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

Culturally adapted CBT may lead to recovery from postnatal depression in British South Asian women

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Angelica Tong explores the ROSHNI-2 trial of a culturally adapted CBT programme for postnatal depression in British South Asian women.

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Smoking and depression: a burning issue for the elf care community

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Gemma Taylor discusses new research on the effects of smoking cessation treatment options for people with past or current major depressive disorder.

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We need to improve sleep assessment and treatment in patients with severe mental illness

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Emiliana Tonini looks at how sleep is recorded and treated in people with serious mental illness—and how it affects their engagement with services. The study finds that sleep is rarely part of routine clinical assessment, and recommended sleep treatments are hardly ever used.

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Which exercise interventions treat depression most effectively? A systematic review and network meta-analysis

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Jakob Yianni celebrates National Walking Day by summarising a recent review which finds that a wide variety of activities can help treat depression, ranging from yoga and tai chi to high-intensity strength and aerobic training.

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Targeting rumination and worry may help with youth anxiety, depression and repetitive negative thinking

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Jenna Jacob summarises a co-produced systematic review and meta-analysis exploring rumination and worry as transdiagnostic targets for mental health interventions in young people.

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Is behavioural activation cost-effective for depression in older adults?

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Olga Lainidi summarises a recently Dutch RCT which asks: is behavioural activation a more cost-effective and accessible alternative to primary care treatments for older adults with depression?

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The inescapable role of stigma in driving depression and distress

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In her debut blog (and the Mental Elf’s first body-focused repetitive behaviours blog), Mallory Moore summarises a systematic review investigating whether internalised stigma can predict depression.

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Quetiapine may pip lithium to the post for augmentation in ‘treatment resistant depression’: results from the LQD study

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Kirsten Lawson and Douglas Badenoch review the new randomised controlled trial by Cleare et al, published today in The Lancet Psychiatry, directly comparing the clinical and cost effectiveness of lithium and quetiapine as augmentation treatments for patients with ‘treatment resistant depression’.

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Hormonal coil dosage and depression risk

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Dr Rachel Reid-McCann discusses the latest research on dosage of levonorgestrel-releasing intrauterine system (LNG-IUS) and the risk of depression. A well conducted study from Denmark “provides evidence of a dose-dependent association between LNG exposure and risk of subsequent depression across three dosages”.

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Childhood adversity and adult depression: Psychoanalysis vs CBT

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Ella Tuominen looks at a study of childhood adversity and ‘treatment resistant depression’ and asks: Can long-term psychoanalytic therapy provide deeper healing for chronic depression than CBT?

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