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

Cost-effectiveness of CBT for depression: uncertainty remains

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Chris Sampson reviews a recent US study which looks at the cost-effectiveness of CBT versus second-generation antidepressants for the initial treatment of major depressive disorder.

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Should we be offering twice weekly psychotherapy for people with depression?

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Jack Kerwin and Derek Tracy summarise a new RCT published in the British Journal of Psychiatry, which suggests that twice weekly psychotherapy (CBT or IPT) may be more effective than once weekly sessions for people with depression.

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Exploring drop-out rates: new review shows poor retention in trials of apps for depression

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In his debut blog, Tom Steare summarises a systematic review looking at drop out rates in randomised controlled trials of smartphone apps for depression, which finds that depression apps with mood monitoring and human feedback were associated with greater retention of research participants.

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Long-term outcomes of childhood sexual abuse #ISTSS2019

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Raphael Underwood summarises a recent umbrella review (a synthesis of meta-analyses), which aimed to evaluate the current literature regarding childhood sexual abuse and long-term outcomes (psychosocial outcomes, psychiatric diagnoses and physical health outcomes).

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Depression in later life: healthcare professionals’ views about referrals and management

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Alison McKinlay summarises a literature review of qualitative research exploring healthcare professionals’ views of depression in later life, which highlights the quandaries faced by healthcare professionals in primary care, particularly in areas where funding and access to services are limited.

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Are antidepressants safe? A new umbrella review of observational studies suggests they are, but we need more accurate data

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Andrea Cipriani and Anneka Tomlinson scrutinise a brand new umbrella review of the associations between antidepressants and adverse health outcomes, which suggests that antidepressants are safe for most people who experience mental health difficulties.

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Internalising problems in children and adolescents: little evidence for distinct disorders

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Katie Finning explores a recent network analysis of internalising disorders (e.g. depression, anxiety, phobias) in children and adolescents, which demonstrates the interconnected nature of internalising symptoms, and challenges the view that such pathology takes the form of distinct disorders.

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In adults with major depression, antidepressants may increase the risk of suicide

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Douglas Badenoch explores a meta-analysis of follow-up data from clinical trials of antidepressants, which found a small but significant increase in suicide risk.

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Younger mums may be at higher risk of mental health problems #ESMI

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Jennifer Burgess summarises the results of a small cross-sectional study of young pregnant women at risk of mental disorders, which found that young women had greater odds of having a common mental disorder and CMDs were associated with living alone and abuse.

Follow #ESMI today on Twitter for all of the updates from the ESMI study day (Effectiveness of Services for Mothers with Mental Illness).

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This be the verse? Negative cognitive styles in fathers and their children

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A group of UCL Mental Health Masters students summarise a cohort study that investigated associations between paternal negative cognitive styles during pregnancy and offspring negative cognitive styles 18 years later.

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