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

Antidepressants for depression in Alzheimer’s Disease

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The EQUATOR Publication School #EQPubSchool group summarise a systematic review and meta-analysis on the efficacy of antidepressants for depression in Alzheimer’s Disease, which finds no statistical difference between antidepressants and placebo.

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Turn on, tune in, drop out! Music therapy no better than usual care for young people

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Lisa Burscheidt is rather disappointed by a randomised controlled trial of music therapy for children and adolescents with behavioural and emotional problems.

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My watch knows when I’m anhedonic: wearable technology and social functioning in older adults with depression

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Dave Steele explores a recent literature review about the impact and measurement of social dysfunction in late life depression, which focuses on how wearable technology can be used to measure and support social functioning in older adults.

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Digital interventions for stress: do they live up to their alleged potential?

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Josefien Breedvelt is encouraged by the findings of a recent systematic review of Internet-based and computer-based interventions for stress, which provides a positive case for offering stress management on a large scale.

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Life’s good under one roof: can co-residing with our adult children prevent depression in later life?

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Farhana Mann and Gemma Lewis pore over an instrumental variable study, which looks at the effect of co-residing with adult children on depression in later life.

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Battle of the meta-analyses: is CBT becoming less effective over time?

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Suzanne Dash explores a recent meta-analysis that looks again at RCTs of cognitive behavioural therapy for depression, to ascertain whether or not the effects of CBT are systematically falling over time.

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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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