illness: current use is not supported by research #MHQT

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As we prepare for our Cannabis #MHQT event on Wed 26 Sep, Luke Sheridan Rains dissects a narrative review that asks: Is cannabis treatment for anxiety, mood, and related disorders ready for prime time?

His answer is that current evidence does not support the use of medical cannabis for mental illnesses such as anxiety or depression.

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Depression and anxiety: two sides of the same coin? #TransDX2018

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Ava Schulz reviews a paper by Mansell and McEvoy which looks at psychopathology in a heterogenous clinical sample of anxiety and depression.

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