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

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Jonas Hagenberg discusses new insights into the possible use of proteomics (the large-scale study of proteins) for improving our prediction of depression remission.

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SMS CBT TLC CYP? 🤔 Does delivering cognitive behavioural therapy via text messages help improve depression in young people?

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Becky Appleton summarises a randomised controlled trial investigating the effectiveness and acceptability of text-based Cognitive Behavioural Therapy for improving depression in young adults.

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Tuberculosis and depression: multimorbidities are a global health challenge

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A team of experts from the Global NIHR Centre for IMPACT consider the findings of a recent meta review, which looks at the prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries.

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Psychotherapy presents hope for people in South Asia with depression and a non-communicable disease

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A team of experts from the Global NIHR Centre for IMPACT consider the findings of a recent review, which looks at the effectiveness and implementation of psychological interventions for depression in people with non-communicable diseases in Pakistan and Bangladesh.

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Finding balance: managing diabetes and depression with physical activity

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Aliya Ayub explores a systematic review and meta-analysis on the effectiveness of physical activity interventions for the management of depression symptoms and glycaemic control in people with depression and type 2 diabetes.

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Antidepressant withdrawal: recommendations for support from people with lived experience

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Hannah Bowers summarises a study exploring the need for antidepressant withdrawal support, from 708 survey respondents with lived experience.

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Self Help Plus for refugees: we need effective, low-intensity and scalable interventions

41.2% of the refugees screened were found to have symptoms of psychological distress. The risk varied between sexes, nationalities and was suggested to be associated with reduced integration and accentuated by less favourable post migration conditions.

Alexis Low considers a meta-analysis which evaluates Self-Help Plus, a promising WHO intervention that could be scaled up to address the mental health needs of refugees and asylum seekers.

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What’s the relationship between the menstrual cycle and suicidal ideation?

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Gemma Sawyer discusses new research on the menstrual cycle as a possible acute trigger for suicidal ideation.

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The experience of treatment-resistant depression: we need to rethink treatment for people who do not respond to antidepressants

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Amelia Talbot summarises a qualitative meta-synthesis exploring people’s experiences of living with ‘treatment-resistant’ depression.

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Towards better psychological treatment of depression #DepressionSolvingTheToll part 3

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Part 3 in a four-part series on solving the toll of depression on populations. Pim Cuijpers focuses on the psychological treatment of depression and gives an overview of a meta-analytic research domain.

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