depression

9511213674_31a3c06cc7_z

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

Singing speeds up recovery from postnatal depression faster than usual care #LetsTalkMentalHealthII

Screenshot 2019-05-17 at 12.42.52

Saoirse Finn writes a #LetsTalkMentalHealthII blog about group singing for women with postnatal depression.

[read the full story...]

Depression in young people: are we researching what matters most?

jc-gellidon-705193-unsplash

Tamsin Ford asks what outcomes count, when it comes to measuring adolescent depression?

[read the full story...]

Infant-feeding behaviours: Can PSAS scores predict the recipe for success?

chayene-rafaela-788075-unsplash

Melisa Selvaratnam summarises a study on postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours.

[read the full story...]

Is self-management ready for the mental health mainstream?

2985206462_d819f602af_b

Josefien Breedvelt and Peter Coventry explore a new systematic review and meta-analysis of self-management interventions for people with severe mental illness.

[read the full story...]

What’s the relationship between adolescent depression and adult depression?

kevin-baquerizo-1357078-unsplash

Katie Finning writes her debut elf blog on a recent systematic review which looks at adult mental health outcomes of adolescent depression; including depression, anxiety and suicidality in adults.

[read the full story...]

Psychotherapy for adult depression: is it as good as it’s cracked up to be?

joshua-brown-784409-unsplash

Ellie Gant summarises a meta-analysis that asks: Was Eysenck right after all? A reassessment of the effects of psychotherapy for adult depression. The paper suggests that we seriously overestimate the benefits of psychotherapy by including biased trials in meta-analyses, and that there’s insufficient reliable research to be certain about the effectiveness of problem-solving therapy, interpersonal psychotherapy and behavioural activation.

[read the full story...]

Cognitive biases in adolescent depression: the more you have, the worse you feel

clay-banks-1295857-unsplash

Maria Loades explores a cross-sectional study of the combined influence of cognitions in adolescent depression, which investigates biases of interpretation, self-evaluation and memory, and concludes that a negative evaluation of the self is strongly associated with depression severity and with a diagnosis of depression.

[read the full story...]

Teenage depression linked to poor psychological and social outcomes in later life

jordan-mcdonald-749064-unsplash

Maria Loades writes her debut elf blog on a recent systematic review and meta-analysis on the long-term psychosocial outcomes of teenage depression, which finds that depression as a youth is linked to poor academic outcomes, unemployment and problems with relationships in adult life.

[read the full story...]

How can we prevent depression in young adults?

aliyah-jamous-1058056-unsplash

Mental Health Masters Students from UCL explore a recent systematic review and meta-analysis of interventions to prevent depression in young adults. The review finds some evidence for the effectiveness of preventative interventions in reducing depressive symptoms in young adults, but the evidence in this area remains weak.

[read the full story...]

Genetic predictors of depression trajectories in adolescence

duri-from-mocup-219269-unsplash

Megan Skelton explores a study that uses polygenic scores in the context of longitudinal developmental data, to characterise developmental trajectories and the role of neuropsychiatric genetic risk variants in early-onset depression.

[read the full story...]