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

Does shame in childhood affect the risk of adolescent depression and anxiety? #CAMHScampfire

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Douglas Badenoch helps us prepare for another CAMHS Around the Campfire session by exploring a recent twin study on the aetiology of shame and its association with adolescent depression and anxiety.

Follow #CAMHScampfire on Twitter at 5pm BST on Tuesday 20th July for an online journal club discussing this paper. Or sign up now to join the free webinar hosted by ACAMH.

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Exercise can help reduce depressive symptoms in people who are not clinically depressed

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Ross Nedoma summarises a recent systematic review and meta-analysis exploring the effectiveness of exercise-based interventions in reducing depressive symptoms in people without clinical depression.

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Turn on, or tune out? Is psilocybin assisted therapy close to becoming a first-line treatment for depression?

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James Rucker and Sameer Jauhar summarise a recent RCT on the effectiveness of psilocybin assisted therapy versus escitalopram assisted therapy for major depressive disorder.

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Could a decision support tool help to guide mental health treatment in primary care?

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Linda Gask reviews a recent randomised controlled trial on the clinical efficacy of a Decision Support Tool (Link-me) to “guide the intensity of mental health care in primary practice”.

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Care farms: can they help with depression, anxiety and quality of life?

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In her debut blog, Sophie Large appraises a recent Campbell systematic review exploring the impact of care farms on quality of life, depression and anxiety among different population groups.

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Self-stigma and depression amongst sexual minorities: can mindfulness help?

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Brendan Dunlop summarises a recent Chinese cross-sectional study, which looks at how mindfulness may be useful in reducing self-stigma and depressive symptoms in lesbian, gay and bisexual people.

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New evidence on treatments for symptoms of depression in dementia

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Andrew Sommerlad appraises a recent review on the efficacy of interventions for depression in people with dementia, which identified several non-drug treatments that can have a meaningful effect on depressive symptoms in dementia.

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Neurodevelopmental conditions and mental health research: it’s time to #EmbraceComplexity!

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In her debut blog, Suzi Sapiets summarises a review exploring psychological treatment of depression in young people with neurodevelopmental conditions, which finds very limited evidence to help neurodiverse individuals. She also tells us that it’s time to #EmbraceComplexity and encourages people to join the Embracing Complexity Research Network.

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NHS-recommended e-therapies for depression, anxiety and stress: promising but limited

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Natalie Berry summarises a meta-analysis which finds a limited body of research exists to support the use of NHS e-therapies for depression, anxiety and stress.

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The COVID-19 pandemic is harming our mental health, and it’s affecting some more than others

When interpreting the results from this study, the recruitment method and representativeness of the sample need to be considered.

In his debut blog, Christian Dalton-Locke reviews a recent longitudinal (online survey) study, which looks at mental health outcomes during the COVID-19 pandemic. The research finds that women, young adults, those from socially disadvantaged backgrounds, and people with pre-existing mental health problems were affected worse than others.

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