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

Smartphone apps for depression: do they work?

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Michelle Eskinazi and Clara Belessiotis write their debut elf blog on a recent meta-analysis of smartphone‐based mental health interventions for depression, which concludes that there is a possibly promising role for apps in the prevention and treatment of sub-clinical, mild and moderate depressive symptoms.

[read the full story...]

Blended psychotherapy: barriers and facilitators identified by psychotherapists

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Stefan Rennick-Egglestone on a qualitative study of psychotherapists’ views about the barriers and facilitators to implementing blended psychotherapy for depression.

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SSRIs and suicidality: effects of SSRIs on rating-scale-assessed suicidality in adults with depression

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Rina Dutta and Patrick McLaughlin summarise a new study looking at the effects of SSRIs (Selective Serotonin Reuptake Inhibitors) on rating-scale-assessed suicidality in adults with depression.

This study published in the British Journal of Psychiatry supports the conclusion that SSRIs remain a safe and effective treatment in depression for those aged 18 and over.

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Perinatal depression in mothers: how can treatment help with parenting and child development?

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Eloise Stark publishes her debut blog on a recent systematic review, which looks at the effect that treatment for perinatal depression in mothers can have on parenting and child development.

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Antidepressants can help adults with major depression

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André Tomlin reports on a new network meta-analysis that brings together the best available evidence comparing the efficacy and acceptability of 21 antidepressants for the acute treatment of adults with major depressive disorder.

This groundbreaking review of 522 trials is the largest ever meta-analysis in psychiatry, and finds that antidepressants are more effective than placebo for short-term treatment of acute depression in adults.

[read the full story...]

Mental illness and neurobiological correlates in the transgender population

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Dean Connolly publish their debut blog on a literature review of transgender research, which reports on the prevalence of mental illness in the transgender population.

[read the full story...]

What causes emotional blunting in people taking antidepressants? Results from a survey

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Linda Gask looks at a recent survey of people with depression that explores their experiences of emotional blunting. The research finds that nearly half of depressed patients on antidepressants report significant emotional blunting, but it’s impossible to say whether this is caused by their medication or the depression itself.

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Prevention and early intervention for youth mental illness: how should we focus our limited resources? #MQScienceMeeting

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André Tomlin presents a summary of all the evidence we have highlighted over the last 3 years relating to prevention and early intervention for mental illness in young people.

This blog accompanies the #MQScienceMeeting coverage this week, which you can follow on Twitter.

[read the full story...]

Antidepressants for depression in schizophrenia: when good-enough evidence is good enough

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Carmine Pariante is positive about a recent systematic review and meta-analysis of antidepressants for the treatment of depression in schizophrenia.

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The Origins of Happiness: can we predict life satisfaction?

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Paul Ramchandani considers the methods, findings and implications of a new book by Andrew E. Clark, Sarah Fleche, Richard Layard, Nattavudh Powdthavee and George Ward, entitled: ‘The Origins of Happiness: The science of well-being over the life course’.

[read the full story...]