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

Social media: good and bad experiences and the impact on depression

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Sarah Hetrick publishes her debut blog on a recent US cross-sectional study that looks at the association between positive and negative social media experiences and symptoms of depression.

[read the full story...]

Preventive cognitive therapy when continuing or tapering off antidepressants

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Linda Gask is encouraged by the findings of a new high quality RCT (the DRD study), which compares preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in the prevention of depressive relapse or recurrence.

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Collaborative care for depression and physical multimorbidity: clinically and cost-effective over the long term

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Gemma Shields summarises the findings of a cluster RCT looking at the long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental-physical multimorbidity.

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Adverse effects of psychotherapy for depression: new meta-analysis looks at deterioration rates

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Edel Mc Glanaghy reacquaints us with the negative effects of psychotherapies for adult depression, through an impressive new meta-analysis of trials that measure deterioration rates in patients receiving psychotherapy compared with controls.

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Universal resilience: could it be the answer?

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Lucinda Powell summarises a systematic review of universal resilience-focused interventions targeting child and adolescent mental health in the school setting.

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Poorer cardiovascular screening, diagnosis and management if you have a mental illness

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Joanne Wallace summarises a systematic review that highlights disparities in the management of cardiovascular risk factors in people with mental illness.

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Brutalised child soldiers and traumatic distress

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Our blog today explores a new study in the British Journal of Psychiatry of post-traumatic stress disorder among former Yazidi child soldiers in northern Iraq.

[read the full story...]

Mental health diagnosis: views and experiences of service users and clinicians

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Vanessa Pinfold and Jennie Parker from the McPin Foundation explore a recent systematic review of service user, clinician, and carer perspectives on mental health diagnosis.

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Moderated online social therapy: relapse prevention for youth depression

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Sarah Knowles looks at a next-generation social media-based relapse prevention intervention for youth depression, explored in an Australian qualitative study looking at social networking, safety and clinical benefit.

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Should we screen new Dads for depression? #DadsMHday

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André Tomlin shares his own experiences of being diagnosed with postnatal depression and wonders how we can improve screening for other fathers at risk during the perinatal period.

[read the full story...]